I must admit, I am still amazed and love it when a patient pronounces they are pain free at the end of a treatment session. And I must admit, I still enjoy hearing them call it “magic” or “voodoo”. Not exactly professional but still amusing!
Truth be told, though, it’s neither magic nor voodoo. The reason pain can sometimes be easily eliminated is because treatment was specific enough to be able to target what may be causing the pain.
Figuring out what is causing pain is both a science and an art. Pain is a very complicated matter and research into pain and how to deal with pain continues to be extensive and unknown for many. There are many causes for pain and there really is no one treatment for all types of pain.
Time Since Pain Started
How pain is dealt with begins with figuring out how long the person has been experiencing the pain. If there was an initial injury or a gradual progression of pain, and it’s within a 6-8 week period, it is considered to be an acute episode of pain. If the pain has lasted longer than 8 weeks but less than 3 months, it is classified as sub-acute pain. Pain after the 12 week mark is then diagnosed as chronic pain.
What causes pain in each of these time periods differs. How the pain is managed is also different.
1. Acute Phase
When you have an initial injury, for example, an ankle sprain, there is a structural problem. In this case, the ligaments of the ankle have torn. This structural injury would cause the body to begin the healing process. The healing process consists of bringing chemical to the area of injury to firstly protect the area from further injury and then begin the mending process. However, this inflammation process itself is also contributing to pain. In the example of an ankle sprain, the swelling in the area may press on other structures and cause pain.
The inflammation and pain response in this acute phase is necessary. The pain serves as a reminder that healing is happening. It is important to rest the area and not to create further injury.
This process has a cycle and a set time. Treatment or medication may temporarily relieve the discomfort but it doesn’t take it away.
If you have acute pain, what can you do? The best thing to do during this phase is truly to let the area rest and use whatever modality is necessary to allow you to rest. So for example, if the swelling is causing you too much discomfort to sleep, you may need to use ice and elevation or even take something to help with swelling. The most important aspect at this point is to prevent further injury.
2. Sub-Acute Phase
If pain lasts longer than 8 weeks post-injury, there could be several reasons. One reason often is that there have been minor re-injuries to the area. As in the case of the ankle sprain, the person may have felt better after a couple of weeks and started doing more again. Although they may not have had pain or swelling, the full healing of the structures has not occurred. As a result, it doesn’t take much to aggravate the area again. This then impedes healing.
An ankle sprain is when the ligaments supporting the joint has been torn. Often, with the tearing of these ligaments, the bone the ligaments are attached to is also affected. In this situation, the talus bone. With the bone slightly off its normal position, it may cause discomfort when weight bearing improperly and cause tension on other structures, resulting in pain.
Another reason for long lasting pain is that the initial mechanism of injury may have caused compensations elsewhere. An ankle sprain would alter how the person walks because of pain and trying to not weight bear. The calf muscle may get tighter. The Achilles tendon may also get tighter if they are walking on their toes. The tightness and the lack of proper weight bearing would then further precipitate increased pain.
If the pain has lasted longer than 8 weeks, what can you do? If you’re finding the pain is not getting better or you’re developing pain elsewhere, this is the time to seek professional advice. There may be reasons or obstacles to your healing. Seeing a professional will help to figure out if the pain you’re still experiencing is normal or due to other causes.
3. Chronic Phase
For the same reasons as sub-acute pain, chronic pain may be pain which lasts longer than 3 months due to re-injury and/or compensatory patterns. In my practice, these reasons are usually when people get more immediate relief. Once alignment and compensations are addressed, people usually begin to feel better right away. Now that they are aware of WHY the pain has persisted, they can resolve the biomechanical issues creating pain.
According to recent estimates, 19% of Canadians suffer from chronic pain. That is approximately 6 million people across Canada. The impact of chronic pain is huge, both economically and personally. The patients we see coming through our doors have been diagnosed with an autoimmune disorder, fibromyalgia, arthritis, or just “chronic pain”. There is a myriad of other conditions that may cause pain lasting greater than 9 months.
Different conditions will affect different systems of the body. Arthritis is inflammation in the joints and thus patients will feel pain in the joints that are affected. The normal healing process of inflammation just doesn’t shut off and is continually trying to heal itself creating inflammation and pain. For example, with fibromyalgia, current research is that the Central Nervous System is affected.
Often, patients will have persistent pain in areas where they haven’t even had injuries.
Treatment of chronic pain is varied depending on the person. The goal of treatment is more to help manage than to actually get rid of the pain.
What can you do for chronic pain? Every situation is different. The cause and the prolonging of pain will dictate what you need to do. This is best managed by working with a health professional trained in dealing with chronic pain. They would be able to ascertain what exactly may be the culprit, or if the pain is due to causes other than structural. What is important for someone suffering from chronic pain is to learn that management of this pain must include physical and mental processes. Pain exacerbates stress. And stress exacerbates pain. All perpetuating the pain cycle. Working with someone who understands this process will help you continue to live your life as you want, despite the pain you’re currently experiencing. But also minimizing the effects of doing too much.
Pain can be scary! But it can also be very helpful in preventing further injuries. Pain lets you know what is not working or working too much, and is a part of the healing process. However, if it’s tough to manage or is affecting your sleep, your stress level, and your ability to cope, then it’s time to reach out for help.