Understanding Pain & Associated Symptoms

Understanding Pain

All pain is real – but a lot of pain is not dangerous even though it feels it. Understanding your pain is helpful for your recovery.

Osteopaths are highly trained to diagnose the cause of your pain, understand how it affects you and work with you through treatment and advice about the best course of action to aid your recovery.

Acute Pain

This is pain that has been there for less than three months. Acute pain can occur as the result of an injury. If this pain comes on as the result of an impact, such as a fall, then it will often be accompanied by some tissue damage. A sprained ankle for example.

A lot of acute pain however, such as a muscle spasm, can occur without any tissue damage and therefore can be seen more as a danger signal. It is a warning to stop us going on to do something that will cause tissue damage.

Usually even with tissue damage, the damaged tissues will have healed by 3 to 6 months post injury and the pain will have reduced to almost nothing.

However, in some people pain comes on with no injury or persists 6 months beyond injury. At this point it is described as Chronic or Persistent Pain.

Chronic Pain

This pain feels as severe as the tissue damage pain but it is not related to any specific tissue. It is being produced as an output from the brain (as all pain is) and is a Neuropathic or Neural Pathway Pain. Chronic neuropathic pain is similar to the pain suffered by people with phantom limb pain. The brain and nerve pathways are producing pain as they have got stuck in this pattern.

Chronic pain can be variable in its intensity and it can move. One day it is in the low back and the next it is in your knee – or both and your shoulders, feet, stomach and head! Pain often does appear in an area where we have had a previous injury which can make it feel like the tissues must still be damaged but this is due to pain neurotags. A series of brain and spinal column interconnected neurones that were triggered when an area was originally injured. Chronic pain is incredibly frustrating and is often accompanied by a variety of other symptoms; fatigue, irritable bowel, anxiety or insomnia to name just a few. Read on to see the full list of associated symptoms.

The reason for the diversity of the pain and other symptoms is due to chronic pain being linked to central sensitisation. This is probably best described as an overwhelm of the central nervous system.

When the nervous system is overwhelmed it goes into high alert or a fight/flight type response which the body perceives as danger. If the body feels under threat it affects all the different systems; the nerves, the hormones, the gut, which is why each person can have such a different array of multiple symptoms.

The overwhelm can be caused by many different factors – stress, previous injury, previous trauma or emotional trauma, self-induced pressures, lack of sleep – and it produces real pain with no tissue damage. Ongoing pain and other symptoms become a stress in themselves which increases the load.

Getting those around you to understand your pain can be quite challenging so learning as much as you can about your pain will not only help you, but them as well, to see why it can be so diverse and variable. We have included some resources in our useful resources section from Lorimer Moseley and the curable health app that also help explain.

Chronic or persistent pain can manifest as any of the following:

  • Pain in the back, neck, joints, limbs, muscles
  • Plantar fasciitis
  • Chronic tendonitis
  • Muscle spasms
  • Piriformis syndrome
  • Sciatica
  • Complex regional pain disorder
  • Carpel tunnel syndrome
  • Shoulder pain
  • Tension headaches
  • Temperomandibular pain (jaw pain)

….and this is why it sometimes takes a long time to get a chronic pain or fibromyalgia diagnosis as it has been diagnosed as 18 different conditions before someone puts all the pieces together.

Pain can feel like it is occurring in any of the musculoskeletal structures of the body – muscles, tendons or ligaments.

Symptoms can also manifest in the nervous system causing tingling, pins and needles, itching or burning sensations, and even brain fog.

Associated Symptoms

Some of the most common symptoms alongside musculoskeletal pain are:

  • Extreme fatigue
  • Headache/Migraine
  • Irritable bowel
  • Irritable bladder
  • Insomnia or sleep disturbance
  • Restless legs
  • Overwhelm
  • Altered mood
  • Brain fog
  • Weight gain
  • Anxiety

Anxiety and Overwhelm

Anxiety or overwhelm accompany many long term symptoms including chronic pain. We often don’t realise that they are a key part of the picture. It may manifest as a strong symptom such as panic attacks or more subtly as sleep disturbance and brain fog.

Anxiety can be as a result of a specific incident or long term stress. It can make the pain symptoms worse which in turn heightens the anxiety and this then perpetuates the vicious cycle.

In most people with long term persistent pain there is an element of overwhelm that produces a generalised tension and ‘fizzing’ within the tissues of the body.

Often what we think of as purely physical symptoms, such as pain and stiffness, are actually strongly connected to an emotional event (or the emotional reaction to a physical event) that can have occurred as far back as childhood. This event, or series of events, causes a heightened state of alertness in the fight/flight response controlled by the amygdala in the brain. Once the brain is in persistent panic mode it only needs a small ongoing stress or a triggering event to cause the overwhelm that eventually manifests in the body as symptoms such as pain or panic attacks. This is the body’s way of trying to slow us down and remove us from the threat. In the past this would have been escaping from a lion but now the same effect can be caused by social media… the brain doesn’t always know the difference between small or large threats.

In everyday life, people in social or work situations become triggered because their actions are unpredictable and can’t be controlled and we find that often chronic pain sufferers end up withdrawing from friends, family and work.

Keeping busy to distract yourself from the uncomfortable feelings, which is easy to do, also perpetuates the cycle.

Anxiety is often one of the parts of chronic illness that is hardest to talk about. It is often much easier to talk about the pain but addressing the anxiety and overwhelm can make a huge difference to recovery.

Osteopathic treatment can help to reduce the physical symptoms of pain discomfort and stiffness and also can help break the physical side of the anxiety cycle. Our osteopaths are trained to help you to recognise and identify what might be the past or present triggers. Usually we are able to help reduce the anxiety symptoms, but if required or requested, we will find you some further appropriate support.

The Meditation, Breathing Techniques, Tapping and Tai Chi/Qi Gong areas of the toolkit have been included as they are an effective way to start decreasing the overwhelm.

Select what feels right for you.

Full List of Possible Stress Related Conditions - SIRPA

Other Key Knowledge Toolkits

You may be interested in our other ‘Key Knowledge’ chapters within the Mindbody Toolkit: