Chronic Pain: Question and Answer: Part Three: Final

Disclaimer: There are items in this post if you purchase Lifestyle Physical Therapy, LLC will receive a commission at no increase cost to you. 

1. If I am feeling pain and my tissues are not damaged, why do I have pain? You are stuck in what we call a chronic pain loop.
2. Did my chronic pain loop just happen or did something trigger it? It was triggered during the initial or recurrent injury, but the brain has not realized you have healed or moved on.
3. Can I exit the chronic pain loop or is it a permanent change? Yes, you can exit the chronic pain loop and No it is not permanent, but you do have to ask the brain to change through retraining.
4. Can I do it on my own? You will require a healthcare provider that is trained in graded motor imagery to assist you exiting the chronic pain loop. Before exiting the loop is the forest of patience and persistence; which means you will have set backs. A knowledgeable practitioner can guide you through each step.
5. Do pain medicines help you exit the pain loop? No. controlling your pain is important to keep you from entering a pain loop, but this can be done with modalities and non-opioid medication.
6. Should I just stop taking pain medication? No. Always work with your healthcare provider to taper any medications appropriately. If you suddenly stop a medication that is assisting in pain control you can enter into a pain crisis. The brain will perceive this as harmful and send greater fear signals. This is why it is important to work with a trained healthcare professional to know when and how you can reduce your medication.

Click on the following link to learn more about graded motor imagery.  Click on the different stages at the top to assist in determining which stage you may be in. You can use the following affiliate links to download the Recognise App appropriate for you and test your right/left discrimination.

1. Recognise App (hand)
2. Recognise Foot App
3. Recognise knee App
4. Recognise Back App
5. Recognise Neck App

Your ability to distinguish your right from the left can be affected when you are in a  chronic pain loop.

To further your reading as a patient or practitioner the Explain Pain book is a good choice and can be found on the iBooks Store.

This article is for education only. This information is not intended to replace the advise or evaluation of a healthcare provider. An evaluation is highly skilled and complex and involves an evaluation of different systems and elements to determine the best approach for each individual. Always follow the instructions of your physical therapist or physician in regards to your personal exercise program. 

Chronic Pain: Question and Answer Part Two

From our last post you now know that pain comes from the brain. I know this is confusing, but it is best if you see pain more as an experience or a signal from the brain. What is the brain trying to tell you? The brain wants to alert and protect you from harm. A pain response can induce fear and result in what we call fear avoidance of movement. At the end of this post are links to connect you to brain retraining tools.

Now for a few more questions.

1. Does pain always mean injury or tissue damage? No pain is more associated with fear and protection. A person can have tissue damage and No pain.
2. My MRI shows bulging disc and I have no pain. Is this possible? Yes, you can have damage to joints and tissue and No pain.
3. I am in a lot of pain, so something must be damaged? No, pain does not always equal injury.
4. So if pain comes from the brain, can my brain be changed? Yes, your brain can be trained.
5. How do I know if my brain needs to be retrained? If you have chronic pain, your brain needs to be retrained. You are stuck in a chronic pain loop.
6. Can my brain be retrained? Yes, our bodies are made for change. If you push your body to be different it will respond. Just like if you increase a weight with exercise the muscle will adapt and produce more muscle fibers.
7. How do I get started with retraining my brain? Graded Motor Imagery is a great program that focuses on retraining the brain.
8. Can a Physical Therapist help? Yes, we will use pain reducing techniques and progress you toward using exercise and self tx. to reduce your pain and get you moving again. Over time brain retraining programs will be used to retrain your brain. Education is a big part of retraining the brain. Reducing fear is a big part as well.
9. I don’t move because I am afraid it will cause me pain. Is this good? No, movement is medicine. Not moving due to fear of pain is called fear avoidance.  It is a fear of movement, not that you should not move. You need to show your body that you can move and not be in pain. You have heard when you fall you need to get back on the horse. This is to reduce the fear of the horse that your brain has produced. Your brain wants to protect you, but it can become over protective. Much like an over protective parent.
10. Are there tools I can use to test and train my brain? Yes! The Recognise App created by NOI. I am an apple affiliate and will benefit from you using theses links, but we want to make it easy for you to find the right resources. The following link will connect you to the Recognise Neck App for iPhone. If another part of your body is the primary source of pain then you can download the Recognise App (hand), Recognise Foot App, Recognise knee App, Recognise Shoulder App, Recognise Back App.

This article is for education only. This information is not intended to replace the advise or evaluation of a healthcare provider. An evaluation is highly skilled and complex and involves an evaluation of different systems and elements to determine the best approach for each individual. Always follow the instructions of your physical therapist or physician in regards to your personal exercise program. 

Chronic Pain: Question and Answer

Chronic Pain and Opioids are a big part of the news today. Are you confused about what chronic pain is? Can someone with chronic pain become pain free without Opioids? Answer to these questions will come in parts.

