Chronic Pain

Welcome to Moms in Motion PT’s resource on chronic pain.

Chronic pain is generally classified as pain that lasts for longer than 6 months [1]. There are many possible reasons that pain becomes chronic, and one thought is that there is a problem with how the receptors of the brain and central nervous system interpret the information they receive [2]. Common complaints include headaches, low back pain, pelvic pain, and joint pain associated with arthritis. Some chronic pain has no known cause, but it is just as real and debilitating as pain with a known cause. All pain is real pain, whether or not the cause is known.

Research has shown that women deal with chronic pain longer and more often than men. Women also feel pain more intensely [3]. Therefore it should come as no surprise that women are 1.5 times more likely to have headaches and neck, shoulder, knee or back pain; two times more likely to have oral or facial pain; 2.5 times more likely to suffer from migraines and four times more likely to have fibromyalgia [4]. As previously mentioned, there are many types of chronic pain in various body regions, but this guide will focus on two: back pain and pelvic pain.

Back pain

Back pain is most often caused by an injury. Strain and stress on the back muscles can linger allowing the pain to become chronic. Back pain can also be due to poor posture or repetitive motions.

Chronic pelvic pain

CPP, also referred to as Chronic Regional Pelvic Pain Syndrome (CRPPS), is one of the most common kinds of pain in women. CPP has been associated with dyspareunia (pain with vaginal penetration), depression and challenges with activities of daily life [5]. A thorough work up by your health care provider is essential for uncovering the underlying causes of chronic pelvic pain.  Some of the diverse causes of CPP are:

  • Gastrointestinal conditions like diverticulitis, irritable bowel syndrome (IBS), constipation, inflammatory bowel disease and ulcerative colitis

  • Urinary conditions like interstitial cystitis or urinary tract infection (UTI)

  • Gynecological conditions like endometriosis, chronic pelvic inflammatory disease, pelvic congestion syndrome, ovarian remnant following a complete hysterectomy, fibroids

  • Psychological conditions like depression, chronic stress or a history of sexual or physical abuse

Treatment:

The complexity of chronic pain requires a thorough medical work up to determine the factors contributing to the condition as well as to match the underlying condition with the appropriate treatment. The goals of the chosen treatment may include general pain relief, improvement in function and mobility, and psychological and emotional strategies to cope with the pain. It is also important to prevent secondary musculoskeletal conditions. Months or years of pain can alter muscles, joints, and nerve sensitivity, resulting in changes in posture, strength, and mobility.
The goal of chronic pain treatment is to improve the quality of life of the patient. This might mean giving them the skills to cope with some measure of pain, including sleeping tips, stress-reducing tips, and things that can be done to help them return to more regular activities. Some of the more common treatments for chronic pain include medications, exercise, biofeedback, cognitive behavioral therapy, healthy diet, acupuncture, and physical therapy.

Physical Therapy encompasses many different types of treatment starting with a comprehensive evaluation of your body’s systems, mobility, and functional abilities. Based on those findings, your physical therapist will choose specific techniques and interventions appropriate for your condition. These may include manual therapy to increase range of motion of joints, ligaments and muscles; exercises to maintain strength, flexibility and mobility; postural correction; hands-on soft tissue mobilization; neuromuscular re-education to improve communication between the nervous and musculoskeletal systems. An extremely important intervention you can receive in physical therapy is education about the origins of chronic pain and the brain’s response to pain over time.

Physical therapy as a treatment for chronic pain can be very effective as it encompasses many of the other treatments discussed. It has also been shown that receiving encouragement from a therapist during treatment will increase motivation and ultimately improve results [6]. By working with a Physical Therapist, instead of on your own, you will receive a customized rehabilitation program as well as encouragement and accountability to carry on with the treatment. Working with a highly trained physical therapist gives you a better chance of success.

Moms in Motion PT provides services for Physical Therapy in the Twin Cities Metro Area.

References

  1. Thienhaus O, Cole BE. Classification of pain. In Weiner, R.S. Pain management: a practical guide for clinicians (6 ed.). American Academy of Pain Management. 2002.

  2. Keay KA, Clement CI, Bandler R. The neuroanatomy of cardiac nociceptive pathways. In Horst, GJT. The nervous system and the heart. Totowa, New Jersey: Humana Press. 2000. p. 304.

  3. Kelly JF. Translating research on chronic pain in women to practice. 118th Annual Convention of the American Psychological Association. 2010 Aug; San Diego, California.

  4. International Association for the Study of Pain. Epidemiology of pain in women. http://www.iasp-pain.org/AM/Template.cfm?Section=Fact_Sheets&Template=/CM/HTMLDisplay.cfm&ContentID=4448. Updated Sept 2007.

  5. Kelly JF. Translating research on chronic pain in women to practice. 118th Annual Convention of the American Psychological Association. 2010 Aug; San Diego, California.

  6. Feldman W, McGrath P, Hodgson C, Ritter H, Shipman RT. The use of dietary fiber in the management of simple, childhood, idiopathic, recurrent, abdominal pain. Results in a prospective, double-blind, randomized, controlled trial. Am J Dis Child. 1985 Dec;139(12):1216-8.