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Robbing Peter to Pay Paul

Pain is sensation we will all feel in our lives from time to time, though largely the pain will subside within a week or two – this is what we would refer to as acute pain. Chronic pain is referred to as pain that lasts over 6 months, pain that people can have difficulty in managing and can be quite debilitating, often affecting an individual’s quality of life. Though pain can be very draining, the below blog will discuss how quick fixes to pain such as common surgeries and medications could be potentially ‘robbing Peter to pay Paul’ – in short, reducing pain but creating more complications. If surgery and medications won’t fix the pain, what will? We will discuss the role of exercise rehabilitation in pain management, and how assessing movement patterns can identify a potential compensatory pattern before experiencing pain at all.

Radiofrequency ablation – process in which the surgeon will ablate the tissue using radiofrequency – essentially burning off the nociceptors (pain fibres) – nerve endings throughout the body that respond to damage or potentially damaging stimuli, sending signals to the brain.

This sounds like a fantastic procedure to ensure a patient no longer feels pain, though when it comes to burning off nerve endings, there is no such thing as a free lunch. Remember we have these nerves throughout the body for a reason - when burning off these nerve endings we are limiting the afferent input (neurons that receive information from our sensory organs and deliver this information to the brain). When limiting the afferent input, we don’t get to choose which sensations we do feel and which sensations we don’t feel anymore – meaning we will lose a lot of the necessary mechano-receptors, limiting proprioception in the area too. By limiting proprioception, the joint loses its awareness of its place in space, leaving it subject to issues such as hypermobility.

In this case, a patient may end up with more arthritis, more injuries and overall the patient may be in less pain before a joint replacement or surgery, though it may speed up the need for the replacement or further surgery.

This same thought process may be applied when looking at long term use of ibuprofen and other pain medications, to control pain. Acute use of pain medications is often needed after an injury, surgery or aggravating an injury, which generally will not have side effects, thus being over the counter and not needing a prescription. Though even over the counter pain medications used long term may blunt the nociceptors, having the same effect on the mechano-receptors, leading to some of the same issues as outlined above.

Not only does long term use of pain medication effect the integrity of the joint/area of the body the pain medication may be targeting. It also has been seen to increase risk of myocardial infarction (heart attack), chronic heart failure, renal failure, effects on liver function, can create gastric discomfort and has been found to lead to onset of osteoporosis.

This should not deter someone from using pain medications when needed to help manage pain from time to time, though to use these medications as a daily vitamin may have unfavourable side effects. So, what can I do to help manage my pain daily?

Pain is there for a reason and understanding this reason is an important part of exercise rehabilitation. This will include understanding the type of pain, either it is intermittent or chronic,

finding patterns of when the patient is more symptomatic than other times, assessing muscle structures to find what may be tight, weak, over-active, inhibited, fatigued etc. When understanding why the patient may have pain, it is also essential to assess the body’s compensatory movement patterns, as the individual will have altered movements to remain as functional as possible, whilst attempting to protect themselves from pain. This may be evident through anterior or posterior pelvic tilt, over pronation at the ankle, increased valgus at the knee etc. - these are all common examples of movement compensations.

Unfortunately, when it comes to pain and exercise rehabilitation there is not a one size fits all approach. Pain is individual, the reasons for pain may be individual and the compensations you may use could be individual, meaning your rehab will be individual to you and your needs. The common themes of an exercise rehabilitation program would include; improving range of movement and to gradually increase load, using combinations of isometrics, isotonic, isokinetic contractions. It would also be very important to incorporate; proprioception, endurance and strength protocols as part of the rehabilitation.

In summary, pain is complex and individual to you. It is recommended to always try exercise rehabilitation/conservative treatment before considering surgical interventions. Though considering how debilitating pain can be and how it can affect an individual’s quality of life, it is understandable to think that surgery is the only answer. When considering surgical interventions like radiofrequency ablation, always understand that there will be some unfavourable effects that come with reduced pain. It may also be helpful to understand that with pain, the human body will alter its movement patterns to stay functional and protect itself from pain. - People go to a dentist for regular check-ups to prevent a problem, it may not be the craziest idea to have your movement patterns assessed on a semi-regular basis, which may pick up compensatory patterns before you even experience pain.

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