True or false. Pain only occurs when you are injured or at risk of being injured. Worse injuries always result in worse pain. Chronic pain means an injury hasn’t healed properly.
If you answered false to each of those statements, you are on your way to being a pain science guru. If you thought some or all of those are true then you’ve happened upon the right place. I’m going to teach you a thing or two about pain today.
"Yum, ice cream. Uggggh! Brain freeze!" Don't worry, you didn't actually injure your brain eating ice cream too fast. The cold temperature receptors in your throat reacted to the extreme change and sent a danger message to your brain. Fortunately, we know "brain freeze" is normal when we eat ice cream too quickly so we just slow down our eating a bit and carry on. Pain does not equal harm. You can feel pain with or without injury or risk of injury.
"$&#%!!! Who left the Legos on the floor!" Ouch. Stepping on a Lego in the dark can feel like a nail was driven straight through your foot but once you know what it is the pain quickly fades. The danger message was sent but no harm was done, no injury inflicted. Pain does not equal harm.
"My shoulder hurts so much I can't lift it over my head and it's affecting my sleep. That must mean I've done something really bad." Nope, not necessarily. Inflammation from even mild injuries can cause significant pain whereas a complete muscle tear (rupture) may cause very little pain or none at all.
Studies have shown that evidence of injury does not correlate with pain. Rotator cuff tears can be seen in diagnostic imaging of 35-40% of the asymptomatic (pain-free) general population across all age groups. It is also estimated that 40% of asymptomatic people have a bulging disc on diagnostic imaging. Injury can be present without pain and worse pain does not mean worse injury.
"I sprained my ankle last year and it still hurts. Why is it taking so long to heal?" Tissues undergo relatively predictable stages of healing. The majority of the healing process is completed in the first few months but some healing can continue for up to a year. It seems reasonable to assume pain is related to healing but, in fact, they are poorly correlated.
There are many reasons why someone may develop chronic pain (pain that persists or recurs for more than 3-6 months). In the example of the sprained ankle, it is most likely that their body's "alarm system" became hypersensitive after the injury and has not yet returned to normal. This can lead to a number of problems including heightened pain in other areas of the body.
Chronic pain affects more than 30% of people worldwide and has become an enormous personal and economic burden. As we learn more about pain, we are better able to find ways to help manage chronic pain. Look out for more pain education including how our "alarm system" works, how we process pain and common coping skills for pain management in comings months of my newsletter.
Transition From Acute to Chronic Low Back
In this study the authors wanted to see if they could predict who would transition from acute to chronic low back pain using a questionnaire and also see if there were other predictive factors based on who they are, where they’re being treated or how they’re being treated. The prognostic tool (questionnaire) separated them into groups of low, medium and high risk. In those groups, 19% of low risk, 33% of medium risk and 49% of high risk transitioned to chronic low back pain. They also found that in these groups, the patients who were treated outside of current guidelines were more likely to transition to chronic low back pain. The treatments considered outside of current guidelines were things like unnecessary diagnostic testing (X-ray,MRI), opioid prescription, and referral to a specialist (neurologist, orthopedist, surgeon, pain specialist). I found this article interesting because it shows how doctors can unknowingly negatively effect our pain experience. So the next time you go to the doctor for back pain and wonder why they aren’t sending you for every test imaginable or giving you pain killers, just remember, they’re doing you a favor.
June’s Wellness Check is a pop quiz. Test your pain knowledge with this short quiz and see if you actually are a pain science guru or if you need to stay tuned for more of my pain education newsletters.
Tips to help ease pain and get back to your routine immediately after a back strain.