It sounds obvious
You may have thought that pain is just an electrical signal
Back in biology class at school, you may have been taught that pain passes as an electrical signal up through the nervous system, in order to get the body to move away from the source of pain. More recent work has proved that even the electrical components of this are more complex (Pain Gate theory), as well as the fact that there is a chemical cascade that is set into motion by the nociceptors (the scientific word for the sensory receptors for painful stimuli in the nervous system). The nociceptors release Substance P and this triggers a release of histamine. Both of these chemicals are neurotransmitters, and the histamines are also involved in the inflammatory response.
The bad news is that these two chemicals have additional impacts – they increase the sensitivity of the nociceptors to pain, and the excess histamine has been linked to increased anxiety in the brain and inhibiting the release of serotonin and dopamine (classic feel-good chemicals in your system).
So if you get into long-term pain, the chemical soup is working against you
Once you are into the chronic pain (pain that has lasted more than 3 months), you are likely to become more sensitive to pain for these chemical reasons. You can start to hurt in new places. And of course the impact on your mental coping strategies for the pain, and the loss of sleep can lead to irritability and depression.
This is why sometimes the medical team talk about taking blood tests to understand the levels of your inflammatory markers, in order to understand your situation better. On the basis of the imbalances (deficiencies or excesses) of neurotransmitters such as serotonin, GABA, dopamine and norepinephrine, the clinician can develop the right treatment plan for you.
How chronic pain can link to depression
Depression and chronic pain share some of the same pathways in the central nervous system of the brain and spinal cord, and the same chemical transmitters are involved.
In addition to some of the chemical reasons why chronic pain can make you feel very low, there is another negative cycle – pain creates anxiety, irritation and agitation in everyone. This tension and stress on your system , which can cause sleeping issues, physical incapability, loss of appetite and a sense of not being able to cope with all of the other issues.
Articles suggest that perhaps half of people who complain of pain to their Doctors are depressed. And depression makes pain feel worse. This in turn is even more depressing.
If you are worried that you have a lot of the symptoms of depression, do talk to your GP about it. Hopefully this blog has set up that a combination of the chemical and physical realities are the reason that people end up in this place. And hence a combination of medication and Cognitive Behavioural Therapy (also known as Talk Therapy) can help .
This is why you need to break the cycle
I found this excellent Pain Management guide from NHS Ayrshire and Arran – with full recognition of the excellent work from the NHS team there. I think that you may find working through it is a breakthrough for you.
Within it, I would strongly recommend that as an injured athlete you turn to the section on ‘Managing Activity’, which starts on page 22. Mapping your activity and pain cycles may seem a little difficult, but if you keep some notes over a few days and then draw them out as a graph over time the patterns become very clear. Are you yo-yo-ing through an Over-Under cycle? Or pushing too hard with an Over cycle? (You can read more about these on pages 22 and 23).
You have got to get your activity down to a sustainable level
Whilst you may find these low levels utterly ludicrous and frustrating, you must give your body the chance by getting your activity down.
This means looking at your day and:
- Planning – not going on feel and overdoing or underdoing it
- Prioritising – you will not be able to do all of the things that you want or need to do, so prioritising will help you choose
- Pacing – breaking things into more manageable chunks with more rest
This should help to avoid flare-ups, but they can still happen. So you also need to have in mind your plan of how to avoid them, and then how to minimise the impact and calm the system down again. For instance, if you go out – can you take a car or have the numbers of friends who might be able to pick you up if you need to get home quickly to manage a flare-up in pain levels.
You will have your own pattern of what causes flare-ups and how you can manage them. But having a plan can reduce the number and impact of flare-ups. (There are also some good worksheets in the booklet on pages 29 and 30 for this).
So in summary, don’t keep pushing through as the challenge of getting out of pain will only increase. There are things that you can do and it is both the right goal, and an achievable goal to get out of pain – even if you have to involve your GP and other clinical support.
Best of luck in your journey to pain-free!