One of the most common feelings associated with chronic pain is fatigue and this feeling of fatigue can be overwhelming. People with chronic pain may report a lack of energy and motivation to engage with others or the world around them.
In fact, a study from the UK of people with long-term health conditions found pain and fatigue to be the two biggest barriers to living an active and meaningful life.
But why the long lasting pain? One clue is the nature of pain and its powerful influence on our thoughts and behavior.
Short-term pain can protect you
The modern way of thinking about pain emphasizes its protective effect – the way it gets your attention and forces you to change your behavior to keep that part of your body safe.
Try this. Gently pinch the skin. As you increase the pressure, you will notice the sensation change until, at some point, it becomes painful. It’s the pain that stops you from squeezing harder, right? In this way, pain protects us.
When we are injured, tissue damage or inflammation makes our pain system more sensitive. This pain prevents us from mechanically lifting the damaged tissue as it heals. For example, the pain of a broken leg or a cut on our leg means that we don’t walk.
The concept that “pain protects us and promotes healing” is one of the most important things people with chronic pain say they learn that help them recover.
But prolonged pain can protect you
In the short term, pain does a good job of protecting us and the longer our pain system is active, the more protective it becomes.
But constant pain can overprotect us and prevent recovery. People who suffer from it are called “hypersensitivity of the pain system”. Think of this as your pain system on a red alert. And this is where the fatigue comes.
When pain becomes a daily experience, triggered or amplified by various activities, contexts and cues, it becomes an ongoing resource. Living with pain requires a lot of effort and constant effort, and it wears us down.
About 80% of us are lucky enough not to feel pain, day after day, for months or years. But take a moment to imagine what it would be like.
Imagine having to concentrate hard, to gather energy and use distraction techniques, just to do everyday tasks, let alone to complete work, care or other tasks.
When you’re in pain, you have a choice about what, and how, to act. Consistently making these choices requires thought, effort and strategy.
Talking about your pain, or explaining how it affects your every moment, task or activity, is also tiring and difficult to do when no one else can see or feel your pain. For listeners, it can be boring, debilitating or worrying.
No wonder the pain is exhausting
In chronic pain, not only the pain system is on the red alert. Increased inflammation in the body (immune system in red alert), disrupted cortisol hormone output (endocrine system in red alert), and stiff and guarded movements (motor system in red alert) also accompany chronic pain. .
Each of these adds to the tiredness and fatigue. So learning how to manage and cope with chronic pain often involves learning how best to manage over-activation of the system.
Lack of sleep is also a contributing factor to fatigue and pain. Pain causes sleep disturbances, and sleep loss causes pain.
In other words, chronic pain is rarely “just” pain. It’s no wonder that being in pain for so long can be overwhelming and exhausting.
Is it really possible?
People with chronic pain are stigmatized, dismissed and blamed, which can lead to them not getting the care they need. Persistent pain can prevent people from working, limit socializing and affect their relationships. This can lead to a downward spiral of social, personal and economic disadvantage.
So we need better access to evidence-based care, with high-quality education for people with chronic pain.
But there is good news here. Modern treatments for chronic pain, which are based on gaining a modern understanding of the biology underlying chronic pain, help.
The key seems to be recognizing, and accepting, that the hypersensitive pain system is a key player in chronic pain. This makes a quick fix very unlikely but a program of gradual change – perhaps over months or even years – is promising.
Understanding how pain works, how chronic pain becomes overprotective, how our brains and bodies adapt to training, then learning new skills and strategies to retrain our brains and bodies, offers science-based hope; there is strong supporting evidence from clinical trials.
Every bit of support helps
The best treatment for chronic pain requires effort, patience, perseverance, courage and often a good coach. All in all it is an incredible proposition for the already exhausted.
So, if you are in the 80% of the population without chronic pain, think about what you need and support your colleagues, friends, spouse, children or parents on your journey.
Michael Henry is a physiotherapist and PhD candidate, Body in Mind Research Group, University of South Australia
Lorimer Moseley is Professor of Clinical Neurosciences and Foundation Chair in Physiotherapy, University of South Australia
(This article is republished from The Conversation under a Creative Commons license. Read the original article here)
Published – 21 September 2024 14:26 IST