Chronic Pain

 

CHRONIC PAIN

 

Pain is the topmost reason why we consult a doctor. Pain tells us that something is wrong with our body and it should be taken care of immediately. When you take proper care of the injured part, this pain slowly reduces as the tissue starts to heal & then goes away….

Do you disagree with the last part?? Do you find it hard to believe that pain is completely relieved so easily?? Are you suffering from pain since long durations & now it just won’t go away??

 

Chronic pain is any pain which lasts longer than 3 months. What causes the pain to persist for so long?

Pain is present continuously when there is any injury to muscle/tendon/ligament/bone. In the initial phases it is accompanied by other symptoms like swelling, weakness, instability etc. These symptoms are not seen when the tissue heals completely. But, pain can be present even after tissue has healed completely. This is chronic pain.

 

What causes chronic pain?

Pain is a signal which travels from your body part to your brain. This signal is transmitted by a dense network of wires called nerves, running throughout your body. These wires conduct the signals which you then feel as aching, sharp pain or shock like pains. This is a very smart, quick and foolproof system which protects our body from more damage due to injury.

 

Imagine an alarm clock which alerts you very quickly to any danger and stops ringing immediately when you turn it off….

Now imagine if this alarm clock was damaged…

You keep turning it off, but it just won’t stop ringing! That is chronic pain. 

Sometimes after a severe injury, a person’s nerves become very sensitive to pain. Even after healing they continue to keep ringing like that damaged alarm clock and you continue to feel pain.

 

Even though this is the main cause of chronic pain, some other factors contributing to maintain the pain are-

●     Inadequate strengthening of injured structure after healing

●     Recurrent loading on injured structure which delays its healing

●     Injury to nerves which generally take a long time to heal

●     Avoiding movement due to fear even after the injury has completely healed, increases muscle weakness, which leads to further pain & person lands up in a vicious circle of pain.

●     Pain related fear, anxiety and depression prolong the pain.

 

Some conditions are very prone to becoming chronic if not managed properly-

●     Low back pain

●     Headaches

●     Ankle sprains

●     Nerve damage

 

Some conditions are associated with chronic pain as one of the main symptoms-

●     Rheumatoid arthritis

●     Fibromyalgia

●     Chronic pain syndrome

●     Myofascial pain syndrome

●     Cancer

●     Ulcers

 

Pain which is present for more than 3 months & in some cases even for several years is definitely difficult to manage. It makes even simple daily activities extremely troublesome for the person. Nothing seems to cure the pain & person begins to feel helpless… This is why chronic pain is significantly associated with fear of movement, anxiety, fatigue, frustration, and in severe cases depression. Chronic pain also disturbs sleep which again increases stress.

 

Thus, chronic pain gets associated with negative emotions and this creates a cycle of pain. Pain leads to stress while increased stress leads to pain…

 

How to deal with chronic pain??

1.      Appropriate, timely treatment of injury- As always, the best treatment is ‘Prevention is better than cure’. If chronic pain scares you then the easiest way is to avoid it! Don’t pull on your sport or job related activities if you have any pain/injury. Consult experts & follow their advice to ensure proper healing of your injury. The most important thing is to continue proper physical therapy even after the initial pain has gone down. Your physiotherapist can advise you regarding strengthening of the injured tissue to prevent re-injuries & recurrent pain.

2.      Pain education- An important aspect of chronic pain is understanding what exactly is causing such prolonged pain. A thorough assessment by an expert will help them to determine the cause of pain. Your expert can further explain why pain is occurring & what can be done to tackle it. Another important aspect of pain education also deals with teaching patients to cope with their pain & be more productive. Even talking about your pain with the doctor is a good step towards pain management!

3.      Strengthening & flexibility exercises to regain movement- In most people with chronic pain, movement is avoided due to fear of pain. In some cases, the person performs usual movements in a different manner to avoid pain. The only cause here is fear of pain. This can be targeted by exercises for specific muscles to make the movement painfree! Strength training with weights, resistance bands or with own body weight have been shown to have pain reducing effects!

4.      Aerobic exercise- This is the most effective, but a thoroughly under-used super pill against chronic pain!! Any aerobic activity like walking, jogging, swimming, skipping releases naturally occurring pain relief chemicals present in our brains!! Furthermore, it very effectively reduces stress! It thus, tackles almost all negative aspects of chronic pain. Aerobic exercise is definitely an easy, enjoyable & productive strategy against chronic pain!!

5.      Yoga- This ancient science of mind & body control helps in relaxation, improving movement, improving function & improving mood! Yoga has also shown proven benefits in stress reduction.

6.      Coping strategies- These are highly personalized techniques which help the person cope up with all his activities in spite of pain. These can include techniques like distracting oneself from pain, performing enjoyable physical activities, mediation, relaxation techniques and so on…

 

                                                                         

What should be strictly avoided?

