Why Do I Still Feel Pain?

Written by Kim Deschamps | Oct 10, 2018

A common question that I hear in my office is 'why do I still feel pain?' This is valid question and can be a complex answer. In this blog post I will be providing a collection of knowledge and resources on the physical changes in a sensitized nervous system that may be causing the persistent pain that you are experiencing. 

It is important that I begin by saying that your pain is real. Research has shown us for well over a decade that pain is produced by our nervous system to protect us, but sometimes the nervous system becomes part of the problem with persistent pain and that is why it is important for you to understand as much as you can about our glorious nervous system.  

Physical Changes in your Sensitized Nervous System Secondary to Persistent Pain 

(reference: Understand Pain, Live Well Again by Neil Person).

In the Neurons (nerve cells) in your body....

1. The threshold for the danger neurons lowers so that they get excited more easily; the neuron believes that you need more protection, so it sends the danger signals to the brain more easily. 

2. The danger neurons usually have a rest period after sending a signal; in persistent pain, this rest period decreases, allowing for more danger signals to be sent. 

3. The danger neurons start to release chemicals out of the "sensor" end into the tissue. These chemicals produce inflammation and are released because your nervous system thinks if there is that much pain, there must be a need for lots of protection. Inflammation is a protective response; this produces swelling in the tissue long after the tissue has healed. 

In the Spinal Cord...

1. These are the relay neurons. The spinal cord neurons become more easily excited the longer pain persists. They will require few signals from your body to feel pain. Similar to the experience of getting angry quicker if you are already upset by something, but having a much longer fuse if you are in a happy mood. 

2. The neurons in the spinal cord build more sensors when pain persists. With more sensors, they can detect more danger chemicals and send the danger message faster. Once again, the nervous system starts to change so that the alarm gets louder, as if you need more protection. 

3. The neurons in the spinal cord that send danger signals can misinterpret normal sensations of touch, stretch and movement as danger signals. This means that you can feel pain just because you stretched an uninjured tissue in the area of the injury. 

In the Brain...

1. The map of the body part that is injured becomes bigger in the brain when pain persists. More neurons in your brain will be dedicated to paying attention to the painful area.

2. When the map changes, you will have less ability to contract and relax your muscles as well. You will have poorer coordination between the deeper stability muscles and the outer mover muscles causing movements that are not smooth and coordinated; it will feel like the joint is stuck, the muscles spasm, or it just plain hurts. When the pelvic floor is the site of persistent pain, you will have voiding dysfunction (retention, dribbling), constipation or diarrhea, and sexual dysfunction. This will feel like there is something terribly wrong inside-there is, but this added problem is in your nervous system, not so much in the tissues or organs. 

3. When pain persists, the brain starts to change the chemicals it produces and releases. Some of these chemicals are hormones and they can stimulate your body's fight/flight/freeze reactions. Not only can this lead to feelings of anxiety, fear, anger and depression, these reactions all tend to feed back into the pain system, increasing its sensitivity even more (adrenaline/cortisol).

4. Pain becomes like a familiar tune or pathway played in the brain. The longer you feel pain, the more the nervous system can start to play the tune even when there are no new signals coming from your body. The longer you experience pain, the more things trigger pain. 

So now what can I do to desensitize (downregulate) my central nervous system???

Remember, all of these things that the nervous system has learned can be changed back. Neurons can become less sensitive; they can stop paying attention to and stop misinterpreting normal sensation as DANGEROUS. 

Sensors can change back to the way they were, the map of your body on your brain can go back to its normal state and your muscles can regain their normal coordinated action. All it took was the wrong circumstances and lots of practice to get them to act the way they are. 

Now you need to practice new things. 

With PATIENCE, PERSISTENCE, COMPASSION and PRACTICE

You will find ways to change them back, instead of just covering up the pain. 

'We are what we repeatedly do. Excellence, therefore, is not an act but a habit.' - Aristotle

(reference: Pelvic Health Solutions; Restoring Pelvic Health through Physiotherapy)

At Holistic Physiotherapy & Wellness we follow a Biopsychosocial (body-mind-social) model to guide our assessments and treatment plans. It is important that we listen to our clients story and I mean really listen. We gather information about when the pain, symptoms, concerns first started and determine if there are patterns to our clients' symptoms that might lead to the 'whys' that their persistent pain remains. We send out specific questionnaires ahead of time to determine if there are factors within daily life that may be contributing to a heightened sensitized nervous system (stress and anxiety for example). We guide questions around sleep, diet, supportive and non-supportive relationships, leisure activities, goals, and coping strategies to further understand the person who has provided us with the honor to hear their story. A mechanical/movement body scan is then performed to provide insight on movement patterns. We also assess our clients' breathing pattern, tissue tenderness, joint range of motion, muscle strength, balance, and posture to further understand their concerns and barriers. All of this information is then processed to determine a holistic treatment approach to their rehabilitation. The client and therapist work as a team to reach goals and improve function. It is our goal to help Bring Balance to Your Life.

What calms my nervous system?

• Retrain the brain and nervous system: look at all of the things that effect the nervous system and what may be contributing to your individual pain.

• Mindfulness/Breathing Practice/Meditation

• Mindful movement (remapping the brain): Yoga, Qi Gong, Tai Chi

• Gratitude Practice/Words of Affirmation

• Healthy Eating

• Improved sleeping habits

• Creativity/Joy/Play- making time in your busy life to do the things that bring you joy

• Surrounding yourself with supportive relationships

• Spiritual/Religion/Belief Practice

• Manual Therapy: joint mobilization, soft tissue release, stretching, non-nociceptive input strategies, etc.

• Physical Activity: at least 30 mins of cardiovascular activity per day.

• Collaborative Care: interdisciplinary approach to your treatment- massage therapist, chiropractor, physiotherapist, naturopath doctor, general practitioner, councillor, reiki practitioner/body talk practitioner, traditional Chinese medicine doctor, etc. There are so many wonderful health professionals within our community. Find practitioners that are eager to work together to provide you with the utmost care.

...and so much more! How exciting is that!?

Thank you for taking the time to learn more about your pain. Please reach out if you have further questions. 

With grace,

Kim Deschamps

Are you a visual learner?....Here is a Video: Understanding Pain in less than 5 minutes, and what to do about it!

For more information please check out Neil Person's Pain Education eBook: Understand Pain, Live Well Again  http://lifeisnow.ca/wp-content/uploads/2017/03/Understand-Pain-Live-Well-Again-for-ENG-new.pdf

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Kim Deschamps

Clinic Owner

Physiotherapist

Therapeutic Yoga Therapist

Pelvic Health Therapist