Persistent Pain

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Persistent pain is generally accepted to be pain which has lasted for more than 3 months.

With persistent pain, the nervous system continues to send potential 'danger' messages to the brain, despite the fact that normal soft tissue healing processes have taken place and therefore the pain is no longer related directly to tissue damage. You can gather a better understanding of how pain works here, as well as finding out about how there are lots of contributing factors to pain.

Persistent pain can originate with an initial injury or infection that then resolves but then leaves the nervous system sensitised, or in some circumstances there may be an ongoing structure within the joint that is a 'source' of pain. Some people suffer with persistent pain in the absence of any past injury or evidence of tissue damage.

In the absence of any worrying signs and symptoms, persistent pain can develop from the nervous system becoming overly sensitive i.e. the pain ‘volume’ has been left ‘turned up’ following an acute injury, rather than being ‘turned back down’ as you would expect it to during the healing process.

It is accepted that there are several factors which influence the volume of pain, including psychological factors such as anxiety and depression, ongoing abnormal movements adopted during the initial pain episode, the presence of other areas of pain in the body and thoughts and beliefs.

A key focus when it comes to persistent pain is to learn to self-manage the condition. The aim of the recommended treatments and management strategies are to reduce the impact of pain on your day-to-day life, even if the pain cannot be eliminated completely. The aim of treatment is to allow you to remain as active as possible within the limits of your pain, but not to avoid activities because you anticipate pain.

There is no single exercise that has been proven to be better than another; the key is to try to engage in something you enjoy. For example can you adapt your favourite activity so that it feels more doable? Could you do a shorter period of it or a different pace? It is a much lower level of activity but being in an environment you love, in the company of people you enjoy being around can actually help pain and general wellbeing. Interestingly even just getting out for a walk (particularly in nature) has been demonstrated to be really effective for persistent pain. Walking also has the added benefits of having a positive effect on mental health conditions like depression, anxiety, dementia, schizophrenia, as well as things like diabetes, stoke and heart attack risk, and concentration.

Evidence supports the use of certain treatments, primarily exercise and movement, but also treatment for the psychological component of persistent pain and there is good evidence to support the use of Cognitive Behavioural Therapy (CBT) to help you change the way that you think, feel and behave in relation to pain.

Many persistent pain services or specialist pain clinics adopt a multidisciplinary approach to persistent pain, and if usual treatments such as Physiotherapy have not resolved the condition, you may be referred to one of these services where Physiotherapy, Psychology and other treatment approaches may be used together to try and reduce your symptoms.

In rare cases a surgical review may be considered when all other treatment options have been exhausted if the pain remains constant and severe. However surgical intervention is often unsuccessful in resolving persistent pain due to the fact that in most cases there is usually an absence of any ongoing tissue 'damage' that the surgery can repair

Credit to MSK REFORM