This informal CPD article on Recovery from Chronic Pain was provided by Georgina Oldfield, Physiotherapist & Founder of SIRPA, who aims to engage health professionals and people in pain to train them in the SIRPA approach to chronic pain recovery.
Treatment of Chronic Pain
Treatment of chronic pain is currently undergoing a revolution as our understanding of the causes, triggers and effective solutions is changing. For 20 years I worked as a traditional physiotherapist, but I was constantly questioning the anomalies my patients presented with. For example, why so often their pain had been triggered while doing something completely innocuous, like bending over to pick up a pen or even turning over in bed. More often than not the pain also didn’t fit a biomechanical diagnosis and would even move around, maybe from one side to another.
There is also a growing number of research studies showing that morphine when used for back pain is no more effective than paracetamol and can actually cause an increased sensitivity to pain. Spinal injections and surgical fusions for central back pain have also been shown to provide limited relief, if at all. With current research not supporting our present treatment options for chronic pain we are in dire need of more effective treatments.
Assumptions about Chronic Pain
The assumption that chronic pain is caused by structural problems in the painful area has led to numerous problems. This is despite the fact that over the past few decades, there has been a growing number of studies showing a lack of correlation between physical findings and pain. This includes a study which showed that in a group of people with an average age of 46 years old, 81% of them were shown to have a herniation/slipped disc and 75% had degeneration of the nucleus/centre of the disc. Despite this, none of them had pain.
Another study that shakes some long-term misconceptions about pain being due to a physical cause is Lederman’s review study in 2010. This concluded that there has not been any evidence to show a link between pain and posture, structure (e.g. scoliosis, spinal degeneration) or biomechanics (e.g. the way we move, muscle tension etc).
With the growth of technology and being able to actually see degeneration etc on scans, when a patient presents with pain there is still a tendency to try and match up any physical findings on the scans with the symptoms a patient presents with, often even when the symptoms don’t actually fit the findings on the scans.
Thankfully though, the work I came across in 2007 is now becoming more widely known and acknowledged. Dr John Sarno pioneered the approach on which my own work is based and which it has evolved from and I had the privilege of visiting him in New York in November 2007. His work has actually recently been featured in The Guardian newspaper and in a documentary All the Rage, Saved by Sarno.
Through Dr Sarno’s work since the 1970s and the evolution of pain science over the past 15 – 20 years, we now know that very real physical pain can be created by the brain and is due to neural pathways that become learned and sensitized. Whether pain becomes persistent has been found not to be related to the extent of any tissue damage. In fact, the main factors involved include; depressed mood, anxiety and early beliefs that pain may become permanent.
Studies in Chronic Pain
We also now know through extensive studies over the past 20 years that there is a strong correlation between the number of adverse experiences individuals experienced in childhood and the likelihood of them experiencing conditions such as fibromyalgia, myofascial pain and other pain and health problems in later life.
Is it any wonder then that if we only assess and treat the physical presentation, pain linked to stress and past trauma, which is also often being fueled by fears and personality traits, will persist?
How to treat a complex condition such as chronic pain
Thankfully there is now a growing awareness in the western world that in order to treat the complex condition that is chronic pain, we need to have an educational approach which addresses psychosocial factors.
Through SIRPA’s educational and self-empowering approach we also help individuals change behaviours that might unintentionally keep the pain pathways turned on, plus help them work through any relevant current and past stressful lifestyle experiences. With this blended approach the aim is to help people not just manage their pain, but change the neural pathways which create it, therefore often allowing them to regain their lives and the pain to resolve.
It’s an exciting time as the understanding of this work spreads and becomes more recognized within health systems around the world.
We hope this article was helpful. For more information from SIRPA, please visit their CPD Member Directory page. Alternatively please visit the CPD Industry Hubs for more CPD articles, courses and events relevant to your Continuing Professional Development requirements.
