Fight Back When Pain Keeps You From Doing Stuff
Chiropractor in Amarillo TX talks about fear avoidance and hurt vs. harm
Pain can be a great equalizer. When the biggest baddest athlete gets hurt, they are reduced to being just a regular human. Almost immediately. This does not even begin to approach the effect pain can have on regular folks like grandparents and parents just making their way through life. Not only can it be frustrating, to say the least, but it can be life-changing if we allow it.
Not only can pain hurt physically, but pain can also affect us mentally. It can lead to depression and cause us to withdraw from the activity and from our lives. The consequences of this behavior can be severe and concerning.
Today, I want to give you some general ideas and thoughts concerning pain and things we can all do to fight back against what can potentially be devastating effects as a result:
Bed Rest vs. Movement
Years ago, it was normal for a healthcare professional to tell a patient suffering back pain to go home, take these muscle relaxors and pain killers, and lay up in bed for a few days or so. These days have fortunately gone the way of bloodletting to let the spirits out and using leeches.
Think about when a patient has an appendectomy, their gall bladder removed, or gives birth; the hospital staff has them up and walking the halls the very next day. Sometimes the same night of the procedure! This is because MOVEMENT IS HEALING. They have shown through quality research that those going on bed rest or engaging in inactivity are much slower to heal and their ultimate healing is less robust or complete.
On the other hand, those that engage in movement and activity as quickly as possible heal better, and they heal faster.
For example, hurt workers don't like to hear this but, in general, the sooner one can go back to work (even if it is light duty) heal better and they heal faster. Not only physically but also mentally.
Ultimately, it is best to move. Hurting on a significant level can be exhausting and it is OK to lay down or sit down and get some rest. Just do not stay there. Get up and walk around the house. Walk to the mailbox or the end of the driveway. Do hip circles clockwise and counterclockwise. Whatever it may be that you can do, just move. You will feel better and you will heal faster and more completely.
Hurt vs. Harm
Sometimes, especially when you hurt when just sitting still, the thought of movement or exercises can be daunting. Then, when you get to moving, it hurts. This can absolutely kill the need and initiative to move. For that reason, there is a key concept. It is the concept of 'Hurt vs. Harm'. When we are doing something new, especially in an injured state, the things we are doing are typically going to hurt on some level. But that does not mean the 'hurt' we feel is necessarily 'harmful'.
In fact, movement is rarely going to be harmful. It is important to separate the two as 'hurt' does not equal 'harm' and moving and exercising through the hurt is vital to recovery. Allowing the 'hurt' to prevent us from activity and movement leads to more profound Fear Avoidance which can be a game-changer for the worse.
Everything we have talked about previously leads us to this point; fear avoidance. Fear-avoidance is when pain sufferers begin avoiding activities they love and enjoy because they are afraid the activities will hurt or aggravate their pain. While we picture pain as something that affects us physically, once again, it can be as much a mental game as a physical one.
There is even a Fear Avoidance Model in the research literature and it goes a long way toward explaining how some engage in the process of recovery. They continue their independence without negative thoughts about their pain which leads to acceptance of the pain and ultimately a faster recovery from the pain. On the other hand, it also explains how patients can slip into a downward spiral or cycle. This can be initiated where a patient misinterprets the pain and catastrophizes it. Meaning, they make a bigger deal out of it than it really is. This harmful or negative thought process about pain can lead to pain-related fear and behaviors that seek to keep patients safe. This means they start avoiding things they think may harm them or at least aggravate the pain.
I called this a downward spiral because avoiding activities you love leads to a loss of enjoyment in your life. That leads to depression. There is a clear link between chronic pain and depression and fear avoidance and loss of enjoyment. Not only that but after a person slips into fear-avoidance for just 7-10 days, they will begin experiencing deconditioning. Meaning they will begin losing abilities, strength, and conditioning they enjoyed while pain-free. It is hard to re-condition but deconditioning can happen fairly rapidly.
Now, instead of simply having pain, once fear-avoidance begins, a patient now has pain that is compounded by loss of enjoyment, depression, increased pain, deconditioning, and a much longer recovery process. If a patient were not already in chronic pain, well they certainly are now.
Chronic Pain And The Sensitized Central Nervous System
Pain can turn chronic and much harder to treat after only 3-6 months. We always think our pain will just resolve and go away on its own. For that reason, we put off treatment. Then one day we look up and we have been hurting for 3-6 months and now it's chronic and much more difficult to treat and resolve. This is a HUGE topic that is well beyond the aim of this article but, in short, chronic pain is partly due to a sensitized, or upregulated central nervous system. The longer pain persists, the more of that pain will also begin to reside within the brain. The brain holds onto that pain to create your future pain experiences and to prevent you from more pain by using your pain experiences as protection mechanisms.
I'm starting to get a bit off into the weeds here so let me give you an example. The perfect example is the curious case of Phantom Limb Pain (PLP). If you do not know what that is, please Google it. In short, it is when an amputee has an arm or leg cut off yet still experiences pain in the amputated limb. How can a limb that no longer exists still hurt? The explanation is a simple one. Part of the pain existed in the brain. At least as much (and maybe more) than actually existed at the site of injury. The physical aspect of the injury was treated. In fact, it was completely cut off!! But the cognitive, central nervous system part of the pain was not treated. As a result, the patient's pain still persists.
This does not just happen in those that have an amputation. When a patient presents to the clinic and has had pain in their back or neck for more than 3-6 months, part of their pain has started to simultaneously reside within the brain itself.
Part of treating this type of pain is movement. Movement, even when it hurts but is not harmful, builds confidence. confidence not only in a patient's current situation but also in a patient's perception of their future and their future ability to be able to get out of pain and move on beyond being in pain all of the time.
Another aspect of treating pain that is also living in the brain is through Cognitive Behavioral Therapy (CBT). CBT is now recommended as first-line therapy for chronic back pain by the American College of Physicians as is spinal manipulative therapy, exercise rehabilitation, acupuncture, heat, low-level laser, and massage. We are not licensed in CBT but do have ALL of the other therapies mentioned available here at Creek Stone.
At the end of the day, pain can be conquered through determination, consistency, commitment, movement, and recognizing that long-lasting pain must be treated as much mentally as we treat it physically.
Dr. Jeff Williams, DC, FIANM is a Fellowship-trained Neuromusculoskeletal specialist and chiropractor in Amarillo, TX. As an Amarillo chiropractor, Dr. Williams treats chronic pain, disc pain, low back pain, neck pain, whiplash injuries, and more. Dr. Williams is also the host of The Chiropractic Forward Podcast (https://www.chiropracticforward.com). Through the podcast, Dr. Williams teaches fellow chiropractors and advocates weekly for evidence-based, patient-centered practice through current and relevant research. If you have any questions for Dr. Williams, feel free to email at [email protected] Learn more about Dr. Williams and his practice at https://www.amarillochiropractor.com.
Dr. Williams was voted Best Chiropractor In Amarillo in the Best of Amarillo 2020. Dr. Williams's full-time Amarillo chiropractic practice is Creek Stone Integrated Care at 3501 SW 45th St., Ste. T, Amarillo, TX 79109. If you are searching for a chiropractor near me, Dr. Williams is your Amarillo Chiropractor.