Approaches to pain have changed a lot over the last few years in response to new scientific evidence on the body’s responses to injury. These new conceptualisations of pain look at the effects of pain on the nervous system, in which pain messages are interpreted as danger signals. When pain becomes chronic, danger signals are continually pumped into the body, and the operation of the nervous system is fundamentally changed. Chronic pain therefore “rewires” the nervous system. This gives rise to a new approach in managing chronic pain. Just as pain can “rewire” the nervous system, you can attempt and succeed in “rewiring” your nervous system to better manage pain.

 

This approach is based on three different interventions; movement, relaxation and pacing.

 

Movement

You need to start moving. If immobilisation demonstrates that pain is necessary, then movement demonstrates that pain is unnecessary. Movement is key to the functioning of our nervous system. While stretches and exercises are good, you need to start moving in a conscious and deliberate way, to start “rewiring” the nervous system. “Nerves that fire together, wire together”. Once nerves fire together in a particular direction, they keep firing together in that direction.

 

Relaxation

You need to learn to relax. The nervous system needs to be “rewired” back into experiencing the parasympathetic response. Relaxation techniques are essential here. Fear of movement is a conditioned response; you need to override the condition of fear of a situation that can cause you pain. You need to pair movement with a relaxation response instead. If you can trigger the nervous system to relax when you have pain, then you remove the message of danger and can avoid going into the full-blown immune response.

 

Pacing

You need to build tolerance. The pacing technique involves timing activities to prevent pain from becoming overwhelming. Start with a baseline for the activity, note when pain begins, and reduce that time by 30%. This buffer allows you to continue with confidence. Gradually increase the time by 10% once the initial duration becomes too easy, continuing until you feel ready for longer sessions. This process helps you train progressively without increasing pain.