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Help For Chronic Pain

Chronic pain hurts not just physically but also emotionally. But there is hope. Customized specific interventions as well as overall lifestyle approaches can make an enormous difference in the quality of life of people with pain.

Since chronic pain affects various aspects of a person's life — physical mental emotional and social — therapists at Howard Head Sports Medicine aim to reprogram both the physical and mental realms which in turn affect the emotional and social.

Chronic pain as fight-or-flight
A variety of causes can contribute to chronic pain including old injuries habitual patterns and even emotional trauma. But it tends to involve a shift in muscle groups and brain response which perpetuates pain. Pain then leads to doctor visits and often a measure of fear which sends people into a fight-or-flight stress response. “Those suffering from pain are in a constant mode of fight response” says Howard Head Sports Medicine physical therapist Brittney Huntimer who has a doctorate in PT. “The brain doesn't know the difference between a tense and relaxed muscle. (Through intervention) they learn to feel the difference and eventually they can actually physically relax their muscles.”

Interventions
Howard Head therapists individualize every treatment based on a patient's needs so there's no one magic bullet. However one of the main things therapists teach involves specific skills to manage pain. Huntimer recently completed a fellowship in chronic pain management and she explains how with chronic pain the input and output system of the pain response in the brain gets mixed up and generates a pain signal when there shouldn't be one. The goal: to help the brain “reorganize that information so more appropriate signals can be output from tissues to the brain” she says. 

Retraining may include joint mobilization which studies have shown interrupts the pain pattern and helps the brain stop producing pain signals when it's not necessary.

Huntimer illustrates how the brain goes into a fight-or-flight response after an injury through a scenario about stepping on a nail in the backyard: Let's say the incident sends a man to the emergency room he receives a tetanus shot and his foot hurts for days. The pain centers of the brain decide that event was harmful. So the next time he steps on a harmless pebble in the yard the brain recalls the more serious injury with the nail and “old information rushes into the brain (causing) anxiety stress huge pain and (a perception of) danger” she says. “(But) if you look down and see it's a pebble the brain reorganizes the information and says 'I'm OK.'”

Huntimer teaches patients how to calm the fight-or-flight stress response with cognitive and behavioral interventions.

Another technique therapists may use is neuromuscular education which retrains the brain to reconnect with specific muscle control. Many patients with lower back pain for instance adopt habitual positions or movements which contribute to their pain. It's not their fault: “The brain has shut down the use of the stability muscles and it goes to the stress muscles” she says explaining that rather than employing deep abdominal and gluteal muscles the brain substitutes other muscle groups which weren't intended to carry the load so they become overworked and cause pain.

Placing dry needles into muscular trigger points can also help relax muscles and interrupt the pain signal. But as Huntimer points out a technique like dry needling “isn't going to be enough.” Patients must learn how they can actively reduce pain through changes in perception and lifestyle. “We're trying to teach the person to abolish pain themselves versus relying on us” she says.  

Cognitive retraining
The first step in fighting chronic pain involves understanding the input/output process of pain exemplified by the nail injury.

“There is a lot of fear and anxiety associated with the pain” she says. “In some cases (patients) have been told they have a bulging disc or a degenerative spine. It becomes a life sentence for them. They think they never have a way out that they may never be normal.” But most of the time that's simply not the case.

“There's great hope in pain management but it's the perspective (shift)” she says. “When people have so much constant pain they stop moving and doing anything. When they do any kind of exercise it's a shock to the body so they think they're feeling all of this pain” she says. “So we start with exercises that are not fearful exercises they enjoy doing breaking it down in a way that's not threatening. We work toward small goals.”

Oftentimes people have lived with pain for so long it becomes a part of their identity. Sometimes there isn't even physical evidence of any injury or debilitation the longer pain persists the better the brain gets at producing pain signals — out of habit — even though the pain-producing stimulus may no longer exist she says.

“The longer somebody has been in pain the more the body becomes adept at generating pain signals when there is no actual tissue damage” Huntimer explains. As a result much of the therapists' work involves stress management because like so many other diseases stress directly impacts chronic pain.

“When you get stressed out you tense up more which contributes to setting off pain signals in the brain” she says. The application of cognitive behavioral therapy which helps people recognize negative thought patterns and provides a method of intervention gradually becomes one life-long approach.

Though this may sound difficult it's like anything else: It becomes a way of life. Huntimer says sometimes it's as easy as taking five minutes a day to turn off all electronics and focus on breathing exercises or progressive muscle relaxation in which a person tenses a muscle and relaxes it to relearn how to relax muscle groups.

The key involves interrupting pain signals so the brain can reorganize its information and stop sending the body into a fight-or-flight response. Through strategic progressive interventions and education therapists work with patients to better manage their pain and allow them to return to the activities they love.

For more information
Howard Head Sports Medicine | howardhead.com | (970) 476-1225
Howard Head Sports Medicine offers a variety of physical and occupational therapy services at 9 locations in Eagle and Summit Counties. They will open a new clinic in Breckenridge this fall. With over 50 trained therapists Howard Head's innovative sports medicine treatments and state-of-the-art equipment help people get back to the activities they love.