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Chronic Pain Management Series – Persisting Pain

I see a lot of people in my Kensington and Ascot osteopathy clinics who have longstanding pain – and they obviously want to do something about it. 

Pain is a normal part of life.  It’s adaptive and when it’s short lived, it’s providing useful information.

From a traumatic knee injury to an achy back from prolonged sitting, pain informs us about problems with our our body’s normal state of affairs. When it’s short lived, it is a normal sensation which is responding to structural damage or challenge.

However, pain becomes more complicated after it begins to persist for more than three months. When this happens, we classify this as persisting or chronic pain. Chronic pain affects greater than 40% of the UK population and can lead to severe consequences such as depression, severe deconditioning and opioid dependence

As an osteopath, I frequently see patients suffering from persisting pain in both my London and Bracknell area pain management clinics. Whether it is a recurring sporting injury or even decades of low back pain, these longstanding problems are complex and multifaceted. And it is because of these complex interactions that persisting pain is one of the most frequently mistreated conditions globally. Addressing just the area of pain, or thinking that surgery will fix it simply doesn’t help.

Why is persisting chronic pain so complicated?

Most people associate pain with ‘damage’, and this is not the case with persisting pain. With chronic pain, the pain has no direct relationships to the state of the tissues, and this has been shown repeatedly by comparing MRI findings to people’s pain scores.  There are people in severe pain with totally normal imaging.  And there are people with very abnormal imaging and lots of pain.

Why?  With the case of someone who had an injury in the past, the tissues are typically fully healed by eight to maybe 12 weeks – but some people are still feeling pain. The manifestation of pain has a tremendous variety of contributing factors, such as a person’s level of activity, nutrition, conditioning to fear-driven behaviour and habit changes. This is very well documented in the literature and in clinical experience.

What factors are associated with chronic pain?

In both research I read and in my practice, I see the deep connection between psychological factors and persisting pain. Specifically, these include unfavourable behaviours, such as avoiding movements and ‘fighting’ the pain. The number one correlate to chronic pain is fear and anxiety, even if people don’t end up avoiding the movements they fear.

Does this mean that your pain is just in your head? No. However, what this suggests is that the experience of persisting pain is complicated.  There is a clear interplay between both psychological and physical features, and our emotional state and beliefs about pain can either help us feel better or cause us to feel unnecessary suffering.

So what can we do about those other non-physical factors? Read Part 2! If you need help, book into my clinic using a virtual session or an in-person session in West London or Ascot.

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