Let’s Talk About Pain
Pain is one of the most complicated, poorly understood symptoms for physicians to treat. This is in part because pain cannot be measured on any objective scale. There are no lab tests, no imaging findings, no blood work markers that allow for one person to truly understand the pain that another person is feeling.
The only measurement we really use is a test called the Visual Analog Scale (VAS), which is a subjective test that asks the patient to rate their pain on a scale of 0-10. As you can imagine, a women who has had a natural childbirth may have a different perspective on what the worst pain imaginable is, compared to a 20-year old male who has never been injured. The answers are all relative, making pain an extremely difficult thing to treat.
Over time, science has come up with ways to differentiate pain, an attempt to categorize the physiological processes that occur after injury. These categories can help determine (1) the likely severity of the pain (2) the best course of treatment and (3) what the prognosis is.
Have you ever 'thrown your back out' or woken up with a 'pinched nerve' feeling in your neck, unable to turn your head because you slept funny? This discomfort can be so overwhelming and intense that it takes over your whole world. Oftentimes though, the more severe the pain is in the moment, the faster we will see the pain dissipate. This is characterized as acute pain, and it is characterized by pain lasting for less than 2 weeks.
Next, we have chronic pain, which is normally less severe than acute pain, but longer lasting. Without the proper intervention (education, reassurance, and appropriate treatment), acute pain has the potential to turn into chronic pain.
When you think of something 'chronic', you may think of something that takes years to develop. In fact, chronic pain is pain lasting longer than 3 months. Not that long, right? That's because after 3 months, your brain has begun to anticipate, integrate, and learn pain. It is also emotionally exhausting; this bleeds into your personal life, it impacts your ability to do activities that you used to enjoy, and affects your mental health. In short, back pain isn't just about back pain. This is called the biopsychosocial model of pain.
The catch-all category for pain is called sub-acute pain, and this is the stage that we (as therapists) tend to see people the most. It's when you've waited to see if the symptoms will go away on their own, and they kind of do, but also kind of don't. You can deal with the pain, but it has gotten to the point where it is impacting your life in a negative way.
We can make significant positive changes in all 3 kinds of pain - acute, chronic, and subacute - but the nature of your pain changes the nature of the treatment.
If you are in acute pain then our top priority is pain management. Laser therapy has shown to be incredibly effective in minimizing people's pain on the VAS scale AND putting the body's natural healing process in hyperdrive, enabling them to make it through the inflammatory stage without the need for pharmaceutical intervention. (I honestly believe that if laser was prescribed with the frequency that physicians prescribe opiates to treat pain, then we'd have a whole lot less suffering in our country today - a topic for another time).
If you re in chronic pain then we need to first break the pain cycle, which gives us a neuroplastic window to make change and get stronger. Radial shockwave therapy and laser therapy can do this, changing the message that your body sends your brain. It also breaks up some of the fibrosis of the muscle tissue, which makes you a bit more malleable for movement and manual therapy (wow, that was a lot of m's).
Sub-acute pain is typically where we focus our attention on movement, mobilizations, and strength exercises. These pain management tools can be saved for a rainy day, as pain levels fluctuate.
It is difficult to watch someone in pain. The desire to heal is why we all (as therapists) chose this profession. I am happy to be able to help Align clients in new ways, using every tool at my disposal to help people get out of pain and move better. Questions? Don't hesitate to reach out. --- Amanda