Part One:

1. What is Chronic pain?
   1. Chronic pain is any pain that has been experienced for greater than 3 months
2. Does my body go through physical changes when my pain is chronic?
   1. Yes, your brain begins to change and can effect the mirror neurons in your brain.
   2. Your body is in pain more often, so you have more pain receptors and more of the chemical that binds to the nerves that produce pain. 
3. Do the changes in my body effect the way my brain views my body and movement?
   1. Yes, the changes in the mirror neurons can cause pain when you think about movement or see someone performing a movement that is painful.
4. Are you saying my pain is in my head?
   1. No, I am saying that pain comes from the brain.
5. Pain comes from the brain, can you be more specific?
   1. The brain is a pre-activity organ and predetermines the way we perceive touch, movement, -and various other sensory inputs- based on experience.
   2. This quick learning process is very helpful in sports. It is called muscle memory, but unfortunately our body’s can develop pain memory.
6. How can I have pain memory that comes from my brain?
   1. Based on past experience you brain can send a pain signal even when that is an inappropriate response. NOI group calls this brain smudging.
   2. That means when a loved one lightly touches your arm,  your brain interprets that as pain instead of touch.
   3. Another example may be experiencing an 8/10 pain rating 2 days after exercise. If you hurt yourself you would have experienced pain sooner. Normal response to exercise 2 days later is soreness due to lactic acid build up. Your brain got it wrong. You should be sore not in extreme pain.
7. Are you saying my pain is not real?
   1. No! The pain and inflammation you experience is very real. I am saying your brain got it wrong and needs to be retrained.
8. Can I help my family to understand that my pain is real?
   1. Yes! Through education people with chronic pain and their loved ones can better understand what the person is going through and that it is not in their  head.
   2. Follow this Youtube link to learn more about Understanding pain in less than 5 minutes.

This article is for education only. This information is not intended to replace the advise or evaluation of a healthcare provider. An evaluation is highly skilled and complex and involves an evaluation of different systems and elements to determine the best approach for each individual. Always follow the instructions of your physical therapist or physician in regards to your personal exercise program. 

Chronic Pain: No Opioids Please

I know many of you have been living with Chronic pain for many years and have worked hard to not take Opiates to manage your pain. The latest news regarding the Opioid epidemic is supporting your decision to not go down that road, but you still find yourself in a loop of chronic pain. You have been told the pain is in your head, but you live in your body and know that you experience 10/10 pain or greater on a daily basis. People tell you “You have a low pain tolerance. Its all in your head. You just need to exercise more.” and more.

The truth is: if you have experienced pain for more than 3 months, you have chronic pain. What happens over time is that your brain begins to change and makes it easier for your body to produce pain even with a light touch. The pain is real, but does not match the input. Pain is supposed to be released as a flight or fight mechanism in response to input that causes harm or tissue damage. In a chronic pain loop the weight of a hair on a nerve can cause pain and a protective inflammatory response.
If you have found yourself in a chronic pain loop you can exit the loop. It does take patience and persistence, but it is achievable. The first step is to break the chronic pain loop. This can be achieved with:

• Meditative Prayer
• Alpha Stimulation
• Myofascial Release
• Relaxation Techniques
• Low Level Laser Therapy

Just to name a few. A qualified professional with experience in treating chronic pain can assist in evaluating you and helping you to determine the right treatment path for you. Treating chronic pain is a multitiered approach that must be customized to each person. Remember chronic pain is something you have and it can be treated.

Fitness and Technology

 If you are wondering if a fit bit, I watch, pedometer, heart monitor or any other type of technology can assist in tracking a healthy lifestyle, then I hope this post will offer you some insight.

If you are like me you are a little skeptical and slow to accept new trends. As the weather improves I am increasing my activity and starting to use the activity feature on my I watch. I obtained my apple I watch to assist with managing a hectic lifestyle of traveling, business ownership, and being accessible to my loved ones. It is great when navigating an airport with luggage in toe to be able to answer a message simply by speaking into your watch. As I learned more about my watch, I started using the activity aspect of the watch more than I thought I would. On office days I get a little tap to remind me to stand, I can see that my calorie burn and step count are low; which motivates me to take the dog for a walk after dinner. On airport days I high five myself for exceeding 10, 000 steps.  The I watch can also act as a Heart Rate monitor and with the help of your I phone you can track your calorie intake and your weight loss goals. I get a medal on days that I exceed my goals. Yes, Words of affirmation is my love language even from inanimate objects. The bottom line is -Even as a physical therapist with knowledge in calories and exercise- it
was very eye opening to see my activity level and very motivating to track and achieve my goals.

The best part is you:

• set your own goals
• make your goals attainable
• and make them fit your life

Now Get out and Enjoy Life!! #Movementismedicine!