I now know I will always have back pain. I have pain when I stand or walk for too long, play jumping sports, or even lie in bed on my stomach. I feel it every day. It varies with activity – too much rest, not enough rest, too much activity, not enough activity. That is the nature of chronic pain. It is unrelenting, and does not go away.

Managing your pain

Chronic pain is not cool. It affects your activities, your lifestyle, and most importantly – your mood and outlook on life. The good news is that chronic pain is manageable!

The first step in dealing with chronic pain is in understanding your symptoms and how they react, and having confidence in your diagnosis. Knowledge is power. With this power, you can gain control of your pain, and your life.

Understanding a situation makes coping with it easier. Imagine the frustration you would feel if you did not understand math. Adding, subtracting – the numbers would be meaningless. Once you understand math, numbers become easy, and calculations simple. Less frustration = happy = less stress. Pain is no different.
With chronic pain, understanding two key relationships is very important:

Pain and function
Hurt versus harm.

Pain and function

A relationship exists between pain and function – more simply, with pain and life. If you have 0/10 pain, chances are you will be able to do everything you want to do physically. If you have 10/10 pain, you will do nothing. You may have tried medications or treatments to help reduce pain. Often, you need to look beyond that, and focus on function to help reduce symptoms.

With pain, often our first reaction is to stop moving. This is a good idea during an acute phase, but deadly in the chronic phase. Tissues will become weak, short, waste away, and finally will no longer work. In the chronic phase, you want to improve overall function, stability, strength, stamina, and flexibility. The goal is to improve your ability to function and reduce symptoms.

Most tissues respond positively to gentle movement. With chronic pain, you need to move these tissues, even if it hurts a bit. In this case, touching gently into positions that cause symptoms is a good thing – not a bad thing.

Hurt versus harm

The second important relationship involves hurt and harm. There is a difference between the two. If you exercise safely and control your movements, your body tissues will begin to react as they should. You may feel some pain with a safe and controlled movement. Ask yourself whether this means you are harming something, or if it is just a hurt. If you understand the difference between hurt and harm, everything about chronic pain becomes easier.

For instance, if you fracture your elbow – that is harm. Your elbow will be in a cast for six to eight weeks. Once the bones are stable, and when the cast is removed, it will hurt to move your elbow. Your first reaction will be to keep it still. You question whether moving it will hurt or harm.

This can be a turning point in your rehabilitation. You might think the elbow must still be broken, as it hurts so much to move. You might want to have it re-cast, though both testing and professionals say it is healed. If you did put another cast on your elbow, what would happen? The pain might lessen temporarily, but your elbow would become stiffer and weaker. In the end, you would have more pain. Four weeks later, when the cast is removed again, your elbow would still hurt. You might think there is still a problem, and ask for another cast. The cycle becomes endless. Eventually, you would end up with chronic pain.

You need to move that elbow, not restrict it. This is the difference between acute and chronic pain. With chronic pain, you must move the affected area before it will start to feel better. If you can do this, your rehabilitation has begun.

Rehabilitation

One of the most important parts of chronic pain rehabilitation is to simply start moving again. Specific exercises – safe and controlled with proper direction – are the key. Understanding pacing and your pain will help to make the most of your rehabilitation program.

Chronic pain requires the right exercises, with the right technique. Often people exercise, but work around problems with the affected side or area of the body. This must change to allow the tissues to do their job properly. You can exercise all day, but if your technique is flawed you simply reinforce poor muscle use patterns.
Many injuries are to soft tissue, meaning muscle, ligament, or tendon. Often, no surgical or invasive options can aid recovery with these injuries. These can be lifelong injuries requiring management, not fixing.

Physical therapists (physiotherapists) have extensive education about anatomy, physiology, muscles, bone, ligaments, tendons, and the human body. They understand pain and structures in a unique way. For patients, this is great. Your physiotherapist will have a high level of understanding of your physical and emotional symptoms.

The role of a physiotherapist in recovery is pretty straightforward. First, your diagnosis is verified and confirmed. Once that is done, the physiotherapist will help determine if the problem is fixable or manageable.

This part of rehabilitation is crucial both for you and your clinical therapist. If you have been searching for a cure – which people often are – the quest now becomes futile for you and your treatment team.

With my current chronic back pain, I would not be able to find a solution even if I kept looking for one. There is no magic fix, no surgery, nothing that could permanently alleviate my pain. Just as I did, you must accept the 'new you' in order to begin your recovery. You need to change your thinking from fixing to managing the problem. This change in focus is a key part of beginning to feel better.

For me, it took six years of on-and-off pain, a university degree, and a few years of practice as a physical therapist before figuring this out. Hopefully, you will understand pain faster than I did! With a proper team, this is possible.

If you noticed I stressed team, there is a reason. Pain affects all of us differently, and so you may need a variety of health care professionals to address all aspects of your pain – physical, mental, spiritual, and emotional.

Managing chronic pain is a balance. You can be medicated to the point where you feel nothing, but you will not be able to function. Without medication, your head will be clear, but you will not be able to function because of the pain. Living a fulfilled life with chronic pain often requires a full team to reach a balance between medication, activity, counselling, and overall well-being.

Talk to your family doctor. With luck, you can be referred to a chronic pain team in your community. These teams often have a pain doctor, pharmacist, physiotherapist, behavioural health consultant, kinesiologist, nurse practitioner, psychologist and dietitian, as well as other allied health care professionals. A team approach addresses all aspects of your pain – medication, exercise, education, stress reduction, and pacing strategies. Putting the pieces in place is essential to helping you cope with chronic pain and getting your life back.

To feel better while living with chronic pain, the best advice is: manage your pain, manage your life, keep a positive attitude, medicate when required, develop a pain flare-up plan, reduce stress, and live an engaged, fulfilled life. Most important – be sure to have fun. The benefits from laughing are endless. These are the keys to managing chronic pain successfully.

Physiotherapy and chronic pain

RELATED ARTICLES:

Managing your pain

Pain and function

Hurt versus harm

Rehabilitation