chronic pain

Pain Explained

Pain & Acute Pain

  • PAIN is the signal the body sends to the brain when tissue is damaged.
  • ACUTE PAIN goes away as the tissue heals. In general, all muscle, bone and joint tissues in the body heal within 3 months, naturally. The job of Physical Therapy is to optimize the strength, flexibility and function of the injured tissue as it repairs naturally. Without rehabilitation to most major injuries, the natural repair does not always result in full returning function of the injured body part. For example, a torn Rotator Cuff will heal itself and scar over in 8 to 12 weeks. However, without Physical Therapy, the scared tissue will be tight and weak, resulting in limited reaching and carrying ability.
  • With skilled Physical Therapy, rehabilitation strengthens and stretches the scared tissue with the muscle to get the arm back to full function. Whether that’s simply reaching into the cabinet or throwing 50 high speed pitches, PT will help you reach your goals after any injury.
Chronic Pain
  • CHRONIC OR PERSISTENT PAIN is defined as pain lasting over 3 months – or beyond the point of time where the injured tissue has healed.
  • Chronic Pain IS real pain – however, there is a physiological shift that occurs in the nervous system that makes the pain pattern hard-wired and persistent, even when the tissue is healed.
  • In short, chronic pain is in your brain. We DO NOT mean that it is “just in your head” or imagined, however, it is no longer stemming from the damaged tissue. This changes the way we treat the pain. In acute pain cases like the one explained in the beginning, we would treat the damaged tissue by massaging the muscle, manipulating the joint, and stretching and strengthening the body part to return to full function. In chronic pain cases, we must treat the pain pattern hard-wired in the brain. This looks very different.
  • Please be sure you read to the end to understand how we can treat your persistent pain. You CAN feel better, and live a life you love!

Brain Basics
1. Your brain’s most basic function is to constantly assess if you are safe or threatened and to chose a mode of action to keep you safe and able to survive. The part of the brain that decides if you are safe or threatened, is in the brain stem, and is called the Amygdala. All sensory input (sight, sound, touch – PAIN, smell, taste) feeds into the Amygdala to make this decision. 2. There are 3 basic channels or modes our brain can be on at any given point. The Amygdala makes this decision.
  • Homeostasis Mode is the state of being calmly awake and alert.
  • Sympathetic Mode is nicknamed “Fight or Flight” and is the state of alarm and hyper activity when a threat is perceived.
  • Parasympathetic Mode is nicknamed “Rest and Digest” and is the restoration state we experience before and during sleep.
  • Each channel or mode creates a particular function in each system in the body.
  • In Homeostasis Mode, all systems are active and functioning normally.
  • In Sympathetic Mode all of our body’s systems (musculoskeletal, digestive, circulatory, endocrine, etc.) are functioning in over-drive to free the body from the real or perceived threat.
  • In the Parasympathetic Mode, healing and regeneration of all systems occur.
  • Safe sensory input will keep you Homeostasis Mode and allow you to drift into the Parasympathetic Mode on a natural circadian rhythm. Threatening input (pain, loud noises, fast movement, etc.) calls on the Sympathetic Mode.
  • One should easily be able to transfer from a state of homeostasis to a state of sympathetic or a state of parasympathetic and back according to what is going on in your environment. In Chronic Pain, you are stuck in the Sympathetic Mode and find it very difficult to get back to the Homeostasis or Parasympathetic Mode. If pain lasts for more than 3 months, your Sympathetic Nervous System will be stuck “on” fight or flight and will be very difficult to turn off. The symptoms of fight or flight create MORE pain… thus, fight or flight… thus, more pain… thus, fight or flight, etc.
More on the Amygdala
  • To add to that, input to the Amygdala comes from outside your body and from inside your brain.
  • Emotions are created and experienced in the mid-brain and also feed into the Amydgdala as sensory input.
  • Thoughts and beliefs occur in our cortex and also feed into the Amygdula as sensory input.
  • *This is important because sensory input can send you into a threat response, but so can emotions, thoughts or beliefs.
  • Acute Pain and injury can very quickly create the experience of “loss” and threatening emotions such as frustration, sadness, anger, fear, or worry. These threatening emotions then add to the pain input to the Amygdula, and create a stronger “fight or flight” response.
  • If someone believes or thinks they cannot get better, this negative limiting belief also feeds into the Amygdula as a threat to survival and produces a persistent strong state of “fight or flight”.
  • Your Amygdula has a threshold of threatening input that will immediately turn on “fight or flight”. The Amygdula does not distinguish a difference between threatening a sensory input, thoughts, or emotions – making any combination of these three trigger the “fight or flight” response. Let’s say the threshold is 100 units of threat.Your pain might be 25, your worry might be 60, and the thought that you haven’t ever healed well in the past might be 30. This combination will throw you into fight or flight, and chronic pain.
Why did my pain become chronic?
  • Simply put, Acute Pain CAN become Chronic Pain under 3 basic circumstances.
  • Non-optimal management of your acute pain which causes your pain to last more than 3 months
  • A significant amount of loss related to the acute injury creating negative thoughts and emotions regarding recovery (i.e. injury creates loss work, difficulty with finances, inability to interact with friends & family, loss of identity, etc.).
  • A past history of trauma (especially a difficult childhood) – this creates a learned pattern of “fight or flight” which the pain links into and becomes part of. Because the fight or flight pattern is a “normal” state of behavior for someone who has grown up with constant threat, they don’t recognize the pattern until the pain becomes part of it and makes the behavior pattern unbearable. In order to get rid of the pain in these cases, you must turn off the “fight or flight” pattern that was turned on in early childhood.
  • In all the cases above, the fight or flight pattern is turned “on” and must be turned “off” in order to return to rid you of pain.
What is happening and why do I feel like this?
  • If someone experiences pain for more than 3 months, the physiological changes that occur in our nervous system are the following:
  • 30 to 50% more pain receptors become active – this can be experienced as the pain spreading to all over your body
  • pain receptors lower the threshold for what is defined as “pain” – this can be experienced as ALL touch hurts, even the tags on your clothes or a hug from your loved one.
  • This is a real phenomenon, you are not imagining this. Your nervous system is becoming more and more sensitive to ensure that you never encounter threat again. This phenomenon is called “Upregulation” of the Central Nervous System.
  • Upregulation of the Central Nervous System is a constant state of “Fight or Flight”. In fight or flight, all body systems behave in a very particular pattern. The systems that are referred to below produce symptoms you will recognize.
Muscle System
  • What is happening: high muscle tension in a very particular pattern – picture someone who has just been scared. Their jaw and fists are clenched, shoulders are pulled up around the neck, thighs are squeezed, and toes are raised.
  • What you feel: YOU HURT. This varies for everybody. But most often is experienced as constant headaches, neck or back tension, and can be the root cause of many common “syndromes” such as IT Band Syndrome, TMJ Dysfunction, and/or Sciatica.

