Adapted from Bahram Jam’s Pain Truth Certification Program
Written by: Megan Graham, PT
If you’re reading this, chances are you’ve experienced physical pain at some point in your life. Pain can be disabling, limit function, and decrease quality of life. Many products exist to help manage pain- medications, topical creams, electrical devices- with mixed effectiveness. An important step to managing pain is understanding how pain works.
Pain is defined as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”(1). The central nervous system (brain and spinal cord) plays in integral part in experiencing pain. The brain receives a signal from nociceptors (pain receptors) from anywhere in your body, warning of potential tissue damage. The brain interprets this signal and will determine if the body’s response will be to feel pain (2). Take the example of stubbing your toe; receptors in your toe detect a change in pressure and will send a signal through your nervous system to the brain, the brain will analyze the information and determine if you feel pain in your toe or not. Without the brain, you would not feel pain. This is your body’s way of protecting you from danger in terms of tissue damage.
However, there doesn’t always need to be tissue damage in order to feel pain. Central sensitization is a condition of pain hypersensitivity, in which the body interprets non-threatening signals as being harmful, or magnifies the intensity of symptoms; the body experiences pain without tissue damage occurring (2). Central sensitization is often present in people experiencing chronic/persistent pain lasting more than 3 months (2). It can occur after an acute injury as a learned behaviour, long after the tissue has healed (2).
If you are experiencing persistent pain, try the tips below to help desensitize your nervous system. Be sure to consult your doctor or physiotherapist first to rule out serious injury.
1. Set clear activity goals.
A study of 20 patients with chronic low back pain participated in patient-led goal setting, facilitated by a physiotherapist, with biweekly visits for 2 months. This resulted in significant improvements in disability, pain, fear avoidance beliefs, quality of life, and self-efficacy; these improvements were also noted 2 months after the program ended (3). Try setting a specific activity goal- something that you are not currently doing that you would like to. The
goal should be important to you and something that you are confident you can achieve.
2. Perform graded physical activity.
The Canadian Guidelines for Management of Fibromyalgia, a condition characterized by chronic
widespread pain, recommend “in the absence of a single exercise program outperforming others, patients should be encouraged to choose an activity either land based or water, that is enjoyable, easy to follow, convenient and within budget in order to improve adherence.” (4) Activities associated with decreasing pain scores include, but are not limited to: walking, Nordic walking, aerobics, aquatic training, resistance training, tai chi, and yoga (4).
3. Practice good sleep hygiene.
“Sleep and pain are critical homeostatic systems that interact in a bidirectional manner. Complaints of sleep disturbance are ubiquitous among patients withchronic pain disorders, and conversely, patients with persistent insomnia symptoms commonly report suffering from chronic pain” (5). Sleep disruptions can inducehyperalgesia,an increased sensitivity to pain (5).
If your sleep is disturbed, try the following (2) :
- Avoid potential stimulants: Avoid caffeine within 6 hours, alcohol within 4 hours, and large
meals within 3 hours of going to bed.
- Avoid pre-bedtime stress: Avoid watching the news, paying bills, or arguing before bed.
- Have a schedule: Try to sleep and wake at the same time each day, even on weekends. Avoid
napping during the day, or limit to 30 mins, if necessary.
- Remove distractions: Block all light and noise from your bedroom.
- Exercise: Exercise regularly, but avoid vigorous physical activity immediately before bed.
- Practice relaxation: This can be in the form of deep breathing, meditation, or listening to music;
many phone apps exist to help guide you.
- See your doctor: Sleep disruption may be a result of sleep apnea or a side effect of medication.
- Consider your mattress: Try flipping your mattress or replacing if over 10 years old.
4. Experience sensory pleasures.
Endorphins are naturally produced molecules in the body that interact with opioid receptors, which act to block the perception of pain and are present when experiencing pleasure (6). “The pain relief experienced as a result of the release of endorphins has been determined to be greater than that of morphine. Additionally, endorphins have been found to be associated with states of pleasure including such emotions brought upon by laughter, love, sex, and even appetizing food” (6).
Try using your 5 senses to experience pleasure in your daily life (2). Here are some examples:
Look at something you find appealing; this could be artwork, photos from a vacation, or nature.
Taste enjoyable food/drinks; this could be your favourite tea, a treat, or your favourite vegetable.
Smell your favourite smells; fresh cut grass, laundry, coffee, fresh baked bread, essential oils.
Listen to soothing sounds; music, the sound of waves, or birds singing.
Touch a soft fabric, your pet or loved one. Feel the sun on your skin or sand under your feet.
5. Manage stress and anxiety.
Stress is negatively associated with numerous health conditions. “Stress is defined as the physiological reaction to real or potential life-threatening conditionsand is accompanied by changes in the associated neural, endocrinological and immunological systems” (7). In study of healthy participants and participants with fibromyalgia, both groups reported increased pain sensitivity to a thermal stimulus after experiencing a social stressor (7).
Strategies to manage stress and desensitize the nervous system include (2) :
- Consulting your doctor or a psychologist
- Participating in regular physical activity
- Practicing mindful meditation or breathing exercises
- Performing proper sleep hygiene
- Experiencing sensory pleasures
- Spending time outdoors
- Socializing
For access to educational videos on pain education and management, visit thepaintruth.org. Contact your physiotherapist for more information.
REFERENCES
1. IASP Terminology. International Association for the Study of Pain. https://www.iasp-
pain.org/Education/Content.aspx?ItemNumber=1698#Pain
2. Bahram, J. Advanced physical therapy persistent pain certification program. APTEI 2009-2019.
3. Gardner, T., Refshauge, K., McAuley, J., Goodall, S., Hübscher, M., Smith, L.Patient-led Goal
Setting. Spine: September 15, 2016 - Volume 41 - Issue 18 - p 1405-1413.
4. Fitzcharles, M. A., Ste-Marie, P. A., Goldenberg, D. L., Pereira, J. X., Abbey, S., Choinière, M., ... &
Shir, Y. (2012). 2012 Canadian Guidelines for the diagnosis and management of fibromyalgia
syndrome.Pain Res Manag,18, 1-52.
5. Bjurstrom, M. F., & Irwin, M. R. (2016). Polysomnographic characteristics in nonmalignant
chronic pain populations: a review of controlled studies.Sleep medicine reviews,26, 74-86.
6. Chaudhry, S. R., & Gossman, W. (2019). Biochemistry, endorphin. InStatPearls [Internet].
StatPearls Publishing.
7. Crettaz, B., Marziniak, M., Willeke, P., Young, P., Hellhammer, D., Stumpf, A., & Burgmer, M.
(2013). Stress-induced allodynia–evidence of increased pain sensitivity in healthy humans and
patients with chronic pain after experimentally induced psychosocial stress.PloS one,8(8).
