Currently, the United States ranks 2nd in the developed world for self-reported ‘chronic pain,’ with 43% of our population living with persistent pain syndromes (Tsang 2008). We have 4.3% of the world’s population and yet we consume 80% of the world’s opioid supply (Manchikanti 2008).
We are clearly in the midst of a pain pandemic and are doing little to actually help those who endure persistent pain. We over-prescribe medications, haphazardly order unnecessary lab work and images, and often fail to provide patients with what they actually need.
There are many layers to this. Some of these errors are due to misinformation and misunderstanding by both patients and practitioners alike. Some are born of a system that places too much value on the quick-fix type methods. And, yes, some of these errors are the result of a generally unhealthy population, both physically and mentally.
I recently heard the phrase, “desperate patients cause desperate clinicians to do desperate things.” Persistent pain is often a vicious cycle.
We must normalize that pain is normal AND non-discriminatory.
What do I mean by that? Let’s break it down.
1. Pain is Normal.
A healthy nervous system is able to interpret dangerous signals from our environment or from within our body as threats and turn those signals into pain. This is healthy, normal, and extremely effective in keeping us free from harm. However, sometimes our nervous system becomes confused by the signals it is receiving and generates a painful response in the absence of true, dangerous stimuli. It should be noted that this is considered abnormal and usually the case in most persistent pain syndromes.
2. Pain is Non-Discriminatory.
I hear people frequently say “I’m too young to have pain.”
Since when is pain only normal in older adults? Certainly, they have more potential for pain given more life experiences and the gradual wear-down of tissues, BUT age is NOT a causative factor for pain.
To understand this, we must understand the definition of pain: an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage (IASP 1979). Meaning pain is not always physical and pain is not always actual tissue damage. Pain is sometimes purely emotional.
Having an age minimum on pain indicates that we are operating under the presupposition that pain is only time-dependent and associated with aging. Pain is far more complex than to ever be attributed to “normal aging.”
In fact, persistent pain is often the derivative of a combination of the following:
-age
-gender
-ethnicity and cultural background
-socio-economic background
-employment status and occupational factors
-smoking
-alcohol
-physical activity
-nutrition
-sunshine and vitamin D
-pain state
-multi-morbidity and mortality
-mental health
-surgical and medical interventions
-weight
-sleep disorders
-genetics
-attitudes and beliefs about pain
-history of violent injury
-abuse
-interpersonal violence
So...yeah. There is an enormous amount that goes into persistent pain. This can feel like a daunting task to face and it is easy to feel overwhelmed. Many of us can even feel guilty about our pain, or victimized by it. Our pain can make us feel misunderstood or like no one believes us.
However, to overcome persistent pain it is important to feel validated and be educated. You must be an ally to your body and listen to what is going on inside of you. Seek care from providers who hear you, support you, and empower you. Own and accept pain as a situation, not a destination.
This is certainly too broad a topic to discuss in a short blog, but let this serve as a launching off point to help guide you to dig a little deeper. Understand that persistent pain in young, middle aged, and older individuals is very common. If you are struggling with persistent, unresolved pain two great places to start your journey toward recovery are 1) mental health (counseling, CBT, etc.,) and 2) physical therapy.
Here are some additional resources to check out:
Explain Pain by David Butler and Lorimer Moseley
Why Do I Hurt by Adriaan Louw
The Body Keeps the Score by Bessel Van der Kolk
Thanks for reading, and don’t hesitate to reach out with any questions!
Jake Reynold, PT, DPT, OCS