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Part 4... The Fear/Pain Cycle

Updated: Aug 10, 2023

Again, pain is exhausting. I do hope that you've been able to find some guidance in the last 3 posts.

Daily pain is exhausting

Our ingrained system of putting our full trust in the medical system of looking for structural issues to 'fix' is broken. It is also driven by the pharmaceutical industry. Yep, I said it. We are over prescribed and under heard. With doctors only having 10 minutes, yes, it is now down to 10 minutes here in Alberta, to listen to their patients and talk with them, that isn't enough. To be honest, if I only had 10 minutes to listen and talk with clients, I wouldn't be able to effectively do my job, I feel bad for doctors. I could do another post about that, though it would mainly just be complaining to deaf ears, so let's move on.

So where can we turn? Google? Yikes! But we do, and the info out there can be scary, misinformed, confusing, and overwhelming. And when you are experiencing chronic pain and the time in between medical appointments is long, Google seems to be your friend. But is it?

For example, Google 'osteoarthritis', heck even specify 'knee osteoarthritis'. First page is all about symptoms and causes with just about every article mentioning 'wear & tear' being primary causes of osteoarthritis. Generally the second cause is from an earlier injury to the joint that lead to osteoarthritis.

Imagine if you will, you are in your early 60's, about to retire and start really living and enjoying activities, travel, and more... but you have some knee pain so you head to your doctor. They send you for imaging (likely x-ray, maybe bone scan, MRI) and you go back for them to tell you it is osteoarthritis, maybe they even read from the report that it is severe osteoarthritis and that it is 'bone on bone'. AH! This sucks, you had everything planned out now you'll have to deal with this knee pain forever and it will only get worse until you finally can get our knee replaced. This is how catastrophic thinking works... then you add in Google, look at images of the 'bone on bone' scans and you can just start 'seeing' the pain every time you move.

This leads and builds in fear. Fear of pain, fear of disability, fear of not being able to do things you love, fear of getting 'old'. This fear causes your nervous system to be on high alert. This high alert is meant to protect you, but it becomes over protective and your neurons start becoming more sensitive to movement, then emotions and stress levels. All of this makes you feel like your knee is getting 10x worse every week, leading to more fear and a higher level of sensitivity. Get it?

But... does the structure of your knee actually get worse? Here is the catch... if you took 100 people over the age of 60 who don't have knee pain and did imaging of their knees, you would find osteoarthritis in over 80% of them. So is the osteoarthritis actually causing the pain? Not to mention, if osteoarthritis is a 'wear and tear' issue due to load bearing in a joint, why does arthritis affect our hands so much?

The fear of not knowing or losing control

This fear/pain cycle can be applied to so many chronic pain/ailments. I've worked with shoulder pain, back pain, neck pain, fibromyalgia, knee pain, injuries, and more.

This all leads me to look for more of a bigger picture, yes there is often a structural issue behind the pain, but there is also strong evidence for the psychosocial contributing factors as well. If you've read the previous 3 articles, you know pain is complex. Fear is a big factor in building the pain experience and it puts our nervous system on high alert and makes us so much more sensitive to the smallest alarm.

So, let's look at that big picture. The good news is that your nervous system is plastic, just as much as it can become highly sensitized, it can change and learn to accept that some sensations are more about tissue health and adaptation rather than catastrophizing tissue damage.

Does that make sense to you? Do you want to build your path back to wellness? Let's chat. Let me help you see the bigger picture.

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