What influences our likelihood of suffering from persistent pain?
By Paul Bolger. Chartered Physiotherapist at Nano Physiotherapy, Kilkenny (www.nanophysio.ie).
Aches and pains are a fact of life. For some of us, an injury occurs, we feel pain, it lingers a while and slowly eases away as we recover. For other people, however, pain sticks around longer or regularly comes back. Some people never suffer from a specific injury in the first place, yet pain causes daily angst and upset.
There are some conditions in which aches and pains are common features, like rheumatoid arthritis and diabetic neuropathy. But what else makes a person vulnerable to persistent pain issues?
The Research
Scientists studying pain have been working for decades trying to figure out why some people suffer from persistent pain while others don’t. In their research, they have investigated a wide range of factors – like posture, injury severity, scan findings, mood, health and beliefs. The findings might surprise you.
Injury matters, but not that much
Injury severity and scan findings seem to have some influence on the severity of pain and how likely pain will become persistent, but they don’t seem all that important. In other words, the amount of damage caused by an injury is relevant, but not all that important when it comes to pain severity or pain becoming a long-term issue.
Posture isn’t so important
As we have explored previously, posture is not a good predictor of pain or pain becoming persistent. This may be a surprise to many of you, as we often hear that “fixing” posture will solve our problems or prevent pain in the first place. But the research shows us that it is just not all that important. So, what does matter?
Mental & Physical Health
General health at the time of an injury predicts the likelihood of pain from that injury lasting longer. The same can be said for psychological wellbeing. Mental and physical health have been found to be greater predictors of long-term pain following a whiplash injury in a car accident than the severity of the accident itself.
Issues like post-traumatic stress, depression and anxiety are all important here. So, general health (mental and physical) matters.
Sleep Quality
Sleep is strongly linked to pain. Poor sleep puts people at risk of suffering from pain, as well as increasing the risk of an injury turning into a persistent pain problem. Considering this, it is unsurprising that improvements in sleep are associated with improvements in persistent pain problems.
Thoughts & Beliefs
Beliefs are strongly linked to the likelihood of pain persisting. Catastrophising (i.e. thinking the worst) and kinesiophobia (i.e. fear of movement) predict poorer outcomes following an injury. This can be influenced by a number of factors, like hearing worrying things about scan findings and our own propensity towards anxious thoughts.
When it comes to back pain, seeing the back as fragile and in need of protection has a negative influence. On the other hand, knowing that your back is robust and able to adapt and improve is linked to better outcomes.
What to do
I believe it is so important for people to be aware that, when it comes to pain, it’s not all about damage, injury and posture – general health, thoughts and behaviours all play an important role.
If you need help with a particular issue, it might be worth bringing up some of these points with a healthcare professional. This might help you to make a plan to better manage your pain.
To my regular readers – I will be away for the next 2 weeks, but I will be back with a new article for you at the end of February.
