Pain: can't live with it, can't live without it!

As a Pilates teacher I am often working with people who are either recovering from or are living with pain. Typically they have been recommended Pilates exercise by a clinical professional after their pain has become chronic and they have exhausted other treatment options. Pilates has a reputation for helping relieve painful symptoms because it is low impact, can easily be modified to the individual’s current capability and, hopefully, allows the person to move in a way that helps them feel good. But like any exercise method it isn’t a silver bullet. Pain is complex and still not very well understood. 

Pain is essentially the body's warning system, a complex integration of our sensory and protective mechanisms. Pain begins with specialised nerve cells called nociceptors, which detect potentially harmful stimuli (1). In acute pain, nociceptors react to immediate threats, such as a burn or a sharp object. These receptors send rapid electrical signals to the brain via the spinal cord, initiating a swift response to remove or protect the injured area (2).

In contrast, chronic pain, often caused by conditions like arthritis or fibromyalgia, results from nociceptors continually sending these signals even after the initial injury has healed (3). The brain's response to chronic pain differs from acute pain; it involves a complex interplay of neural pathways, including those responsible for memory and emotions and can lead to long term changes in the nervous system (4) (5). 

The brain's interpretation of pain signals influences our emotional and behavioural responses, such as feelings of discomfort, anxiety, and even depression, especially in cases of chronic pain (6). This is what makes treating chronic pain so difficult, our experience of it is completely unique because our neural pathways, memories and emotional responses are all individual to us. I’ve worked with many people living with chronic pain who feel like after exhausting the medical treatment available they have been told “it’s all in your head”, and feel like they have been told they are imagining it, that their pain isn’t real. This isn’t the case. However it is probably true to say the pain no longer has an acute cause but it now exists within the complex neurology that makes up the human brain and nervous system. 

Acute pain serves as a vital protective mechanism, while chronic pain underscores the complexity of our nervous system and the challenges of managing ongoing discomfort. Pain scientist and Physiotherapist Lorimer Moseley compares acute pain to the fence at the edge of a cliff, a warning to protect us from harm. In the case of chronic pain we can become desensitised to this warning, resulting in the fence moving further and further from the cliff edge and leaving us with fewer and fewer activities that are pain free. However, this doesn’t mean that if you’re living with chronic pain that your experience can’t be improved. A great deal of research into strategies for managing pain now show that a multi faceted approach using exercise, talking and alternative therapies can make a huge difference to an individual’s experience. If you are someone living with chronic pain I highly recommend checking out Lorimer Moseley’s work and advice at tamethebeast.org (7) as well as talking to your GP to see what non-medical therapies might be available to help you manage your pain. There won’t be one single answer but with a multi-faceted approach, that maybe includes some kind of exercise, you make a huge difference to your pain and consequently the pleasure in your life.

References:

• Woolf CJ. (2010). What is this thing called pain? The Journal of Clinical Investigation, 120(11), 3742-3744.

• Basbaum AI, Bautista DM, Scherrer G, et al. (2009). Cellular and molecular mechanisms of pain. Cell, 139(2), 267-284.

• Treede RD, Rief W, Barke A, et al. (2015). Chronic pain as a symptom or a disease: The IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain, 156(6), 1003-1007.

• Apkarian AV, Baliki MN, Geha PY. (2009). Towards a theory of chronic pain. Progress in Neurobiology, 87(2), 81-97.

• Woolf CJ. (2011). Central sensitization: Implications for the diagnosis and treatment of pain. Pain, 152(3 Suppl), S2-S15.

• Melzack R, Casey KL. (1968). Sensory, motivational, and central control determinants of pain: A new conceptual model. The Skin Senses, 423-443.

• Prof. Lorimer Moseley. www.tamethebeast.org