Pain is our brain's way of warning us that it perceives we may be at risk of hurting ourselves, or that some damage may have actually occured. The brain decides to generate the unpleasant sensation of pain based on information provided to it from lots of different sources. These include nerve endings in the skin, muscles, ligaments, tendons and joints. Importantly however, the brain interprets the level of threat from these nerve endings by comparing it to information about what we are doing at the time, what we can see, our perceptions of how much danger we are in and how much damage we believe we have caused, our memories of previous similar situations and painful experiences, how anxious or threatened we feel, and our current stress levels. All these factors influence whether our brain starts sending out pain messages and how intense they should be.
Pain can generally be categorised as acute or chronic. Acute pain is generally considered to have been present for 6 weeks or less. Chronic pain is usually defined as that which has been present for more than 3 months. The gap between 6 weeks and 3 months is often referred to as sub-acute pain. The mechanisms that drive these different types of pain can be very different, which means the type of treatment that is most appropriate also differs.
Acute pain is usually a result of damage to a tissue such as a muscle, ligament or tendon. This can occur suddenly from a large trauma; such as trying to lift something too heavy, or over a long period of time through repetative micro trauma; such as when we sit for too long in a chair. Once damaged, the body begins to repair itself straight away. The first stage of this process is inflammation, although this itself is often painful due to the chemicals produded by the body at the site of injury. Inflammation normally resolves quickly and the chemicals produced help to trigger the next stage of the repair process called proliferation. During this stage new tissue is formed to repair the damage, before the final stage of remodelling begins, where the new tissue is shaped to become as functional as possible. This whole process takes between 6 weeks and 3 months, depending on the kind of injury and what the person does about it. For successful healing to take place, it is crucial that we do the right things and avoid doing the wrong things during this period. The exact course of action will depend upon you and your injury and that is why having treatment at this stage can help prevent problems in the future.
Chronic pain is much more complicated, as we know that after 3 months any tissue damage should have healed. To be able to treat chronic pain, we first have to identify why the brain is warning us about damage which really should have healed by now. Often this is because we are still doing the thing that caused the damage or pain in the first place. This could be related to our posture, or the way we perform activities at work or as part of sport. Sometimes, during the healing process we develop adaptations to help us heal quicker, these changes can sometimes persist after the damage has healed and actually cause problems in the longer term. These changes may include stiffness, weakness, changes in the way we move or changes in the way our nervous system interprets messages from the body. Other times the healing process isn't as successful as it needs to be. This may be because we were too active during the proliferation phase, and the repair wasn't allowed to take place adequately, or we weren't active enough during the remodelling phase, and the repair is weak or stiff. Underlying conditions such as arthritis can also play a role in chronic pain. At City Osteopaths we will help to identify which of these things is most likely to be the cause of your pain and provide the correct treatment and advice to address them.