Understanding chronic pain
Chronic pain is very different, and does not have the same role as acute pain, which serves as an alarm signal to protect our body.
Pain is an “unpleasant sensory and emotional experience associated with actual or possible tissue damage, or described in terms suggestive of such damage” (IASP, International association for the study of pain). This experience should not be minimized, especially when it can impact every sphere of life. Chronic pain is often accompanied by chronic fatigue, anxiety, depression, psychomotor slowdown, overall physical deconditioning, and social isolation.
Pain is complex and diverse, and has its origins in a number of different mechanisms. A thorough understanding of these mechanisms is essential to guide interventions in the right direction.
Pain description
Nociceptive pain: stimulation of nociceptors in response to tissue damage (unaffected nervous system). Pain may be mechanical (e.g. musculoskeletal injury) or inflammatory (e.g. arthritis attack) in origin. Loss of muscle strength and joint amplitude, loss of endurance on exertion, etc. are common.
Neuropathic pain : the result of injury or disease to the somatosensory nervous system (peripheral or central). Nerve signals become disrupted, generating abnormal sensations such as tingling, burning, electrical discharges, numbness, tingling, etc. Movements remain difficult to perform despite the injury. Movements remain difficult to perform despite the maintenance of muscle strength and joint amplitude.
Nociplastic pain: Unlike the two above, nociplastic pain is not directly linked to identifiable nerve or tissue damage. It results from an alteration in the central (brain) pain-processing system. Neuroplastic changes in the brain alter the way pain is perceived, leading to increased sensitization. Medications used to treat pain are not very effective. Damage is widespread and changeable. This pain demonstrates the link between body and mind, because just as mechanical effort can trigger pain, so strong emotions (stress, sadness, intense joy) can also amplify it.
Explanation of the "wicket door" effect
When referring to the pain mechanism, one speaks of the wicket door. In fact, in the spinal column, there is a wicket gate (= dorsal horn) which acts as a barrier to let painful messages through or not.
When pain messages are too numerous and intense, the gate has difficulty fulfilling its role, and so the painful message makes its way to the brain, where modulation (neuronal plasticity) takes place.
Each individual can contribute factors that help to close the gate and thus reduce pain intensity: active energy management (rest/activity), intense concentration/distraction, experience of flow (pleasure in performing an activity, medication, etc.).
Benefits of interdisciplinary interventions
Collaboration between various healthcare professionals, such as kinesiologists, occupational therapists and physiotherapists, enriches our holistic approach.
The occupational therapist’s approach is based on an in-depth understanding of the specific mechanisms of each type of pain and their functional impact. Interventions are tailored to promote self-management of pain and improved quality of life. By combining their skills, we approach pain from a number of angles, promoting complete adaptation to this chronic condition.
- Adaptation of your occupational schedule: review your operating schedule over the course of a week, with the aim of maximizing your performance and satisfaction with your occupations (ranging from personal care to leisure and work).
- Enriching your pain self-management strategies: there are many different methods, and the more of them you use, the less impact your pain will have. For example: managing the impact of emotions on pain, relaxation techniques, postural hygiene, activity adaptation, energy management, etc.
- Integration of physical approaches: resuming adapted physical activities to develop physical fitness and endurance and improve well-being.
- Reduction of Aggravating Factors: Close coordination enables aggravating factors to be identified and dealt with effectively, optimizing intervention results.
- Comprehensive Education: Together, we provide in-depth education on chronic pain, equipping our customers with essential knowledge for their daily self-management.
In addition to medication, approaches such as motor imagery and mirror therapy can be used to try to teach the brain to process information and transform the processing of stimuli that trigger neuropathic pain. Dr. Murielle Grangeon, PhD, the founder of Neuro-Concept, has written a book on the use of motor imagery with neurological clients. Mirror therapy is a rehabilitation therapy in which a mirror is placed between the arms or legs so that the image of a moving unaffected limb gives the illusion of normal movement in the affected limb. Through this configuration, different areas of the brain for movement, sensation and pain are stimulated.
Explore solutions for your chronic pain with our trained pain management team. Contact us to find out more about our individualized approaches and interdisciplinary interventions. Your pain is a personal experience, with a sensory as well as an emotional component. It is present on a daily basis and its expression is strongly influenced by our life baggage (life experiences, genetics, cultures, etc.).
Resources available for people living with chronic pain:
https://gerermadouleur.ca/