In this article, we’re going to look at two different scenarios between acute (short term) back pain and persistent (long term) back pain, and how the nervous system can influence the outcome.
What does it mean?
Acute pain is short-term pain that last no longer than three months and tends to be associated with damage, or possible damage, to your body. For example, if you pull your lower back it is likely you will feel pain associated with the spasm and inflammation. This is acute pain. Usually it will settle as your body heals because the affected part no longer needs protecting. Healing is usually less than three months, even for quite severe injuries.
It may seem strange, but pain can be a good thing. When you first injure yourself, acute pain can help you change what you are doing so you avoid further damage. Without acute pain, a person might keep lifting heavy boxes when the lower back is in spasm potentially leading to further injury.
When we injure ourselves, our nerves carry a lot of information to the brain to make it take notice. In our body there are millions of nerves and they constantly interact with each other. It’s not a one-way street – signals travel up and down constantly.
Your brain – the biggest bunch of nerve cells in the body is really important when it comes to understanding pain. It may surprise you to learn that all pain, no matter where or how it is felt, is produced by the brain. When you injure yourself, it is the nerves’ job is to say to your brain ‘danger – something is happening to your back.’ It is then your brain (and not your back) that interprets this and says to you ‘hey, this hurts!’
In this time your brain also weighs up many aspects of your immediate environment as well as other life factors such as what you do for a job, your personal or cultural beliefs, whether you’ve injured your back in the past or what you are planning to do in the future! Only after sorting through all of this, will it tell you whether your back hurts or not. It does this incredibly quickly and well before we are aware of any pain.
Here’s an example:
Jane hurt her lower back when lifting boxes during her house move. She was sorting through old family photos which reminded her of her late husband who passed away five years ago. It was a stressful time for Jane, as she had lived in her family home for over 30 years. Jane wasn’t sleeping at night due to stress and found she was drinking in the evening to help her relax.
Jane finally came in for Soft Tissue Massage two weeks later after she became frustrated about the pain. Thankfully she responded well to treatment and the pain reduced after one session. She found the treatment relaxing and slept well that evening.
Six months later, Jane had to sort through the unpacked boxes that she had yet to put up into the loft in her new house. Jane became stressed as she was going through photos and old memories of life before she moved. Once again, Jane developed acute lower back pain.
Emotions Vs Pain:
It is also worth looking at how our emotions also impact acute pain.
Nerves work like electrical-chemical computers that send messages up and down the body and when part of the body is injured, messages are sent via the nerves to the brain. The brain then perceives these messages as danger so sends pain down to the affected site.
The natural chemicals released when we are tired stressed, anxious or depressed are very similar to the chemicals released to communicate danger or damage. This therefore can lead to an injured body part being over sensitised, increasing the intensity of the pain.
Why does this happen and what causes these changes? The brain is made up of different sections, each with different main functions. All of these sections are amazingly interconnected and work together as a team. Even seemingly unrelated parts such as those related to smell, movement or feeling emotions can form connections.
Thankfully it works the other way too. The natural chemicals associated with happiness, fun, exercise, touch and satisfaction can relax and desensitise the nervous system. This is a powerful system which some people have likened to a “medicine cabinet in the brain.” By doing these things such as yoga, running or a relaxing hot bath, you can help to prevent the nervous system from being over worked and stressed, helping decrease pain levels.
What does it mean?
Persistent pain (also known as chronic pain) is pain that lasts longer than three months but doesn’t always indicate ongoing damage, even though it may feel like it. In the past we assumed that this was because we had not healed after an injury, but for most people we now know that this is unlikely.
Instead, the pain is less to do with injury in our bodies and more to do with our central nervous system. Persistent pain can take over a person’s life. Nerves do a lot more than just send messages around the body. All of the nerves in our body, including the spinal cord and brain, change in response to what we do and the world around us.
However, pain that remains after three months often has more to do with changes in the nervous system. A lot of persistent pain could be described as ‘unhelpful changes in the nervous system.’ The original injury will have healed as much as it can and although you may still be getting some signals from stiff joints or poor muscle control, the biggest problem is often the over sensitised nerves.
While persistent pain may feel a lot like acute pain, it tends to act differently. Your nervous system responds to normal messages such as touch, cold or movement as if they are dangerous. The nervous system stays alert way after the injury has healed. A little bit of this ‘input’ can lead to lot of pain. Something that might have hurt just a bit, starts to hurt a whole lot more. These are all signs that the problem is changing from one of physical injury to that of an over sensitised nervous system.
Here’s an example:
Dave hurt his back and it hurt to bend. His wife told him that bending was bad for his back and that he must lie down in bed until it gets better.
Eight months later, Dave still has pain, walks stiffly and moves in strange ways to avoid bending. Dave finally try’s soft tissue massage to see if it can help his pain. The interesting thing is that Dave’s back has healed but his brain is stuck in an unhelpful movement pattern that says, ‘it’s not safe to bend.’
Apart from some stiffness in the soft tissues because of the lack of movement, Dave needed to be re-educated that it’s safe to move so he was referred into Physiotherapy. It’ll take time and determination, yet by practicing functional movements and regular soft tissue massage, Dave can retrain his body and brain to allow him to bend normally again.
Now let’s look at ‘fear avoidance’. When the nervous system is sensitised, it is common to experience pain with everyday movements such as walking, bending or twisting. In some cases, even just thinking about a particular movement or activity can trigger pain.
In the same way, when a person repeats a particular movement or activity on a regular basis, the brain creates a pattern of nerve connections. If a movement is painful for long enough the brain will strengthen the connection between movement and pain. It’s like your brain has joined the dots between, the normal sensations coming from your back, the movement of bending, the memory of injury and the experience of pain. This unhelpful pattern can then become sensitised. Once sensitised, just preparing to do that movement may be enough to cause the pattern to kick in and for you to feel pain. The body has healed as much as it’s going to, but the movement still hurts.
Every system in our body gets involved in producing and responding to pain. The way a person experiences pain is influenced by a lot of factors such as our work life balance, health and wellbeing, sleep patterns, diet and exercise and stress levels.
Pain is a problem that can affect your whole life, so effective management needs to take a whole-of-life approach and the way we experience pain is highly influenced by our overall well-being.
Soft Tissue Therapy can help to improve both acute or chronic back pain effectively not only by reducing the initial tightness and tension in the affected area but improves your range of movement too.
It is important that back pain is managed properly and that you don’t leave back pain for too long before being seen by a professional.