Vivir con dolor crónico: consejos de afrontamiento desde el fisioterapeuta

Much of the time, pain is unpleasant but at least it serves a purpose: It alerts you to an injury, infection, or another problem that warrants your attention. Once the root issue is attended to, the pain should resolve. But what if it doesn’t?

This is what happens in the case of chronic pain, which affects an estimated 30% of people worldwide. Chronic pain is typically defined as pain that persists for at least three months. In some cases, it stems from an ongoing condition like arthritis. In other cases, the pain persists well after an injury (like a broken bone or infection) has healed. And in the most frustrating of instances, chronic pain occurs for no clear reason at all.

No matter what your symptoms of chronic pain are or how they impact your life, living with chronic pain is often stressful, upsetting, and frustrating. While you might be hoping to find one single remedy that will give you relief, pain management likely requires a multifaceted approach, which is exactly what Hinge Health physical therapists offer members with chronic pain. Read on to learn more about chronic pain and find out how to feel better with tips from our Hinge Health physical therapists.

What causes chronic pain 

In recent years, scientists have learned more about chronic pain, and it’s become clear that it’s quite complex. “A lot of chronic pain has to do with central sensitization, which is a hyperactivity or increased vigilance of the central nervous system,” says Caitlin Shaw, PT, DPT, a physical therapist at Hinge Health. In other words, your body might be perceiving relatively harmless stimuli as more painful than it should. 

You can think of it like a car alarm that goes on high alert. Normally, a car alarm sounds if something happens like a window being broken to alert you to an intruder. An overprotective pain system is like a car alarm that goes off when a leaf falls on its hood. There’s no true threat, but the alarm has become very sensitive. And sometimes, that alarm not only goes on high alert, but stays on high alert long after it’s helpful. Safe movements trigger a pain response, and activities that weren’t painful in the past start to hurt. 

Additionally, pain has social and emotional components, as well as a physiological one. This means that while the pain you feel is always very real, mental and lifestyle aspects impact your pain in addition to physical aspects.

One thing that often makes chronic pain worse is the misconception that discomfort is a sign you shouldn’t move, or that you should rest to allow your body to heal. In reality, it’s the opposite, says Dr. Shaw. “Being too sedentary leads to an overall increase in muscular stiffness and tightness, as well as loss of muscle strength,” she explains. “And that can negatively affect stability and your ability to move around with confidence.”

Whether your chronic pain is influenced by a known condition — arthritis, fibromyalgia, and neurological conditions are some common culprits — or is completely mysterious, there are many things that can help you cope if you're living with chronic pain, including working with a physical therapist.

Living with chronic pain: coping tips  

Every person’s pain is different, but there are several things that may help you better manage your pain, says Dr. Shaw. “Personally, I deal with chronic pain in addition to treating it as a physical therapist, and I’ve tried many of these approaches,” she says. Here are Hinge Health’s top tips:

Consult a physical therapist. A physical therapist can help in many ways. Most importantly, they can develop a personalized routine for you, which will likely include strength training, stretching, and flexibility exercises. Such moves are designed to desensitize an overactive pain system, as well as build overall strength and stamina and improve your daily functioning, Dr. Shaw says. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

Move more. Whether you’re with the physical therapist or on your own, simply upping your activity can make a big difference. Exercise helps to prevent muscles from tightening and weakening, and it also improves your flexibility and range of motion. This makes it easier to move around and do the things you enjoy. “Exercise also prompts your brain to release endorphins, which are chemicals that counteract pain,” Dr. Shaw says. 

We know that getting started with exercise — or increasing your exercise intensity or frequency — when you’re in pain is hard. So it may help to start with low-impact options (think: walking, biking, etc.) and gradually work up to higher-impact activities. And if lacing up your walking shoes seems daunting, starting with swimming or water workouts is a great option, says Dr. Shaw. “A lot of people do better in the pool because they are able to move with less pressure on their joints,” she explains. 

Get educated. One key to better managing chronic pain, says Dr. Shaw, is simply understanding it. That’s where pain neuroscience education (PNE), which your physical therapist can provide, comes in. Research suggests that PNE can actually reduce pain and disability in people living with chronic pain. 

