Pain is our friend.
What a way to start an article that you thought was going to talk about how to relieve pain, right?
In order to understand this we’ll need to define pain: pain is a bodily alarm system that sounds when there is real or potential tissue damage. This means that the brain prepares a pain signal when it receives information about both real and potential harm.
What is real harm? If you’re walking down the street and a dog bites you, that is real harm and a pain caused by a verifiable injury to the tissue.
But what about when you’ve been sitting in front of the computer for two hours and your back starts hurting? The postural pain that arose in those two hours can hardly be thought of as the result of real damage. What is really happening is that the tissues send information to the brain that the area is overloaded and when the brain processes that information, it reaches the conclusion that the body is under threat and sends a pain signal causing us to get up, thereby protecting us from a real injury. So why do we usually think that pain is our enemy?
Pain is unpleasant.
We can all agree, right? If it weren’t unpleasant, it wouldn’t cause us to act in a way to free ourselves from it and it wouldn’t carry out its function as an alert system that saves us from situations that may cause bodily harm or injury.
Imagine for a moment that the pain signal that, again, comes from the brain, were a light tickle instead of an unpleasant feeling. Imagine a scenario in which you’re walking barefoot on a floor covered in broken glass that simply causes you to feel a slight, even pleasant, tickle on your feet. We’d probably end up footless at the drop of a hat. So, in order to be effective, pain has to hurt. Ideally, pain should be proportional to the injury or potential injury detected by the brain, but, unfortunately, that is often not the case.
Pain is capricious and sometimes strange.
This is because situations may arise in which a minimal aggression causes exacerbated pain. For example, a violinist may feel intense pain in response to a prick on the finger, because the brain interprets it as a great threat to successfully practicing their profession. On the other hand, a surfer would feel little to no pain in response to the same injury.
Why is that?
Because the pain signal originating from the brain depends on the context and is the sum of a number of factors:
Damage or potential damage to the tissue, the information that the patient has about the damage, the patient’s emotional and mental state, the family, social, work, emotional environment, etc.
All of this information is gathered in the brain and it mixes everything together like a cocktail shaker to prepare the pain signal.
Can pain become our enemy?
Absolutely. If, based on the information it has, the brain prepares the wrong signal with regard to intensity and duration, a disproportionate signal (chronic pain, pain related to context), and even exacerbated pain in circumstances where there is no real or potential danger (this is the case for amputees and fibromyalgia patients when they feel phantom pain).
What role does physical therapy and the physical therapist play in these cases?
Physical therapists clearly must use all the techniques at their disposal: Manual therapy, electrotherapy, active and passive exercise, trigger point treatment, heat, cold, spinal manipulation, etc.
To provide an example of how these methods act on pain, here are some of the most popular methods that physical therapists and others recommend to their patients:
Massage: improves circulation, acts on the nervous system, sedating it, promotes the secretion of endorphins, relaxes contracted muscles.
Spinal manipulations: these are absolutely fantastic because with a single, painless manipulation lasting one second, a muscular contraction that had been lingering for days can be eliminated, thereby also eliminating pain.
Trigger point treatment: these are the points with the most tension that cause localized pain (at the point) and radiating pain (around the point). If the point is treated, both localized and radiating pain disappear.
Stretches: these are very effective when therapists see pain-inducing muscular retractions and hypertonia. A single stretch of 15 seconds can help eliminate tension and pain.
Self-treatment: patients can also self-treat at home using very simple methods such as:
Deep diaphragmatic breathing: Five minutes laying face up and breathing slowly and calmly filling the belly on the inhale and exhaling twice as long as the inhale (generally sedating and analgesic effects in addition to increasing stamina).
The application of heat: If it is a pain that lasts more than two days and the area is not inflamed (red or hot), patients can apply a bit of soft heat with a hot water bottle or electric blanket (20 minutes is enough).
Self-massage and stretching: patients can massage the area in pain (especially if the pain is muscular) prior to applying heat and rub a bit of almond oil on it. They should create friction, knead the muscle, and put pressure on it. 10 minutes is enough. After this a good stretch will help to further relax the area. Finally, drinking water after self-treatment will help to flush out any toxins that may have been released from the tissue during the massage.
Physical therapists must also be able to inform patients on the process they’re going through. Accurate, non-sensationalist information will help reduce the patient’s anxiety, which is making the pain worse. They should give recommendations about the activities that will help relieve the pain and, above all, given the proximity that physical therapists usually have with their patients, they must empathize with them: be their first psychological and emotional support. Often being listened to when they feel they haven’t been understood is a bigger relief than the latest and most expensive pain relief technique on the market.
Let’s be great professionals and great human beings: there are no greater weapons.