A presentation from the WSFT physiotherapy department on understanding and responding to pain

1. Physiotherapy
Patient Information
On Pain

2. Outcomes of the talk:
• Understanding the mechanisms of pain
• Explanation of the different types of pain
• Explanation of “normal” and “abnormal” pain
• Brief examples and explanation of pain medication and how they
help different types of pain.
• Explanation on the effects of pain on mood and mood on pain
• Discussion about the emotional and physical effect of pain on
work, home life and social life
• Discussion on the effects of poor sleep and raised pain levels
• Discussion around how you are able to help yourself – relaxation,
life style, life story etc.

3. Pain Definition
• Pain is an emotion, experienced in the brain, it is not
like touch, taste, sight, smell or hearing. It is
categorised into:
• Acute pain - less than twelve weeks duration
• Chronic/persistent pain - of more than twelve weeks.
• Pain can be perceived as a warning of potential or
actual damage, but can also be present when no
actual harm is being done to the body.
(British Pain Society)

4. Pain
• It is essential we all feel pain to limit risks of serious
injury and warn us of illness. E.g. Putting a hand in a
flame or angina.
• It is experienced differently by everyone.
• Our body has the ability to control the amount of pain
we will feel. This has evolved to help our survival. E.g.
Twisting our ankle when running from a burning
building.
• We would not feel pain at that time, because it would
risk our survival chances. This is our body changing
our pain response.

5. What Is Persistent Pain?
• This is when tissue damage may not be present.
• The bodies tissues may have already healed. Soft tissue
injuries will be healed within 6-8 weeks and most parts
of the body will have healed in 3-6 months.
• So it is less about structural change and more about the
central nervous systems involvement.
• In order to treat persistent pain we would need to look
at individual pain responses, and retrain the brain.

6. How Do We Feel Pain?
• Everywhere in the body there are
sensors called nociceptors.
• These respond to different
stimuli. If the stimuli is strong
enough they can generate nerve
impulses.
• These nerve impulses travel from
the area of actual or potential
injury, to the spinal cord and up
to the brain.

7. How Do We Feel Pain?
• When these nerve signals get to
the brain they arrive at the
thalamus – here the signals are
sent to the different areas of the
brain to be processed.
• When the information is being
processed it can be influenced by;
past experiences, mood, sleep
patterns, emotions or pain
memory amongst other things (e.g.
a previous scratch developed into a
big infection).
• Our brain will then decide how
much of a threat the injury is, and
what action needs to be carried
out.

8. Natural Pain Killers
• As well as signals going to the brain, we have pain
relieving hormones released by the brain E.g.
endorphins and serotonin
• These natural pain relieving signals can disrupt the
signals at the spinal cord. These will stop signals getting
to the brain to be registered as a possible painful feeling.

9. “Abnormal” Pain Response
• Our body can become sensitive to non
threatening stimulus.
• This can happen locally (in your upper or lower
limbs) OR centrally (in your spinal cord and brain).
• This means we can feel pain without tissue
damage.
• Our nervous system can become sensitive to non-
harmful stimuli.

10. Did You Know?
1. The brain and spinal cord can store memory of
previous pain experiences, when under similar
situations the brain will draw on these experiences.
2. The brain and spinal cord can become more
efficient at producing a certain pain the more the
pain is provoked.
3. The level of pain you are experiencing is not always
a true reflection of the level of tissue damage.

11. Why Hasn’t My Pain Gone?
• We know that the things that can predict back pain persisting are
more related to:
– Our thoughts (E.g. worrying, negative thoughts and becoming fearful
of moving)
– Our emotions (E.g. high levels of stress, anxiety, low mood and
frustration)
– Our lifestyle (E.g. poor sleep, overdoing it, smoking, excess drinking
and avoiding movements/exercise and work)
These things can make our nervous system more sensitive and can
cause persistent pain and disability.

12. Effects Of Pain On Mood
• Aspects of your brain associated with thinking and feelings
communicate to our pain centers in our brain.
• Pain can affect our emotions and vice versa.
• If we are angry, depressed or anxious – our pain will often
feel worse.
• If we are positive and happy we may experience less pain
and be able to cope better.
• Pain is not “just in our head” or “just in the body” but a mix
affecting our whole being.

13. Effects Of Pain
Pain can affect many areas of your life:
• Sleep
• Energy levels
• Mood
• Anxiety levels
• Activity levels
• Work
• Relationship and social life
• Hobbies
• Image Chronic pain coalition (impact of pain)

14. Emotional Aspects Of Pain
Pain can be connected with different emotions:
• Joy
• Surprise
• Fear
• Anger
• Sadness
• Disgust

15. How Pain Impacts On People’s Lives
Patients report being concerned about:
• Engaging in meaningful activities
• Not being believed.
• Meeting social expectations and obligations.
• Not being able to meet social demands.
(Froud et al, 2013)

16. How Pain Impacts On People’s Lives
• Reports of anxiety and depression are more frequent
among people with back pain comparing to people
without back pain. (Bener et al. 2013)
• According to research findings;
– Poor sleep quality would result to a day with higher pain
intensity.
– A day with higher pain intensity was associated with poor
sleep quality.
Alsaadi et al (2014)

17. 5 Ways To Help
1) Medical Help
2) Diet and Lifestyle
3) Life Story
4) Activity and Exercise
5) Pacing

18. 1) Medical Help
• Pain medication to help you get going in acute episodes.
Pain experience less than 3 months. E.G. post op, post
sprain.
• Regular pain relief will allow your to be more proactive in
your ability to approach to rehabilitation.
• Surgery is often not always the solution.

19. What Kind Of Pain Relief?
• Paracetamol
• Non steroidal anti-inflammatories
(NSAIDs) e.g. Ibuprofen or naproxen.
• Paracetamol with NSAIDs.
• Weak opioid such as Codeine (risk of
dependence and constipation)
• Benzodiazepine (e.g. Diazepam) for
muscle spasm
• Neuropathic pain relief such as
Amitriptyline, Gabapentin or
Pregabalin.
Always ask your GP or pharmacist
regarding your pain relief.
(NICE guidelines recommendation, 2015)

20. 2) Diet and Lifestyle
To think about:
• Static sitting
• Poor diet
• Smoking
• Nutrition
• Activity levels
All can improve pain if they are improved.

21. 2) Diet and Lifestyle
Things that can help:
• Relaxation
• Psychological support
• Talking
• Socialising
• Sleep (at night)

22. 3) Life Story
– Can you think of any links between a stressful
time in your life/occupation/family situation
which maybe linked to your pain levels?
– Was their a stressful or difficult time around the
time your pain started?

23. 4) Activity and Exercise
• Guided exercises to help
change your pain and
move within
comfortable levels to
help ease your pain.
• Being physically active is
always beneficial!

24. • Using a paced approach when you manage your
pain is important.
• Learning how to do the correct amount is difficult.
It is important not to over or under do it.
• Pacing gives you a way to break everyday activities
and exercise into smaller bits. E.g. splitting the
gardening or hoovering up over the day.
• Pacing is important in pain management because
it allows you to stay active on good and bad days.
This will help avoid flare-ups.
5) Pacing