It is important for both the client and the therapist to understand the type of pain they are dealing with when planning therapy sessions or individual programmes.
Acute pain is pain that occurs immediately on or after a physical injury or invasive surgery. It is a warning signal, the body’s way of telling us that something is wrong. If the cause of acute pain is not treated it can develop into long-term chronic pain.
Acute pain may be caused by injuries resulting from one-off accidents such as car accidents or sports injuries. Acute pain may also be the result of invasive surgery.
The immediate reaction of the body to injury is inflammation which is typically identified by swelling, heat, redness and acute pain in the injured area. Inflammation should be treated immediately using the PRICE protocol:
An acute injury will usually start to subside after a few days and therapy may begin once the inflammation has gone.
In the early stages of an acute pain injury it is generally not possible to work directly on the injury, although it may be possible to work around the area to reduce muscle spasm and increase blood flow.
If left untreated for too long, acute pain may develop into chronic pain.
Chronic pain may be the result of:
- an injury which is not properly healed, or which the body ‘thinks’ is not properly healed.
- a long-term medical condition
Chronic pain from injuries
Chronic pain can be caused by sports injuries, accidents, poor posture and over-use, for example prolonged computer use or intensive practice on a musical instrument.
Chronic pain can develop as the result of a vicious circle in which the body adapts its movements to avoid pain from the original injury. This creates tension in the surrounding soft tissues and therefore more pain. The effect is gradually to expand the painful area and/or to create patterns of referred pain. So, for example, what originally started as a shoulder injury can eventually result in pain in the knee. This type of chronic referred pain can be confusing to clients especially as the body is unpredictable in how it recognises pain and so the client may not necessarily feel pain in the areas between the shoulder and the knee.
As all injuries result in some sort of damage to the soft tissues of the body, we have found that a short programme of non-invasive myofascial release followed by a programme of longer-term myofascial self care exercises can be very effective for immediate pain relief and for further injury prevention.
Chronic pain from long-term conditions or surgery.
Chronic pain can be the result of long-term medical conditions, such as ankylosing spondylitis, arthritis, hiatus hernia, irritable bowel syndrome (IBS), and many others.
Some diagnosed medical conditions consist of few symptoms other than chronic pain and the effects of chronic pain(poor sleep, anxiety, depression) with no explanation of how the pain has developed. And no medical treatments offered. Fibromyalgia is an example of one such diagnosed medical condition. We have found myofascial release to be very effective in relieving pain and the effects of pain in clients with fibromyalgia.
Chronic pain can also be the result of damage to the body caused by surgery. This can have the vicious circle effect referred to above. Even minor scar tissue in one part of the body can cause major referred pain elsewhere.
There is a lot of controversy about chronic pain conditions or how chronic pain develops after injury or invasive surgery. Research is a sensitive issue because some healthcare professionals do not like to acknowledge the limits of current medical knowledge or the fact that patients suffer chronic pain which they believe is a direct result of medical treatment.
Both Acute Pain And Chronic Pain Can Be Either Referred Pain Or Diffuse Pain:
Referred pain is pain which is felt in one part of the body but caused by a problem in a different part of the body. Referred pain can often be particularly confusing and distressing to clients. At the Pain Care Clinic we have found myofascial release and trigger point therapy to be effective therapies for referred pain.
Diffuse pain is pain that shifts in location and intensity throughout the body. An example of a diffuse pain condition is fibromyalgia. In small clinical trials myofascial release has been found to be effective on patients with fibromyalgia, although further research is necessary. At the Pain Care Clinic we have had positive results using myofascial release techniques on clients with fibromyalgia and other diffuse pain conditions.
Psychology Of Pain
Although it may not seem that way, short-term acute pain can be a good thing as it is the body’s way of warning us that there is a problem that needs to be corrected.
Pain signals travel from the affected area via the peripheral nervous system to the brain. This enables us to respond to the problem, correct it and avoid long-term problems like chronic pain.
Unfortunately, if the body doesn’t fully repair the original injury (for example, we continue to use the affected limb) then the acute pain can shift from being a short term issue to becoming a longer-term chronic pain problem.
This happens because the body adapts to accommodate the pain, possibly changing its posture, and the temporary feelings of pain shift from the peripheral nervous system to become established in the brain. This can cause the brain to become oversensitive to pain. Stress in other parts of the body may then be ‘felt’ at the site of the original injury as the body ‘learns’ to hold itself awkwardly in a counter-productive attempt to avoid further pain. In these cases the pain is no longer a helpful short-term warning signal and has become an unhelpful learned behaviour.
Many Pain Care Clinic clients come to us because they are beginning to doubt themselves or because those around them believe their pain is ‘all in the mind’. This may be because their acute pain has shifted to become chronic pain. In these cases our complementary therapy sessions are focussed around releasing the restrictions and postural imbalances, so the mind-body can learn to override the learned pain behaviour by noticing fresh pain-free movement.
Complementary therapy is perfectly possible for those clients who have a diagnosed permanent medical condition causing chronic pain. In these cases complementary therapy is focussed on reducing the immediate pain by working on muscles and other soft tissues to reduce the feelings of pain and maximise pain-free time between treatments.
With a regular course of therapy such as myofascial release it is possible for a client with a diagnosis of a chronic pain condition such as fibromyalgia to live an active and substantially pain-free life.
The serious impact of chronic pain conditions on a client’s ability to work and their enjoyment of free time and family life should not be under-estimated. Not least because chronic pain tends to have a vicious circle effect: The more pain a client feels, the more tense they become, the more tense they become the more pressure there is on their body, and so the more pain they feel and the more pain they feel the more conscious they become of the pain, and so on. Feelings of anxiety, hopelessness and depression are common among those with chronic pain conditions.
For many clients having medical treatment and hands-on complementary therapy is enough to help them cope. For others, particularly those with chronic pain as the result of an ongoing medical condition, the challenges are greater. Some find that, in addition to medical treatment and hands-on complementary therapy, talk therapies can help them find positive ways to cope.
We can recommend reputable and confidential talk therapists referrals for all clients at any time.