Chronic Pain

What is Chronic Pain?
There are two main categories of pain: acute pain and chronic pain. Acute pain is a symptom of a tissue injury. For instance, if you sprain your ankle, you have pain in your ankle as a symptom of injuring the ligament. Acute pain is directly related to an injury, and has a predictable and relatively short duration. It can be easily managed by manual therapy and progressive exercises, and we often treat acute pain in our practice with good results.

The second type of pain is chronic pain. Chronic pain is not clearly caused by a tissue injury, or the pain doesn’t go away after the tissues have healed. Even though the tissues have healed, we tend to continue to think of the ligaments or other tissues as causing the pain. This often leads to a lot of doctor’s visits seeking an answer, failed interventions, surgeries, medications, etc., and no clear answer to what is causing their pain. This is because chronic pain is not just long-lasting acute pain.

Chronic pain lasts longer than acute pain, it is independent of the original injury, and has taken on a life of its own. Because of this, interventions that aim to treat the original injury often fail to reduce the pain.

What causes Chronic Pain?
Whatever the type or original cause of pain, pain is a function of the nervous system. With an ankle sprain, nerves in your ankle detect the injury, send a signal to the spinal cord, and then to your brain. You don’t perceive the ankle pain until the pain signals are processed by your brain. These pain signals tell you that something is wrong, and this leads you to modify your activities in an attempt to protect your joint. This can work well with acute pain, and usually the system becomes less reactive in a predictable time period.

However, with chronic pain, the nervous system remains at an increased level of reactivity or sensitivity, even after the injured body part is healed. The whole nervous system becomes more sensitive, in a process called central sensitization. Central sensitization can show up as pain that is out of proportion with the original injury, widespread or spreading pain, decreased ability to tolerate activities, poor sleep, fatigue, and anxiety.

What can physical therapy do for central sensitization?
We will provide education and hands-on therapy to help reduce the sensitivity of your nerves and tissues. Simply understanding how pain works can help reduce pain and improve function. Sarah and Shani can teach you about pain using Therapeutic Neuroscience Education (TNE).

We will help you to calm down your nervous system with graded exposure to provocative activities, a progressive home exercise program including aerobic exercise, and education on ways to improve your sleep and reduce your stress.