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Taking Control of your Complex Pain

Take some time to learn about potential drivers of complex pain, and

some tips about becoming the leader in your healthcare team.


Diving into Complex Pain

Previously, the healthcare community used the term “Chronic Pain” to

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describe symptoms of pain that persist past expected timelines or are of

unknown origins. However, pain science is evolving and changing rapidly, and we’ve transitioned to a belief that our experience of pain is influenced

and perpetuated by many different factors and may not fall under a

specific timeline, thus the shift to “Complex Pain.”


We often speak of pain as a symptom that accompanies an injury or

condition, however pain itself can be a diagnosis. This can feel extremely

frustrating, and it’s natural to hope that something else is causing your

symptoms, which if corrected will stop the pain. Accepting a diagnosis of

complex pain can be frightening, but also empowering. Acknowledging

that persistent pain is occurring, either on its own or in conjunction with

another condition, allows us to dive deeper into the drivers of our pain. In

other words, we can investigate things that may be contributing to our

experience of pain.


Taking the Lead

Pain is unique to the person that experiences it, and no two people will

ever have the same pain (Melzack & Katz, 2013). This is because our

nervous system is amazingly complex, and it takes inputs from many

different sources to create the experience of pain (learn more in this post).

Because we know this, we can also deduce that there is not a one size fits

all approach to treat chronic pain. What works for one person may have no

effect for the next.


We often look to healthcare professionals to tell us what is causing our

symptoms and tell us the treatment. However, when we consider how

unique the pain experience is, it may be beneficial to shift our perspective,

and view the patient as the expert and the leader of your healthcare team.


Persistent Pain

The job of your healthcare team is to work with you to help find strategies

that fit in your life, not the other way around.The first step is understanding these drivers of chronic pain, so that we can find places to make changes and help you achieve your goals and do the things you want to do. It’s also very important to acknowledge that pain is multi-factorial- many things contribute to pain, and though we may not be able to influence one factor, we can attack pain from multiple others.


Drivers of Complex Pain


Central Sensitization

Our central nervous system (composed of the brain and spinal cord)

receives a large amount of information all at once, and it must filter

through to decide what is important, and what signal can be “turned down”.


For instance, you likely weren’t conscious of the feeling of your clothes on

your body until I mentioned it, however you’re now considering the feel of

the different fabrics and materials you’re currently touching. Similarly, our

nervous system is constantly sending information about stimuli that may

be threatening to us, whether it’s a deep pressure or a hot surface. It isn’t

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until the signal reaches our brain that we decide if that stimulus is painful.

Our brain makes this choice based on many factors, including previous

exposure to that stimulus, its current environment, and how strong the

signal from the tissue is. With complex pain, we find that these signals

have been ”turned up”, with increased efficiency and transmission,

sometimes so much so that non-painful stimuli such as muscle activation

or a change in position can trigger a pain response. This is called central

sensitization.


Managing central sensitization can include many things, and even learning

more about it can be an important step of managing it. We can’t think pain

away (mind over matter is not a cure-all), however like we talked about

earlier, our brain creates a pain signal based on several inputs, and we can

give more context for it to consider (Melzack & Katz, 2013, Lepri et al.,

2023). LivePlanBe is a resource with several topics on complex pain &

management strategies that can be very helpful for patient looking to

know more. Speaking to your physician about pharmaceutical options can

also be a piece of your management plan, with many different avenues of

treatment available.


Mental Health, Stress, &; Thoughts/Beliefs

Another aspect of our pain experience is our emotional state, thoughts and

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behaviours surrounding pain, and mental health. Things can get

complicated here, because having complex pain is stressful, can cause

feelings, of anxiety, and cause fear and hesitation to move. However, these

things can also feed into pain, and patients often report that pain can flare

with life stressors, and feelings of fear and avoidance can feed into pain.

We can address these drivers in several ways, whether its talking to a

psychologist, accessing psychological resources for complex pain (this is a

great self-serve resource), or creating a routine that helps you manage

when life stressors occur. Finding time for activities you enjoy, whether it’s

taking a warm bath, going outside, or spending time with a loved one, can

help with stress, and potentially help manage your pain experience.

We can also consider thoughts and beliefs we have about our pain- are

there activities you avoid because you’re scared of causing harm? How are

you coping with your pain experience? Has it affected your personal

relationships? Why do you think you’re experiencing pain? It’s okay not to

know the answers to some of these questions, but taking the time to

consider them may open impacts of your pain experience that you haven’t

explored yet, and areas that you might be able to make changes.


Wellness

Finally, we can think about ways to keep our body healthy despite living

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with complex pain. Movement, diet, and sleep can be critical for optimal

body function, and can play a significant role in how we experience pain

(Nijs, 2019). Looking for ways to move your body and exercise despite pain

can be challenging, however starting with a low impact activity like

walking, yoga, or stationary biking can be a great start. The best type of movement is the one you feel you can commit to!


Take Home Message

Complex pain is unique to each individual, and so our treatments must also

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be individualized! Exploring ways in which your pain may be perpetuated

can be the foundation of creating your personalized treatment plan. Your

healthcare team can be multidisciplinary, and custom designed to fit your

needs. Our professionals at Shift are here whenever you need us to help

you come up with a game plan for your complex pain.



By: Samantha Playfair



References

Melzack, R., & Katz, J. (2013). Pain. Wiley interdisciplinary reviews. Cognitive

science, 4(1), 1–15. https://doi.org/10.1002/wcs.1201


Lepri, B., Romani, D., Storari, L., & Barbari, V. (2023). Effectiveness of pain

neuroscience education in patients with chronic musculoskeletal pain and

central sensitization: a systematic review. International journal of

environmental research and public health, 20(5), 4098.


Nijs, J., Leysen, L., Vanlauwe, J., Logghe, T., Ickmans, K., Polli, A., ... &

Huysmans, E. (2019). Treatment of central sensitization in patients with

chronic pain: time for change?. Expert Opinion on Pharmacotherapy, 20(16),

1961-1970.


Wijma, A. J., van Wilgen, C. P., Meeus, M., & Nijs, J. (2016). Clinical biopsychosocial physiotherapy assessment of patients with chronic pain: The first step in pain neuroscience education. Physiotherapy theory and practice, 32(5), 368-384.

Walton, D. M., & Elliott, J. M. (2018). A new clinical model for facilitating the development of pattern recognition skills in clinical pain assessment. Musculoskeletal Science and Practice, 36, 17-24.

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