Persistent pain, chronic pain, or long term pain all pretty much mean the same thing; pain that is present for more than 3 months. Because pain is invisible, living with ongoing pain can feel very isolating, but what you might not realize is that the person standing behind you in line at the coffee shop, the upstairs neighbor, or the bus driver who you see everyday may be suffering from the same symptoms as you. According to Stats Canada, 20% of Canadians live with chronic pain- let's compare that to the 7.6% of Canadians who live with Diabetes, or the approximate 2.6% Canadians who suffer a stroke. Bottom line: persistent pain is common. You are not alone.
Just because chronic pain is complex, invisible, difficult to understand and treat, does not mean we can downplay its effects. There are definitely ways we can help, but it starts by understanding the individual.
Pain is a complicated, personal and emotional experience. It is not measurable. There are no biomarkers or scans that we can do to objectify someone's pain. Asking someone to report their pain levels on a scale of 1 to 10 is a way of communicating pain, its not a direct measure. To add to this complexity, as pain science is advancing, we now know that tissue damage and pain levels rarely relate, meaning that pain doesn't always mean danger, it is a protector that can easily and commonly become overprotective. Think about it- if you break a bone, it hurts initially, but once it is casted the pain settles. Is the bone healed? No. If the bone hasn't healed yet, then why did the pain drop? Simply because you feel safety >> danger. Another example from the literature; a construction worker jumped from a small structure from where he was working, he landed on a long rusty that went through his shoe. He was in extreme agony, thinking that he really messed up his foot and he was rushed to the emergency. When he arrived at the hospital, the doctors removed his shoe only to realize that the nail went between his toes and nothing was actually injured. His pain settled almost immediately. Why? Because the meaning behind his pain changed. There are many examples of this, but I want to get to the main point of this post... As a healthcare practitioner, I am not so much interested in measuring your pain, I am more curious about what pain means to you? The meaning someone attaches to pain, is very important to understand, probably more than attempting to attach a number or use a scale to describe an experience. Once we understand the meaning, we can work towards deconstructing this belief system and begin to learn new ways of thinking.
{Let's put this into context with a quick example. Belle is experiencing low back pain on and off for 6 months. Belle's grandfather had to get back surgery because of a herniated disc, the more she thinks about it, the more she believes her pain means that she needs surgery. She stops all exercises because she thinks it will make her back worse. Over the next few months, her pain is increasing even though she stopped everything. She is feeling anxious, no one is taking her seriously, she feels alone and now she is getting muscle spasms and nerve pain down her leg. Every time she feels a pinch in her back, she thinks danger and surgery.... This can go on, seeing many health professionals, getting information overload etc. If we understood what Belle's pain meant to her in the beginning, we could have saved a lot of time, suffering and disability. This example may seem extreme, but it shows up all the time in slightly different presentations ...}
Next, after learning about meaning, we need to shift our focus from reducing pain to improving life. The goal is not to eliminate pain, if that happens as a secondary effect, then amazing, however what's the point of all this if we can't get people back to enjoying life? We must not forget about the basics and start by simply asking the question. Which brings me to the second thing I am most curious about; what activities do you enjoy that you are no longer doing because of your pain? . After knowing this, we can work together to bring you closer to doing more of the activities that bring you joy, and even if you still have some pain, the glass will become half full.
**Please remember that if someone has pain for > 3 months, I definitely do NOT assume that there is no urgent / dangerous cause (ex fractures, cancer, vascular compromise etc) for this pain experience, because 2% of the time there is something urgent. If there is any question about a red flag, there is no question, and I will refer back to the doctor with a note because this is beyond my scope. I also need to assess which tissue types may be involved and if they are able to tolerate tissue loading. Once I am confident that these two areas are clear, then we can dive into retraining the pain system and all the interesting stuff.
Just because it's common, does not mean it needs to be normal. If you or someone you know is living with chronic pain, please reach out.