Digestive System
  • What is happening: digestion fully shuts down, the blood flow in your circulatory system is sent from your stomach to the extremities to support punching and running. Think about it, if a lion was behind you… you probably wouldn’t bother eating your lunch first!
  • What you feel: YOU CAN’T EAT OR YOU OVER-EAT. This varies for everybody. But most often is experienced as stomach aches, nausea, reflux, or Irritable Bowel Syndrome (the fluctuation between constipation and diarrhea).

Endocrine (Hormone) System
  • What is happening: Adrenaline and Cortisol (high energy/stress hormones) run high to support fast and strong movement, Melatonin (sleep hormone) and Serotonin (happy mood hormone) are replaced by these energy/stress hormones, making it difficult to relax, go to sleep, and experience content.
  • What you feel: YOU CAN’T SLEEP. This varies for everybody. But most often is experienced as difficulty falling asleep, waking up frequently or too early because of pain or because you cannot calm your mind.

How do I get better?
Our answer? The Associative Awareness Technique.
  • AAT is the a Physical Therapy technique that systematically desensitizes the Central Nervous System. AAT reduces chronic muscle tension and pain, anxiety and depression, improves insomnia and digestive issues, and restores emotional balance and mental clarity. The key is changing the sensory input to your brain and body.
  • Too much threatening input turned “on” the fight or flight response and hard-wired your pain.
  • Safe sensory input will turn “off” the fight or flight response and release your pain pattern.
  • This technique helps the brain learn to turn “off” the “flight or fight” response and turn “on” the normal state of Homeostasis and “rest and digest” rhythm.
What is it like?
  • Your Physical Therapist delivers safe sensory input to the skin sensors to the face, arms, legs, hands and feet using heat, music and a variety of calm touches to comfort each of the five senses. This is all done is a private room to promote the feeling of safety.
  • You will receive an individualized self-care program in order to keep your nervous system in it’s healthy state on your own between treatments, and long after your plan of care ends.