This section is based on a talk by Randolph Sparks, a psychologist specialising in chronic pain and a guest lecturer at the School of Psychology at the Australian National University. <\/i><\/p>\n
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 \u201crewires\u201d the nervous system.<\/p>\n
\u201cTo me, being a pain psychologist for quite a few years already, this particular model has really filled in some missing pieces of the puzzle, and it’s doing so for my own clients as well.\u201d<\/p>\n
This gives rise to a new approach in managing chronic pain. Just as pain can \u201crewire\u201d the nervous system, you can attempt and succeed in \u201crewiring\u201d your nervous system to better manage pain. The strategies to manage chronic pain themselves are not new, but how we understand the processes and how we implement the strategies is changing.<\/p>\n
This new approach is based around three practical interventions you can take to start \u201crewiring\u201d your nervous system and thus learn to manage your pain more effectively. These are movement, relaxation and pacing.<\/b><\/p>\n
Chronic pain is partly a dysfunction of the immune system. The role of the immune system is to immobilise the body when injured, sick or in danger. For example, when a person has the flu, they become more sensitive to pain, their mood deteriorates and they experience stiffness, fatigue and changes in temperature. This is an immune response to the flu. The immune system has immobilised the body to aid healing and allow it to safely increase the body\u2019s temperature to deal with the virus.<\/p>\n
Similarly, after an acute injury the body responds with pain, a deteriorated mood, stiffness and fatigue. There may also be slight changes in temperature. We also immobilise the injured body part. This is an appropriate and helpful response to a short term injury. However, we also tend to respond in a similar way when an injury becomes chronic.<\/p>\n
People with chronic pain often immobilise the areas that are giving them pain and are often not even aware they are doing it. Movement is painful and therefore dangerous \u2013 and the painful part of the body needs to be immobilised. For acute pain, immobilisation is necessary, but for chronic pain, it is not.<\/p>\n
If you are already immobilising part of the body, you are already enacting the beginning of an immunological response, which means the full-blown response is primed and ready to kick in at any time.<\/p>\n
\u201cIf you have chronic and constant pain, observe how you move to see if you\u2019re not already immobilising parts of your body. It can be very subtle.\u201d<\/p>\n
This new approach to chronic pain employs feedback loops to start \u201crewiring\u201d the body to better deal with pain. For people with chronic pain, the feedback loop is simple. You immobilise because you are in pain, but immobilisation, in turn, tells your body you are in pain. This is an automatic immunological response. You need to consciously and deliberately \u201crewire\u201d the body to reduce your suffering.<\/p>\n
You need to start moving.<\/b> If immobilisation<\/b> demonstrates that pain is necessary, then movement<\/b> 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 \u201crewiring\u201d the nervous system. \u201cNerves that fire together, wire together\u201d<\/i>. Once nerves fire together in a particular direction, they keep firing together in that direction.<\/p>\n
\u201cFor someone like me with 20 years of lower back pain, my pain experience has changed completely since I\u2019ve started using these techniques.\u201d<\/p>\n
Many people with chronic pain fear movement, as movement has caused them pain, and pain is perceived as dangerous. Therefore a person can increasingly limit movement and cease activities requiring it. These activities can include exercise, social activities and work, and can result in the person experiencing a significant reduction in quality of life.<\/p>\n
So fear of movement can have severe effects on quality of life in many areas, and produce or increase anxiety and depression, as well as having a direct effect on the nervous system.<\/p>\n
You need to do two things when it comes to movement. You need to:<\/p>\n
\u201cI remind myself that my back is there, my back is moving and that it\u2019s okay. I actually say out loud to myself, \u201cYep, my back is here, my back is moving, and it\u2019s okay\u201d. In as many ways as you can, you need to start \u201crewiring\u201d your body.\u201d<\/p>\n
The danger reaction is the natural “fight or flight” reaction when a person is facing imminent danger. This is the sympathetic nervous response: adrenaline kicks in, breathing goes to the upper chest, blood flows out to the extremities, the digestive system stops working, heart rate increases. This is great for immediate danger, but not so good if it goes on for a long time.<\/p>\n
The body is always trying to achieve homeostasis, or balance. Following a sympathetic nervous response (the danger response), the nervous system then activates the parasympathetic response (the relaxation response) and relaxes the body, and the person then often becomes tired.<\/p>\n
This is the body\u2019s way of restoring balance. For people with chronic pain, however, their nervous system is continually bombarded with danger signals, stimulating a constant sympathetic nervous response. They do not experience the usual parasympathetic response that follows.<\/p>\n
\u201cI\u2019ve conditioned myself. So I just have to say the word, \u201crelax, breathe\u201d, and I get really sleepy.\u201d<\/p>\n
You need to learn to relax.<\/b> The nervous system needs to be \u201crewired\u201d 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.<\/p>\n