In addition to PNE, a physical therapist can help you explore guided imagery, which research shows may be able to reduce your pain symptoms. “We have neuroplasticity in our brains which allows them to change and rewire throughout our lifetime,” says Dr. Shaw. Guided imagery can help you turn down the volume on your pain and rewire your pain system over time. “This might entail envisioning a package around your pain and then picturing it leaving your body as you do certain activities,” says Dr. Shaw. A physical therapist can talk you through this technique and teach you how to use it at home.

Warm up to unwind. Taking a warm bath or shower in the evening can help you destress as well as loosen up tight muscles before bedtime. To get a better night’s rest, you can also ask your physical therapist for advice on how to position your body and pillows in bed, especially if you have neck, back, or shoulder pain.

Jot down positive affirmations. “Chronic pain can lead to a lot of unproductive thought processes, which can make pain even worse,” says Dr. Shaw. To help break the cycle, she advises patients to take a few minutes to write down a handful of affirmations, like “My pain is lessening” or “I’m getting stronger every day” and store them in a jar. Pick one up and read it whenever you’re in need of a little extra motivation, including right before you do the exercises your physical therapist has prescribed. 

Pace your activity. For some people, tracking their pain can uncover factors that trigger their pain. But tracking your pain can also be frustrating and make it feel like you are moving backwards at times. This is because it is normal to have ups and downs as you recover. Instead of focusing on the outcome of pain, focusing on gradually pacing your activities to be longer or more intense can help you focus on the process and celebrate the wins of being consistent, even as you experience the ups and downs of pain recovery. 

Consider counseling. You know better than anyone how difficult it can be to live with pain day in and day out. It’s natural for that to take a toll on you. In fact, 54% of people with chronic pain report severe anxiety and 47% report severe depression, according to a recent survey by Mental Health America. To get a better handle on the emotional and social aspects of your pain, you may need to work with a trained mental health provider who may be able to help you with cognitive behavioral therapy (CBT) or other therapy techniques.

This can help you identify and change negative thought patterns and behaviors that may not be helping your pain. The goal, says Dr. Shaw, is to learn to reframe your pain so that you’re not dwelling on the distressing aspects of your symptoms all the time. For instance, you can learn to celebrate small wins, such as being able to go for longer periods without pain, as well as focus on your overall quality of life. “I had a patient email me yesterday who was able to go ziplining,” says Dr. Shaw. “Yes, she still has some symptoms, but she was able to change her outlook to focus on what she was able to do, instead of what she couldn’t do. And look how it turned out!”

Living with chronic pain is an ongoing battle that requires courage, resilience, and proactive management. While it may be a persistent presence in your life right now, it does not have to define you and it certainly isn’t something you have to simply deal with forever. By combining medical treatments, lifestyle adjustments, support networks, and mindfulness practices, you can regain control of your pain and your life and get back to doing the things that you love. 

How Hinge Health can help you

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Cohen, S. P., Vase, L., & Hooten, W. M. (2021). Chronic pain: an update on burden, best practices, and new advances. The Lancet, 397(10289), 2082–2097. doi:10.1016/S0140-6736(21)00393-7

2. Chronic Pain. (2021, September 1). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/4798-chronic-pain

3. Dydyk, A. M., & Givler, A. (2023). Central Pain Syndrome. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK553027/#:~:text=Introduction-,Central%20sensitization%20of%20pain%20occurs%20when%20the%20patient's%20nervous%20system,sensitivity%20to%20fire%20action%20potentials

4. Louw, A., Puentedura, E. J., Zimney, K., & Schmidt, S. (2016). Know Pain, Know Gain? A Perspective on Pain Neuroscience Education in Physical Therapy. Journal of Orthopaedic & Sports Physical Therapy, 46(3), 131–134. doi:10.2519/jospt.2016.0602

5. Posadzki, P., & Ernst, E. (2011). Guided Imagery for Musculoskeletal Pain. The Clinical Journal of Pain, 27(7), 648–653. doi:10.1097/ajp.0b013e31821124a5

6. Mental Health America Reports a Strong Connection between Chronic Pain and Untreated Mental Health Challenges. (2020, September 22). Mental Health America. https://www.mhanational.org/mental-health-america-reports-strong-connection-between-chronic-pain-and-untreated-mental-health