May 28, 2018

The Pathway to Pain and How Physical Therapy Can Help

By Darren Marchant, PT,MSPT,OCS – CEO, FIT Physical Therapy

Pain is a normal part of life. Living in pain however is not!  Unfortunately many of our friends, family and neighbors live with chronic pain.  Current data indicates over 100 million people in the U.S. suffer from some form of persistent pain. It is a huge problem for our society in many ways but most of all in the very personal way it robs people of living a full, joyful life.

A large reason the opioid epidemic has occurred is because our health care/pharmaceutical system has done a poor and inadequate job at helping our patients understand, cope with and treat chronic pain outside of a bottle of pills.

Fortunately this is changing. Drug manufactures and health care providers are being held more accountable for their actions in continually pushing and prescribing addictive medications.  Doctors are finding other alternatives to offer their patients suffering with chronic pain.
As a physical therapist, I am excited to see that physical therapy is now considered  one of the leading alternative options in helping chronic pain sufferers. I may be a bit biased, but  I have seen time and time again in our clinics the significant impact that a skilled, compassionate and knowledgeable PT can have in helping those who have suffered the pain of injury or surgery to their bodies.

Chronic pain has been defined as any discomfort or unpleasant sensation that lasts for more than 3 months, or beyond an expected normal healing time. Chronic pain can be complex, But this simple model, developed by two leading neuroscientists (Vlayen and Linton, 2000) called the Fear-Avoidance model is very helpful to understand how chronic pain can develop and why one person recovers, and another person does not after an injury occurs.

The path to chronic pain usually starts with an injury or trauma either physical or emotional which leads to a painful experience.  At that point, two pathways emerge. To the right is the path that leads to recovery and to the left is the path that leads into the cycle of chronic pain.

The individual who goes to the right on the diagram is a person who employs effective coping mechanism and strategies to confront and deal with the issue at hand. Words or sayings of individuals on this path would be something like: “No big deal”, “Keep moving”  “I can deal with this” “I can learn from this”  “I’ll be OK”, and my favorite, “just rub some dirt on it”.  The attitude is one of being proactive and in control. And most people get better.

The other pathway to the left is the one that leads to chronic pain. A painful experience, again, either physical or emotional or both, is followed by catastrophizing, fear, avoidance of activity and movement that ultimately leads to disuse, depression, loss of hope and disability. This continues to feed the pain experience making this pathway more like a round about that you drive on and can never exit. See picture by (Louw, 2016)

Words or sayings on this path could be: “I have a bad back,” My doctor told me I have the worst (insert body part) he has ever seen” “My Dad had the same thing”, and “ I saw on the internet”.  Catastrophizing is irrational or incorrect thoughts in believing that something is far worse than it actually is.  It often drives fear, which then leads to avoidance, withdrawal, and further debilitating effects.

Of course not all injuries are of the same type and severity and it’s easy to think that the bigger the injury the more likely the chance of developing long term problems. But this is not the case. Tissues heal over time. Our bodies have an amazing ability to repair and regenerate. I’ve seen some patients with pretty horrific injuries in the clinic and been amazed by their recovery. I’ve also seen some relatively minor injuries that turn into bigger and bigger problems and don’t get better.
While I don’t claim to have an explanation for every case, generally what I have witnessed is that it is not the size or type of injury that predicts chronic pain and it’s effect on our lives, rather it’s the attitude, mindset, and ability to cope with challenge that is the larger determinate of success or failure in the healing process from injury and pain.

If you, or someone you know is suffering from chronic pain, the good news is there is help. Beyond opioids, healthcare providers are offering their patients alternative solutions from chronic pain. A team, multidisciplinary approach has been shown to be most effective.
Physical therapy treatments given by compassionate, knowledgeable and skilled physical therapists can be an important part of the solution along the road to your recovery, or to help you navigate an exit off the cycle of chronic pain.

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