Breathing is key.<\/b> There are other relaxation methods but learning to relax through breathing is a simple and easy technique to start practicing. The aim is to practice breathing until you can think \u201cbreathe\u201d and you relax.<\/p>\n
When we breathe in, we activate the sympathetic system, and when we breathe out, we activate the parasympathetic system. When facing imminent danger, breathing goes to the upper chest, taking long breaths in and short breaths out. A person in pain will often breathe like this.<\/p>\n
You need to train your breathing to do the opposite. Breathe in for a count of one, and out for a count of two. You will activate the sympathetic system slightly, but the parasympathetic system more, and you will relax. You need to practice this technique all the time, not just when you are desperate, but when you have little to no pain at all. You need to practice until you can employ this technique automatically, calming your system and bringing you out of the danger response automatically.<\/p>\n
For people with chronic pain, certain activities will often cause pain. For these people, pain becomes their “stop” signal. Sometimes pain can be delayed, so a person will often stop “just in case” the next time around. For people with chronic pain, pain is saying \u201cstop\u201d all<\/i> the time. Generally, a person with chronic pain will always check their pain before undertaking an activity. They are thus restricted by a binary operating system which is pain-driven.<\/p>\n
For people who do not experience chronic pain, \u201cgo\u201d is normal. There is no need to check for pain. Pain has an acute function in this basic operating system; a person will stop if they are injured to allow time for their injury to heal. In general, however, pain is not important. For these people, their basic operating system is a quota system based on choice<\/b>.<\/p>\n
A choice is made when to stop, usually based on distance, time or repetitions. For example, at the gym a person may decide to do 20 push ups, and even though it may start to hurt after 5 push ups, the person will not stop. The pain is not important because they made a decision to do 20 push-ups.<\/p>\n
But for a person in chronic pain, this system is defunct. They have lost their choice and are restricted by a binary operating system driven by pain. Pain is functional because it is in control. If you have chronic pain, you rely on pain to know when it is safe to move or not. You need to \u201crewire\u201d your nervous system, remove pain from the equation and return to a system based on choice.<\/p>\n
\u201cIt took me about 2 years to shift my nervous system and immune response. Now it works to my liking. It doesn\u2019t mean that I don\u2019t have pain. It doesn\u2019t mean that I don\u2019t get flare-ups. But my pain flare-ups have gone from 3 weeks of immobilisation to 3 or 4 days with full movement.\u201d<\/p>\n
It is a long process to \u201crewire\u201d the nervous system, but if you stay with the program then your baseline of pain will eventually increase. Do not be overconfident when increasing the time frame. You can also work with repetition and distance, but always be planned and accurate.<\/p>\n
\u201cChronic pain is like the dark side of neuroplasticity, but what I\u2019m saying is this is the bright side of neuroplasticity, this is how we can rewire ourselves to live a better life. Chronic pain has already rewired your nervous system, so you are going to have to retrain it back.\u201d<\/p>\n
Practice is key. You need to practice normalising and increasing your movement<\/b>. You need to practice your relaxation<\/b> techniques. You need to practice your pacing<\/b> activities. When you practice these three practical interventions, you are successfully \u201crewiring\u201d your nervous system to better manage your pain and achieve a better quality of life.<\/p>\n
If you want to read more about this approach to pain, we recommend “Pain Tracking” by Deborah Barrett and “Explain Pain” by Dr Lorimer Moseley.<\/p>\n
While you\u2019re here, how about helping us out with a donation?<\/p>\n
\nWe\u2019re a really small organisation doing a really big job. We give people with RSI across Australia the info they need to get the right treatments, navigate the worker\u2019s compensation system and better manage daily life. This section is based on a talk by Randolph Sparks, a psychologist specialising in chronic pain and a guest lecturer at the School of Psychology at the Australian National University. Approaches to pain have changed a lot over the last few years in response to new scientific evidence on the […]<\/p>\n","protected":false},"author":4,"featured_media":0,"parent":15,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"class_list":["post-25","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/rsi.org.au\/index.php\/wp-json\/wp\/v2\/pages\/25","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/rsi.org.au\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/rsi.org.au\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/rsi.org.au\/index.php\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/rsi.org.au\/index.php\/wp-json\/wp\/v2\/comments?post=25"}],"version-history":[{"count":5,"href":"https:\/\/rsi.org.au\/index.php\/wp-json\/wp\/v2\/pages\/25\/revisions"}],"predecessor-version":[{"id":822,"href":"https:\/\/rsi.org.au\/index.php\/wp-json\/wp\/v2\/pages\/25\/revisions\/822"}],"up":[{"embeddable":true,"href":"https:\/\/rsi.org.au\/index.php\/wp-json\/wp\/v2\/pages\/15"}],"wp:attachment":[{"href":"https:\/\/rsi.org.au\/index.php\/wp-json\/wp\/v2\/media?parent=25"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
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