Explaining Pain and health problems

It is quite common and affects around one in seven of us. Persistent pain is caused by health problems like arthritis or nerve damage like in diabetes. It can be the result of a specific problem that has often healed, like shingles. It can also develop slowly, sometimes for no obvious reason. It may even come on some time months or years after an activity or injury like a road accident or surgery.

Persistent pain can be in a specific part of the body like the back, shoulder or legs, or throughout the whole body. It may be continuous or vary in its level. It can flare up or become worse very quickly, often agonizing and at other times being easier to manage. It can have other symptoms like numbness, burning or electric shocks.

Pain can come from tissues like muscles, ligaments, joints, or be coming from the nerves. It can be made up of both tissue pain and nerve pain so is a tricky condition to manage at times.

Pain scientists have found it is important to help the brain and the body to wind down the pain by looking after the body through building fitness, healthy eating and being more kind and soothing to a sensitive nerve system.

So balancing activities, unwinding and relaxing and doing enjoyable all help the brain turn down the sensitive pain systems. Getting anxious, fearful or angry or stressed turn up the pain sensitivity in the brain.

What is going on when people have persistent pain?

Persistent pain is different to short-acting ‘acute’ pain that lasts some weeks and goes away. It often doesn’t respond to usual treatments. We now know the problem is in the pain-sensing system itself, rather than being a specific problem in the body itself. One way to understand persistent pain is to think about a very sensitive car alarm. Car alarms are good when someone is trying to break into your car. The lights flash, the siren blares out and it grabs your attention instantly to tell you the car is at threat of a break-in.

However, car alarms are annoying when the same thing happens just when someone brushes past the car or a butterfly lands on the roof. The siren still sounds and lights flash yet there is no break-in threat. The body’s nervous system is like this too. In persistent pain the pain-sensing nerves send off the same signals as if there was an instant threat of injury or damage when none exists. It’s not just annoying though, it hurts too!

However, the car alarm system can be fixed or replaced. With persistent pain, you are stuck with your faulty sensitive nervous system, which needs to be managed. Sadly there are no treatments to fix the sensitive pain-sensing nerves and nervous system at the moment. Scientists are exploring ways to change the sensitivity settings and so new treatments will emerge in time. Pain relief medication can reduce some of the pain, so reduce some of the sound of the car alarm. They cannot stop it sounding or switch it off completely. It is too complex a system and we do not have enough knowledge yet to stop persistent pain. So at the moment, we don’t have a complete cure for persistent pain.

Why do people develop persistent pain?

There is still an awful lot that is not understood about why pain can continue after injuries heal, or why it can be present without any ongoing physical problem or damage. We know for example if there is nerve damage that has healed the nerves can still be very sensitive and excitable. We also know that managing moods like stress, frustration, depression can change the sensitivity, so lessen pain. It is the same if a person is very distracted or focused on an absorbing activity: pain becomes less.

However, we do not know all the reasons why nerves are so sensitive or how to make them less excitable or sensitive. It remains a puzzle at present.

Studies suggest some people are born with genes that make them more vulnerable – in other words, some are unlucky and more prone to developing problems in their pain systems.

How does persistent pain make people feel?

Living with persistent pain can be stressful and can affect people in lots of different ways. Managing at home, work duties and dealing with friends and family can be difficult. People often feel they have no control over the pain and are unable to cope with it.

Experiencing pain can lead to feelings of anxiety or fear about what might be causing the pain and what the future might hold. This is usual for many people, especially where there is no obvious cause. Feeling pain can also make you feel tense, especially if you expect the pain to come back or get worse. You may feel easily angered and hostile towards people that don’t understand your situation or how your pain affects you. Some people even feel anger towards the pain itself.

When things aren’t going so well, it can lead to troubling thoughts. You may feel hopeless and very down about feeling this pain, which can result in depression. The pain itself or worrying about it may cause difficulties with sleeping. Being tired and having a sleepless night can make you feel more upset and bad-tempered.

The good news is there are many things you can do to live a full enjoyable life, despite your pain.

What can you do about persistent pain?

Many people with pain have to accept that this is a condition they have to live with long-term. In fact acceptance, and no longer searching for ‘the fix or cure’, is an important part of controlling your pain. Acceptance helps reduce pain’s nasty effects on your life and health.

Everyone creates their own toolbox for managing their own pain. Like a gymnast, cyclist or athlete who hones their skills to get the most from them, you can learn how to make the most of the skills you already have for managing your pain. You may learn new ones to add to the ones you’ve got. Some people become so good at managing their pain that it fades completely into the background for much of the time.
Everyone is different so the right self-management plan will vary from person to person. This could involve understanding more about the way pain works – for example, the fact that fear, uncertainty about causes, past experiences (including traumatic childhood events) tiredness, your genes and many other things ALL effect the way the pain system behaves now.

It could involve learning how to do things differently (acceptance, pacing, positive focusing skills). It is also about learning about helpful treatments and medicines, as well as thinking and reacting differently to the pain and life events in general.

It helps to explore ways to build fitness gently, balance activities with patience and set enjoyable goals or hobbies and plans. Support to build a self-management plan may be found in different places from sports centres to local community health group activities. Check with your GP or practice team what support is there in your area. There is more than you think … and it’s fun too!