Hurt Does Not Equal Harm: Take-Home Tips for Understanding and Managing Your Pain

Pain is a common experience shared by all human beings. It’s the body’s natural alarm system which is produced by the brain and occurs in response to a perceived threat. This means that pain is not only normal, but necessary for survival. However, as most of us know, suffering from pain has the potential to be very disruptive to daily life. But what many don’t realize is that pain, especially pain that persists for long periods of time, is extremely complex. Factors that impact pain include physiological stress (i.e. muscles, bones, ligaments, and nerves), emotional and psychological stress, sleep hygiene (i.e. amount of sleep, quality of sleep, and regularity of sleep pattern), past experiences with injuries or pain, and beliefs about pain and recovery. For this reason and many others, everyone experiences pain differently and will have different ways to manage pain for different situations.
As you may have heard in the media, the U.S. is currently in an opioid epidemic as a result of increased prescription and abuse of pain medications. This is because opioids have been found to be highly addictive which can lead to overdose and death if used improperly. Luckily, there are many ways in which pain can be managed without using pain medication. Your physical therapist can help you better understand and manage your pain. Here is a testimonial from a previous patient about her experience with managing her painful condition at our facility:

“Over the past 20 years, I have suffered with painful lower back pain, sciatica and shoulder issues. I have sought treatment from countless physical therapists and orthopedic surgeons. Along with the enduring physical pain, I developed a fear to pursue activities that I enjoyed; I was worried that exercise could worsen my condition. At the evaluation appointment, I expressed fear, hopelessness and skepticism about undergoing more physical therapy treatment. However, soon it became clear to me that this experience would be different because Tori was different than what I’ve ever experienced. She was patient, encouraging and pushed me beyond what I thought I could accomplish. I’ve never been treated and taken care of with so much one on one care. I’ve never been consistent or motivated with PT exercises, however, this time I was. I benefitted from being educated on correct lifting techniques and form applied to my weight training at the gym, backyard gardening, lap swimming, daily living activities, and even mastering stairways! I am for the first time in many years finally not fearful of pursuing my preferred active lifestyle.”

– Emma

You, too, are capable of taking back control of your life with pain management strategies individualized to you. Below are some take-home tips to help you get started.
1. Understand that pain does not always equal harm or tissue damage. As previously mentioned, pain is complicated. And in many cases, it isn’t a direct reflection of the health of our body’s tissues or structures. Your physical therapist can help you identify various factors that may be contributing to your pain experience and can help guide you through movements that will help you get back to your daily life. If you’re feeling stuck or are interested in learning more about your pain, your physical therapist may introduce you to the “Why Do I Hurt? Workbook,” an interactive and evidence-based booklet created by Dr. Adriaan Louw, PT, PhD, that can further help you understand and lessen your pain. The following quote is from a previous patient who utilized the workbook:

“Dr. Tori Williams helped me work on a painful hip problem that had been preventing me from exercising and interfered with sleeping well. The physical therapy did the trick, however at one point I felt like progress had stalled and I was frustrated. I was getting stronger and could move much better, but the pain kept flaring up. Tori suggested that the Why Do I Hurt Workbook might give me some insight on the problem. The Workbook provided the missing pieces of the puzzle. It helped me put it all together and move past the pain cycle. I learned that the tissue problem is only one part of the equation. My history, emotions and attitudes were me keeping me in the pain cycle. Once I began to work on some of those things, combined with the PT and exercise I was able to easily move forward and move out of the pain cycle”

– Pat

Another patient who has used the workbook had this to say about what he learned:

“It helped me understand how personal emotions and the fear of pain can cause pain. Now I realize how physical activity can help mitigate the pain and strengthen me both physically and mentally. I don’t focus on the pain when I am physically active and the book taught me the importance of that.”
– Steve

2. Find your favorite relaxation techniques. As previously mentioned, pain occurs in response to a perceived threat. This can come in many forms and can be compounded by physical, emotional, and mental stress. Relaxation techniques such as deep breathing, meditation, listening to music, and soft tissue massage can be helpful in managing stress and turning down the body’s natural alarm system. Taking as little as 5 minutes of each day to devote to relaxation can be beneficial to decrease pain and stress over time. One evidence-based strategy for calming your nervous system is using the 4-7-8 breathing technique which involves breathing in through the nose for 4 seconds, holding for 7 seconds, and exhaling through the mouth slowly for 8 seconds.

3. Keep moving. Research has shown that just a single bout of light aerobic exercise increases the production of the natural opioids produced by your body, called endogenous opioids. These are well-known to reduce anxiety, enhance mood, and aid in pain relief. So if you are able to move around, it’s always a good idea to work up a little sweat by going for a walk, jog, bike ride, or participating in other physical activities that you enjoy. If you’re concerned that movement might make your condition worse, your physical therapist can provide reassurance and help you determine which exercises and at what intensity and duration are appropriate and individualized to you. Movement is medicine!

4. Establish healthy sleep habits. Sleep is crucial for daily functioning and has been shown to have effects on how your body processes and perceives pain. This means that if you don’t get adequate sleep, you may experience increased pain, reduced quality of life, and a whole host of other negative effects. Try going to bed and waking up at the same time every day to help set your body’s natural biological clock. You should also try to block blue light before bed, which has been shown to disrupt the ability to fall asleep and stay asleep. This includes the light from your cell phone, television, or tablet. (Tip: Most smart devices now have blue light screens/off switches which can be manually or automatically turned on at night.) Lastly, make your bed a sacred sleeping place; try not to do anything in your bed other than sleep and sexual activities.
If you are struggling with pain, know that you are not alone and there is hope. Our qualified physical therapists at North County Water and Sports Therapy Center can help you establish an individualized plan to manage your pain.

Tori Williams, PT, DPT

References:
1. Louw, A. Why Do I Hurt? Workbook. Orthopedic Physical Therapy Products; 2016.
2. Goyal M, Singh S, Sibinga E, et al. Meditation Programs for Psychological Stress and Well-being: A Systematic Review and Meta-analysis. Deutsche Zeitschrift für Akupunktur. 2014;57(3):26-27. doi:10.1016/j.dza.2014.07.007.
3. Hannibal KE, Bishop MD. Chronic Stress, Cortisol Dysfunction, and Pain: A Psychoneuroendocrine Rationale for Stress Management in Pain Rehabilitation. Physical Therapy. 2014;94(12):1816-1825. doi:10.2522/ptj.20130597.
4. Ambrose KR, Golightly YM. Physical exercise as non-pharmacological treatment of chronic pain: Why and when. Best Practice & Research Clinical Rheumatology. 2015;29(1):120-130. doi:10.1016/j.berh.2015.04.022.
5. Siengsukon CF, Al-Dughmi M, Stevens S. Sleep Health Promotion: Practical Information for Physical Therapists. Physical Therapy. 2017;97(8):826-836. doi:10.1093/ptj/pzx057.
6. Louw A, Puentedura EJ, Zimney K, Schmidt S. Know Pain, Know Gain? A Perspective on Pain Neuroscience Education in Physical Therapy. Journal of Orthopaedic & Sports Physical Therapy. 2016;46(3):131-134. doi:10.2519/jospt.2016.0602.