chronic back pain

Pain is pain? Yes and no…

We’ve all experienced pain. Some time’s the pain just doesn’t go away. If pain is there for more than a month or so it is often called Chronic pain. Chronic pain is less about an injury, and more about you brain.

To understand more, lets look at the experience of pain.

Why is it that the same pain sometimes feels worse than other times? The classic example is if you roll your ankle. Most of us have done this at some stage. It hurts. A lot. Often you can’t walk on it immediately afterwards. However, what if you were hurrying to cross a busy street and you rolled your ankle? Would you stop and sit down in the middle of the road? Of course not. You’d hobble off the dangerous road before you stopped to address your injury. So how can you do this when you are in “so much pain?” Because you don’t experience the pain at the same intensity at the same time because of what other things your brain is processing. It just isn’t important enough (at that moment).

Pain – well the experience of pain is caused by your brain in your head, but it is very real.


The brain constantly assesses all the information from millions of nerves through the body. After processing this information it decides what you will ‘experience’. The information includes;

  • You and your physical make up (anatomy, physiology, hormonal etc.)
  • Previous experiences – of pain but also of life.
  • Education and understanding levels
  • Current location and situation
  • Current mood level of stress
  • Myriad of other factors

The brain then decides how best to act. It may decide that you are in mortal danger and fire a long and consistent alarm making you experience a lot of pain in order to change your behaviour and protect yourself (such as putting your hand into a fire).  Or it may decide that you’re actually not too bad at the moment and you can just get on with your day.

Your brain determines how loud and long it will ring the alarm for the pain experience.

It is important to note that the severity of an injury and severity of pain are not correlated. You can have significant injury to tissue and experience minimal pain and the reverse. Imagine that paper cut! So small yet so painful! Now remember that bruise on you arm that you have no recollection about getting.

So what about memory of pain?

Dr Lorimer Mosely  world renowned pain scientist tells a great story about an incident with a snake. So he was bush walking one day and enjoying the sunshine, company of friends and the amazing surroundings of an Adelaide national park. Suddenly he stepped on a stick which flicked up an whacked him in his shin. It really hurt but hey a hit in the shin with a sharp stick does hurt right?! However, very quickly a companion noticed that it was in fact a Brown snake – the most venomous snakes in the world. Panic settled in and suddenly the pain was excruciating! The next few hours of getting medical help were extremely stressful and the pain continued. He could ‘feel’ the poison travelling through his blood. The ‘what if’ became overwhelming! He survived and thankfully made a full recovery and returned to bush walking.

However the next time he was walking and talking on the trails and he stepped on a stick which flicked up and hit him in the shin, what do you think happened?

He immediately went into blind panic. The memory of the snake bite was really and he was sure that it was happening again. The pain was excruciating. Until his friends said “It’s OK mate, it’s just a stick”.

Previous experiences can bias the brains response

Thats the power of the mind. Because of the previous experience your brain is capable of sending off an exaggerated alarm excessive of the actual threat to you. Unless you are able to tell the brain “it’s ok I’m not under threat” that alarm can continue to ring too loud and your experience of pain can be excessive.

How does this apply to me?

There are so many other examples just like this. You may have one of your own? Have you ever had major pain, say in your back which took you a long time to get over? Then some time later you hurt your back again and immediately thought “Oh no, I’ve done my back again”. Your brain is relying on the previous experience to determine how much danger you are in. It may be a completely different injury or not even an injury at all. Studies done on people with chronic low back pain have shown they are infinitely more sensitive to light touch on their painful side (of their back) then they are on the other side.

The problem with this excessive alarm response is that if it continues for too long you may start to alter your activity levels and thought processes. The brain then becomes further sensitised requiring less and less to trigger the ‘alarm’. This is what we see in patients with Chronic Pain.

A major management goal for people with Chronic Pain, is to turn down the alarm response.

How can we turn down the alarm?

Vital Core Physiotherapists assess each person to determine what their pain is stopping them from doing. What are their goals? Do they want to get back to walking around the block? Caring for grandchildren? Travelling over seas?

Goal focused management of chronic pain is essential for success

By refocusing on goals we can remove the word ‘pain’. By assessing each person individually and determining where they are weak, strong, stiff or mobile, we have a focus that is away from ‘pain’. We can gradually decrease the brains expression of pain by focusing on a management plan that has clear goals.

What about exercise?

Exercise performed carefully and accurately can have a positive influence on the experience of pain. By moving and NOT experiencing pain we teach the brain that we CAN MOVE without pain.

Exercise strengthens the body and encourages normal movement. These movements are sent as signals to the brain, which in turns says that “Yes you can move without pain”.

Exercise causes the release of hormones that promote a feeling of well-being. A positive and calm mind has an increased ability to dampen the experience of pain.

At Vital Core we have a large number of exercise classes that can help sufferers of pain. Please have a loot at our timetable.

Please speak to your Vital Core Physio about how we can help you achieve your goals and decrease your sensitivity to pain and get you back to doing what you love.