Persistent Pain Treatment & Physiotherapy
September was pain awareness month and there have been a lot of interesting discussions in the media lately regarding persistent pain (pain that lasts longer than 6 months). The college of BC physicians have set out new opioid dispensing guidelines and similarly, a campaign against opioid use, called Get PT First, is rolling through the United States.
I thought that it was fitting for me to take a course focused on pain education and management during pain awareness month, so I packed my bags and flew to Calgary in early September. While there, I gained even more insight and developed skills to address persistent pain and I’m pleased to be sharing some of that knowledge in this post.
The Bio-Psycho-Social Method
I have found success managing pain with many of my physiotherapy clients, but I understood that I was missing a piece in my care plans. I completed a course on pain through Pelvic Health Solutions and it gave me more skills and resources than I could ask for! We discussed many topics and were educated to look at our clients using the biopsychosocial method.
The biopsychosocial model does not consist solely of muscles, ligaments or joints; this model focuses on biological, psychological and social factors. Treating clients using this model is important because often an injury can be mistakenly packaged into just the biological factors. When pain is treated this way, it precipitates the high rate of persistent pain worldwide.
Pain is a tricky topic. The old condescending saying, “It’s all in your head” is actually true. Let’s remove the condescending tone and really take a look at how pain is “all in your head.” Your brain is an amazing organ, and it is the operating centre for our bodies.
In the realm of pain, the body will send signals to the brain and it is the brain’s job to:
- Evaluate the signal to determine if pain is present
- Identify the intensity of pain
- Consider our surrounding environment and place pain in the context of the environment.
The McCaffrey 1989 definition of pain is fitting for this discussion. McCaffrey’s definition of pain is, “pain exists when and where the experiencing person says it does.”
How a Physiotherapist Might Approach Pain
We now understand that pain is multifaceted, what next? I want to break down what central sensitization means and explain how a physiotherapist might approach this form of pain.
Central sensitization occurs when the nervous system is wound up. This winding up results in a hyper aroused state of the nervous system causing sensations such as touch and even movement to be interpreted as painful even after injured tissues have healed. For example, if a centrally sensitized individual is bumped on a busy street, they may experience an increase in pain enough that they must stop and use coping mechanisms to calm the pain prior to continuing down the street.
We are continuing to research to increase the depth of our knowledge in regards to central sensitization and how to manage it. In essence, management is all about unwinding the nervous system.
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Physiotherapy at Burnaby PhysioCare
If you are experiencing persistent pain and would like to learn more about how physiotherapy can help treat your pain, please book an appointment with a therapist at Absolute Physio Care in Burnaby BC.