How to Heal Chronic Pain

Headaches, migraine, back, neck or joint pain, irritable bowel syndrome (IBS), fibromyalgia – they’re just some of the common causes of chronic pain, which is estimated to affect between a third to half of all UK adults, or just under 28 million of us.

These symptoms make up a very large proportion of worries and concerns for our patients at the SOP too, and it is not uncommon for us to be seeing patients on long-term ‘treatment maintenance’ type programs.

We understand how physically and emotionally draining long term pain can be, and many clients come to us having ‘tried everything’!

Recent neuroscience research reveals that our brains play a pivotal role in the experience of pain through a process known as predictive processing. This mechanism suggests that pain is not solely a result of physical injury but is also influenced by the brain's interpretation of the situation, our past experiences of pain and our expectations of pain.

For example, twisting your ankle while running across a field to pull your child away from a rivers edge may cause no pain at all in the moment, but twisting your ankle whilst out on a run through a field will likely result in immediate pain and coming to an abrupt halt.

In many cases of chronic pain, there is no underlying structural issue such as injury or infection. Instead, the brain has developed neural pathways that perpetuate the sensation of pain, creating a cycle where fear of pain leads to stress, which in turn intensifies the pain experience.

For someone who has developed fear and worries around pain, because, for example they had a very severe episode of acute back pain in the past, they are terrified of ever returning to that state again. That person may have developed tension, anxiety and guarding behaviours (most likely sub-consciously) that may actually be perpetuating the constant cycle of niggles, twinges and occasional acute episodes which is actually driving the long-term chronic pain situation.

Emotions and stress can activate the same pain centres in the brain as physical injuries, leading to a sensitisation of the central nervous system which can keep patients in a constant loop of worry, tension, pain and re-injury.

It's crucial to understand that this pain is real; it's not merely ‘all in your head’. The key to breaking this cycle lies in altering the narrative around pain. A doctor called Howard Schubiner has developed a therapy which focuses on reprogramming the brain's response to pain.

He describes the pain loops that patients get stuck in, called the ‘6 F’s’:
Fear – scared, helplessness, loss of confidence
Focus – the constant monitoring
Fight – trying to push back, which just gives the pain more ‘power’
Frustration – this creates anger, stress and upset
Figure it out – seeking advice from books, therapists, doctors etc
Fix it – trying to find a solution

Dr Schubiner’s approach is to find a break point in the cycle, and he calls this Pain Reprocessing.

For the person with the back pain situation, it maybe that there is now a fear pattern and avoidance behaviour to ever lifting any kind of weight ever again.

Firstly he suggests visiting a practitioner who understands this approach and can offer reassurance and guidance as to what is the underlying cause of a person’s symptoms, and as Osteopaths we have the ability to screen for ‘red flags’ and have great understanding about the key role the central nervous system plays in the experience of pain.

Secondly he describes the way this person may approach beginning to feel confident about lifting again, and it’s not just creating a progressive exercise program, but actually a progressive brain reprogramming.

To begin this process, and as this person approaches the opportunity to pick up a load again, they may find these steps helpful:

·      Take a few gentle calming breaths

·      Relax the body and release any gripped muscles in the jaw, abdomen or buttocks

·      Allow a smile to spread across your face

·      Tell yourself ‘I am stronger than I think’ or ‘I’ve got this’

·      And keep breathing, smiling and relaxing as you go to lift your load

·      After you’ve lifted your load and realised there is no pain, it’s important to then reflect. Allow your mind to fully process that you are safe, you are strong and you are going to be OK

Sometimes, he says, it really can be as simple as that to begin the pain reprocessing pathways.

However, it can take time. There is a lot of behaviour to unlearn and confidence to rebuild. We can help you on this journey to heal from chronic pain.

If you are interested in learning more about Dr Schubiner’s work you can read his book; Unlearn your Pain, listen to him chatting to Dr Chatterjee on the Feel Better: Live More podcast or watch the documentary Pain Brain.

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Emma Wightman
www.the-sop.com