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Understanding and Managing Long Term Pain

In their latest report about the treatment options for persistent pain, the National Institute of Clinical Excellence (NICE) recommended exercise, acupuncture, Acceptance and Commitment Therapy (ACT) and education. This is a huge breakthrough for the treatment of persistent pain as the guidelines are no longer recommending it be treated with medication, surgery or injections. I have worked successfully for years with many, many clients who have come to me with persistent pain issues, the vast majority of which have a long history of increasingly complex medication regimes, injections and in many cases surgery - all of which have offered little improvement for their pain. 

Pain is a complex phenomenon. It is difficult to live with, yet impossible to live without. What I mean by this is that pain is a natural response to a situation and designed to be protective. 

  • If you have broken bone, pain would prevent you from moving it around so that it would have a chance to heal.

  • Pain can stop you from burning yourself - you will quickly move your hand away from something that feels hot. 

  • If you have pains in your chest which you are concerned about, you may seek urgent medical assistance. 

From an evolutionary perspective, pain is a protective mechanism that we use when there is a threat of tissue damage - it is designed to make us pull away from danger, or to cease movement if it going to cause tissue damage. But tissue in the body repair very readily, even bone repairs in a matter of weeks. However, persistent, long term pain can occur if the brain perceives the threat of damage as real and ongoing. 

This is where the mechanisms of pain start to get confusing. 

We may have pain in our back or neck, and an Xray or MRI scan may show we have a disc bulge, it may show we have signs of osteoarthritis. But in reality, these findings have shown to have little relation to symptoms of pain - as we age, these findings would be considered to be normal and the vast majority of people with disc bulges or osteoarthritic changes have no symptoms of pain. There is a growing body of evidence to suggest that the pain symptoms are not caused by the disc bulges or the osteoarthritis but by something else. 

80% of amputees have pain in their missing limb. The relationship between tissue damage and pain doesn't exist - even when a limb is no longer there, we can still feel pain in it. If some part of our brain is convinced there is a reason for pain, we can make it real. 

There is a map of the body within the cortex of the brain. This map can get confused, which makes it difficult for the brain to pinpoint and interpret nerve signals coming from the body. This can result in the brain determining pain in a particular area of the body, even when there is no damaged tissue and no reason for the sensations of pain. It is this perception of pain that is often at the root of long term, persistent pain conditions. 

When someone is told their pain is just in their brain, this feels as though they are being told that they are making it up. If someone has been on pain medication for a long time, this could not be further from the truth. The problem with treating persistent pain with pills is that most of them have side effects, these often have an impact on the immune system which is closely tied to the nervous system. Therefore, taking pain medication for a long time can actually cause an increase in the sensitivity of our pain detection system, which in turn causes even more pain. 

The answer to the problem is to find a solution that does not rely on medication but can help to reset the pain mechanisms. Using a combination of acupuncture, electro-acupuncture, movement and education, I help my clients to reset their pain systems and move away from a dependency on pain medication.

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