Learning to feel and move normally again in recovery from persistent pain
By Paul Bolger. Chartered Physiotherapist at Nano Physiotherapy, Kilkenny (www.nanophysio.ie).
We often overlook the seemingly simple experience of moving and feeling these bodies of ours. For those with persistent pain, however, normal movement and normal feeling of a body part can be thrown out of whack. To recover from chronic pain, the body must, in a sense, learn how to feel and move normally again.
Changes seen in those with long-term pain
Changes occur within the pain systems and the nervous systems of people who have suffered from long-term pain. These changes make recovery challenging. But there is hope – excellent research in people with long-term back pain has found that an approach that targets these deficits can have powerful effects.
Losing touch with the body
Changes occur in how a person feels the painful area of their body. Special nerve cells that send signals of potential danger from the area become more easily activated (read ‘Learning to Feel Pain’ on the Observer’s website for more). There is also a reduction in signalling from other nerve cells responsible for messages relating to body position and touch. On top of this, brain networks associated with normal feeling of that body area become disrupted.
These changes correspond to the fact that many people suffering from chronic pain have a disrupted sense of the painful are in their body – often the body part starts to feel foreign, peculiar, disconnected, and unfit.
None of this is to say that the pain is not real – it most definitely is. Spend a day in the shoes of a person with chronic pain and you won’t question this!
Losing fitness
When a person believes that they may be causing harm to themselves with certain activities and movements, and when their perception of their body reinforces these beliefs, it’s no surprise that they often disengage from normal movement and activities. With time, if they continue to avoid such activities, they become more unfit and subsequently less capable of doing these activities.
Towards Recovery
It is possible to turn the tide. Research has shown that many people who suffer from persistent pain have capacity to partially or fully recover and engage more freely with things that matter to them.
The ‘RESOLVE’ trial is an exciting study in people with chronic lower back pain. The researchers aimed to help people to overcome negative beliefs associated with pain, help them to develop a more normal sense of their affected body area (through practices like mindful body awareness tasks), help them to move more regularly and more freely, and help them to build back the fitness required to engage in activities that matter to them.
Initial results are really encouraging; large numbers of people who have had back pain for many years reporting that they have recovered >50% or even completely!
A key feature of the study is how much the participants engaged in their efforts to recover – with 12 individual hour-long sessions with a specially trained physiotherapist and regular home exercises up to 5 days per week over a 3–4-month period. Adaptation takes consistent, gradual and progressive effort – just like with learning an instrument, learning to feel and move normally again takes consistency, effort and patience.
While approaching recovery in this way may be valuable for many people, there are some painful conditions, like some cancers and connective tissue disorders such as Ehlers Danlos Syndromes, that warrant a more individualised approach.
I will again turn your attention to the website ‘Flippin Pain’ (www.flippinpain.co.uk) which is an amazing resource for people who suffer from persistent pain. As always, do discuss this with your healthcare provider if you need help.
