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Understanding Pain, A Ten Week Ecourse: Part 2

by Jonathan Blood Smyth

Hi, this is Jonathan Blood Smyth again, Founder of The Physiotherapy Site and author of Secrets of Pacing, and welcome to the second instalment of my Ten Week Ecourse, I hope you find it interesting and stimulating.

Part Two covers the second part of the discussion about the link between injury, damage and pain. in pain and whether we can isolate one from the other or not. I think hope you will find it interesting.

You are welcome to publish this course in your newsletters or on your web site, on condition you do not alter it and that you keep the resource box at the bottom of each instalment.

Week 2 The Paradox of Damage and Pain. The Link Which Sometimes Isn’t. Part Two.

Let’s go over quickly what we covered last time. Acute pain is the typical, normal pain we suffer as children and adults, and which protects us all of our lives. It is of recent origin, and we usually know what’s caused it, how to treat it and when we are going to get better.

Acute pain means tissue damage is occurring and is therefore a USEFUL pain, protecting us from harm.

Chronic pain is very different. None of the things we know about acute pain still hold and we have to think about the pain in new ways. If we think about chronic pain in the way we think about acute pain we will be confused and suffer from conflicting ideas and feelings.

Chronic pain


Let’s go through the same process we did with acute pain.

  1. Chronic pain is long lasting, it has stayed beyond the normal time of healing of the injured tissue.
  2. What does chronic pain mean? What’s the message? It feels like “Warning! Tissue Damage” but there is no evidence in most chronic pain problems that damage is occurring. The message from chronic pain is UNCLEAR.
  3. What happens when we get a chronic pain problem? Do we change our behaviour? Oh yes. We take the necessary steps to attempt to improve the situation, to solve the problem.
  4. So, once we have taken what we think are the necessary steps to improve things, do we heal and does the pain start to recede? No it doesn’t, does it? And why?
  5. Well, if there is no injury there can be no healing. The second question, why does the pain remain, is much harder to answer. It is enough to say for the moment that whatever the person does, the pain remains.
  6. As time goes on and we keep going with the efforts we make to improve things, there is no reduction in the pain and we are not able to return to normal.

So, let’s this at this process the same way we examined the acute pain process last week. Let’s look at all the things in this case that we do NOT know:

We don’t know what caused the chronic pain or how it started to go wrong.

We don’t know what has happened, whether there is injury or some kind of damage.

We don’t know how to treat the problem. If we did, it would get better.

We don’t know if there is a time scale for the pain to improve.

We don’t know if we will ever go back to normal again.

Isn’t that amazing? ALL the things we know about acute pain do not apply when we come to chronic pain. Nothing makes sense with chronic pain anymore. The landscape is unfamiliar, all the sign posts have been removed and the map is entirely unreliable.

If we try and think about chronic pain in the acute pain way only two things are going to occur. Conflict and confusion. What was it brought on the pain? Surely there must be something going on in my body to have this much pain. Surely there must be some kind of investigation or treatment. When is it going to get better? When am I going to be able to return to normal?

To understand chronic pain we must think about the pain process in an entirely different way. Not until we turn our knowledge on its head and accept new ideas will be begin to cope with or start to understand the challenges of chronic pain.

Here the link between damage/injury and pain is broken, as most chronic pain syndromes show no evidence of ongoing tissue damage to explain the pain. In chronic pain, hurt does most definitely not equal harm.

This is a fundamental point for lots of reasons, not least the problem know as fear avoidance. However, that is for the future, next we need to look at the generation of pain. How our pain is normally generated and how it goes wrong in abnormal cases is a fundamental requirement of understanding pain syndromes. Next time!

Well, that’s the end of the second instalment of the ten week pain ecourse. I hope you found it interesting. There’s a long way to go yet, so stick with me!

Check out the third instalment of the Pain Ecourse.

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Understanding Pain, A Ten+ Week Ecourse by Jonathan Blood Smyth.
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