Chronic Pain

When pain remains after 3-6 months, we consider it to be chronic. In some cases, such as osteoarthritis, this is because there is a constant or frequent stimulus. But in other cases, the original cause has resolved and the pain continues. This second kind of pain is what we typically mean when we talk about “chronic pain”.

Pain Basics

Pain is transmitted through the nervous system, so technically all pain is “in your head”. That is not to say that it is made up. It affects around 20% of people, and accounts for up to a fifth of GP appointments. If you suffer from chronic pain, you’re not alone.

It’s not easy to define pain. The current definition is “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”. Notice the inclusion of “emotional experience” and “potential tissue damage”.

Emotional experience

Context is a big part of how we feel pain. If a child falls over, they might not cry until they see how their parent reacts. Although we rely less on other people’s reactions in adulthood, pain does not exist in a vacuum.

The emotional side of pain is particularly true in chronic pain. We know that for acute pain like sciatica, positive beliefs about the pain lead to quicker recovery. We also know that lower back pain is more likely to become chronic in patients with a fear of movement or high depression scores.

Actual or potential tissue damage

If you were to step on a nail while wearing trainers, and you saw the nail come through the top of your shoe, you might feel pain in your foot. This could happen even if the nail misses your foot and passes between two toes.

Pain can be present without a physical stimulus if the brain has another reason to believe there is danger. As before, that doesn’t make the sensation any less real. As such, some chronic pain can be treated effectively with a nerve block or epidural- just like any other pain.

Chronic Primary Pain

Chronic primary pain (CPP) is defined as chronic pain “that cannot be better explained by another chronic pain condition”

This includes chronic lower back pain if the cause cannot be found. It excludes ongoing arthritic pain and conditions such as fibromyalgia (these would be classified as Chronic Secondary Musculoskeletal Pain).

CPP may involve a heightened pain response (hyperalgesia) or pain from stimuli that wouldn’t normally be painful (allodynia). An example of allodynia could be sleeping without covers over the painful part of the body, because the sensation of the sheets on skin is excruciating.

What We Can Do

When pain becomes chronic it can become complicated. Your osteopath’s job is to help you unpick the factors that led to it.

As a patient, understanding what’s going on is an important part of rehabilitation for chronic pain. Knowing that while there is no damage, but the pain is still real can be a tough but necessary concept to grasp.

Some people find that working through the original injury or area of pain can help. Allowing your osteopath to put movement through your painful back can show your brain that movement is safe. Over time this can be built up into stronger movements and exercises for you to do at home.

Osteopaths are trained to understand the many elements of chronic pain, and NHS guidelines recommend manual therapists for chronic lower back pain. However, if your pain is out of our remit, we can support you in getting the help you need.

Make an appointment with one of our osteopaths now to address your chronic pain.