Today’s blog post comes from Leda McDaniel. Leda is a current Doctorate of Physical Therapy (DPT) candidate at Ohio University and upon graduating in May 2019 is interested in working with patients with various chronic pain conditions.
As a current physical therapy student and someone who has recovered from chronic pain, I wanted to share my experience with others in the hopes of providing a perspective of a chronic pain patient and also future healthcare professional. I believe my experience of developing chronic pain could have been prevented had the doctors, physical therapists, and orthopedic specialists had a better understanding of possible contributors to chronic pain and early signs indicating need for change in plan of care (I don’t want to place blame, I merely wish to suggest that we can do better in how we deal with pain acutely so that it doesn’t turn chronic!).
I hope that by sharing my experience, I may help both populations: chronic pain patients to find inspiration with my story of recovery, and healthcare professionals to gain perspective of what it is like to live with chronic pain and how they can work to prevent and/or treat chronic pain (Instead of reverting to the extremes of: “no pain no gain” vs. “don’t do anything that hurts”).
Leda’s Injury & Recovery Timeline:
Side Note: As you can see, after a very typical injury (ACL tear) rehabilitation was nothing but typical. Where continued progress was expected, chronic pain ensued instead.
The big 3 lessons that helped me recover from chronic pain: “Patience, Persistence, and Positive Inputs”
We know that chronic pain is NOT the same as acute pain! The pain you experience once pain becomes chronic (past the point at which your tissues should realistically have had the chance to heal) has a different cause than acute pain. Most widely accepted definitions of chronic pain say, pain is “chronic” if it lasts > 3 months or > 6 months. Chronic pain indicates that there is likely more going on than tissue injury. This state is maintained by a sensitive nervous system and maladaptive “neuroplasticity” or nervous system changes. That is- if you have chronic pain it is easier to trigger a pain response because your nervous system becomes “good” at feeling pain! Also, the process of retraining the brain- or the idea of engaging in positive or healing neuroplastic activity or change (getting out of chronic pain) takes time.
Just like other conditions involving neurologic change (e.g., after neurologic injury like a stroke) in which our goal is positive neuroplasticity, retraining the brain to be less sensitive and less apt to send down the pain signal takes many many repetitions, inputs, and practice of stimuli that are NOT PAINFUL. These many many repetitions take some time and thus patience is key. Personally, I struggled with chronic pain for 3 years (spending a total of 1 year on crutches!) before I saw any meaningful change in my function and really started taking “steps”- (literal and figurative) towards my recovery.
Just as the above section noted, the process of battling chronic pain and creating neuroplastic changes (literally changing your brain’s structure and nerve cell firing patterns) takes time. It also takes the ability to adapt your approach to what works for you. The key here is that you want to maximize ANY stimulus that is NOT PAINFUL. This stimulus in effect overrides or outcompetes the pain signalling and lets your brain reprogram such that the area in which you have pain can be stimulated (physically and neurally- we have brain maps for different areas of our body and part of “retraining the brain” is reconfiguring these “brain maps”). At least that is one of the currently proposed mechanisms for treating chronic pain. So, this stimulus could be light touch. It could be gentle movement. Or, in the case of extreme hypersensitivity (clinically called: hyperalgesia) or the experience of pain to a stimulus that is not normally painful (clinically called: allodynia) the best approach may be to imagine movement.
Another way to conceptualize this is to engage in what is known as “implicit processes” or non-conscious neural processing. For example, you may view pictures of your painful body part and make the decision about whether it is a right vs. a left knee, hip, hand (called “laterality recognition” and the first stage in the treatment paradigm of Graded Motor Imagery- which I used and had success with). It is important to not get discouraged if one method does not work or does not work right away and continue to seek out small victories- thus, persistence is key and the introduction of the non-painful stimuli over and over again is the goal (You cannot necessarily gauge success based on your immediate response to this training/practice, it may take time and dogged determination).
As someone who has experienced chronic pain, I can relate to the idea that it is very easy to become discouraged by thinking about all of the things that you cannot do and to just get really down about being in pain all of the time. However, I think it is crucial to acknowledge the control you do have over the different inputs in your life and the ability that you have (no matter what the circumstances) to improve your situation. As Dr. John Kabat-Zinn writes, “As long as you are breathing there is more right with you than wrong with you, no matter what is wrong.” I know it can be hard, but I believe that you can still pursue health even though you have chronic pain! Pursuit of health for me in my recovery included adding as many “Positive Inputs” to my life as possible. I intentionally pursued positive inputs in these areas of my life: Mind, Body, and Spirit. These are examples of the changes that I made and practices that I integrated during my recovery:
Mind– continued to take classes to pursue physical therapy degree (in person and later when unable, online), read books about various subjects (many on how the body processes pain! See Resources section below), wrote blog posts consistently, wrote a book about my experience, practiced Spanish translation (an interest since childhood). Sought out psychotherapy for situational depression via in person sessions and later skype sessions when unable to attend in person. Engaged in daily guided meditation practice (audio recordings- guided breath meditation).
Body-sought out physical therapy, massage, and acupuncture and committed to eating a healthy diet including fresh fruits/vegetables, collagen supplements, humanely raised animal products (meat, eggs, etc.), and healthy fats (avocado, olive oil, coconut oil, nuts and seeds). I also committed to engaging in only activities that didn’t cause excessive pain- so I graded my activity to what I could tolerate and to what level didn’t provoke a worse pain response (VERY gradual graded reintroduction of load to my knee- so non-weight bearing > partial weight bearing > full weight bearing).
Spirit– Made an effort to stay connected with friends (via phone calls, email, letter writing). Tried to stay connected with purpose/meaningful work- via pursuing physical therapy related career path/continuing education (I read LOTS of physical therapy related books, pain science books, listened to podcasts, etc.). Using music to improve my mood- via listening to recorded music and learning to play the guitar (when I was homebound due to pain- I would practice guitar and singing for an hour or two every day and this significantly improved my mood and gave me a sense of “flow” and purpose).
That’s it! I hope you find some of this information helpful as someone battling with chronic pain or as a healthcare professional working with those with chronic pain. Please feel free to get in touch with any questions/comments. I can be reached at: email@example.com
Best wishes for your personal and professional successes!
Leda recently published a book about her experience of personal recovery from chronic pain, which you can find on Amazon:
You can also find her blogging at:
Pain Science and Mindfulness/Meditation Resources:
Butler, D.S. & Moseley, G. L. (2003). Explain pain. Adelaide, Australia: Noigroup Publications.
Kabat-Zinn J. (1996). Full Catastrophe Living: How to cope with stress, pain and illness using mindfulness meditation. Piatkus Books.
Louw A, Puentedura EJ. (2013). Therapeutic Neuroscience Education: Teaching Patients About Pain. Minneapolis, Minnesota: Orthopedic Physical Therapy Products.
Moseley, GL, (2007). Painful Yarns: Metaphors and stories to help understand the biology of pain. Orthopedic Physical Therapy Products.
Moseley, GL, Butler, DS, Beames, TB, and Giles, TJ (2012). The graded motor imagery handbook. Adelaide, Australia: NoiGroup Publications.
Wall, PD. (2000). Pain: The science of suffering. Columbia University Press.
Free MBSR Online Course: (Mindfulness Based Stress Reduction Online Course: https://palousemindfulness.com/)
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