1.      Over use of pain relief medications- It is very important to understand that pain killer drugs only work until a certain level & their side effects exceed their usefulness. It is advantageous to understand what causes pain and deal with it instead of depending on pain killers.

2.      Prolonged bed rest- Even if movement is causing pain, bed rest is not the answer. Prolonged bed rest/inactivity results in muscle weakness which further increases pain. Movement should be done, initially only in pain free ranges, but later in all directions. Consult your physiotherapist regarding ways to perform movement painlessly.

3.      Continuous use of protective braces, belts, corsets- These should be used only during activities which load the injured body part. A lumbar corset need not be worn even when you are just lying down. Use braces only in activities like walking, during sports, or travelling. Follow expert’s advice regarding appropriate duration of using braces & gradually reduce its use.

 

 

Chronic pain may seem like the most stressful & disabling condition. But, it is important to know that it can definitely be treated & is not entirely un-manageable.

It just takes some time & a few simple tricks to fix the alarm clock that won’t stop ringing!

 

We at REHAB STATION are a team of expert physiotherapists who can guide you to manage your chronic pain in a better way! We conduct thorough musculoskeletal & neurological assessments at our physiotherapy lab, which can help you identify the causes of your pain. Based on assessments we design personalized, goal-directed exercise plans aimed at achieving pain relief & physical fitness. You can avail of supervised physiotherapy sessions for proper performance of exercises & posture & technique correction.

-Dr. Shriya Joshi (PT)

Senior Musculoskeletal Physiotherapist, Rehab Station

Falls in Elderly - Why and How to prevent them?

Falls in Elderly

            Falls are one of the leading causes of accidents in the people over the age of 65 years. Before we discuss falls and their causes in detail, it is important to have clear understanding of what a “fall” is. Fall can be defined as “an unplanned, unexpected contact with a supporting surface”. A surface may not necessarily mean a floor, but may also mean a wall or a chair, etc.  They are the main cause of accidental injuries in elderly, which can be non-life threatening or life threatening!

An elderly individual falls in the category of “At-Risk” individuals who are likely to fall. To prevent such an incident, the likely causes of falls should be understood. Let’s have a look at them! 

The causes of falls in elderly individuals:

As we compare this problem of falls with other conditions like diabetes, arthritis, etc. we do realize that we can address 90% of these causes and the incidence of falls can be reduced drastically. Recent study has shown that most individuals are not aware that falls can be prevented by appropriate guidance & physiotherapy.

Why is it important to prevent falls?

Even one incident of a fall or a near- fall leaves us with a fear that our balance will be lost any time and it will lead to a fall. It is a vicious cycle of which the components are interlinked. This fear of falls is physically as well as mentally disabling, because our social engagements are reduced one tends to get isolated.

Balance and anticipatory adjustments to maintain balance are controlled by various systems in the body. Reduced functioning of one or more systems gives rise to fear of falls and loss of balance leading to falls.

Our body and the receptors controlling our balance can be trained by various strategies, let us see them!

Prevention strategies that can be incorporated with the help of exercises:

v  Doing functional exercises which are time based for improving reaction time so that anticipatory balance adjustments are made in time and you don’t lose balance!

v  Balance training by doing exercises on different surfaces such as floor (stable surface), moving platforms, etc.

v  Analyzing what goes wrong and where it goes wrong during walking, and targeting the specific components to improve way of walking

v  Gaze stabilization exercises can improve the vision difficulties and co-ordination of vision with balance

v  Joint proprioception can be improved by giving weight bearing exercises on floor initially and progressing to the Bosu and or vestibular ball

v  Strengthening exercises of the individual muscles which are found to be weak and contributing towards weak balance

v  Proper technique of using a walking aid and knowledge about how it should improve your stability

v  How can you upgrade your surroundings to improve support?

 

Duration & Frequency:

Exercise programmes that have successfully reduced the number of falls in elderly have required exercise sessions of atleast 3 times/ week for a duration of 30-40 minutes. The exercises are advised to be done under supervision for initial few weeks and then home program can be given, with weekly follow up.

How can we prevent falls?

The management of such a condition, requires a detailed assessment, so as to correctly identify the cause, among of all these potential causes listed above.

All individuals are different and hence, their problems are different, but all the individuals who are at a risk of falls have a common goal: “To prevent falls”. Take a sigh of relief as unlike other accidents in life, these are the accidents that can prevented! We at Rehab Station, offer a complete detailed evaluation with the help of physiotherapeutic skills and also with use of advance technology (Huber 360); a patient tailored exercise protocol; detailed counselling about the condition and coping strategies which are going to be implemented; all under one roof!

- Dr. Sukanya Dandekar (PT)
Neuro physiotherapist at Rehab Station, Pune