Chronic Pain

There has been awareness and an opinion shared throughout the medical community about people in pain, especially low back pain. This is that what is maintaining a disabling level of pain could be something more complicated than a straightforward biomechanical soft tissue and structural issue. Another possible factor that is slowly being addressed in the physical therapy community is psychosocial, behavioral and possible emotional components affecting an individual’s pain. This new specialty in chronic pain studies the neurological and physiological, mechanisms of pain. It also addresses the relationships between the immune; the endocrine, the sympathetic and parasympathetic nervous systems. This approach is related to the sensitization of the sensory cortex and brain in general, including the deregulation of the immune, endocrine and nervous systems. Through knowledge of how these systems function, and how they have ceased to function properly, we can address a treatment plan that has benefits of application outside the biomedical model.

We work with the latest research through Neuro Orthopedic Institute to understand the mechanisms of pain and what it takes to overcome them. We realize that all tissue can heal and that the extent of the pain does not always correlate to the tissue damage that is present. We present the usage of graded motor activities and a thorough understanding of the neuroscience of pain towards pain free function.


Assessing patients from an anatomical and biomedical viewpoint we can determine their response to pain and how it affects their movement activity and well-being. It has been observed that similar diagnosis can completely disable some individual and not others. Some patients seem to move forward quite well and improve their pain, whereas others do not. Patients can be observed from a cognitive behavioral perspective and use that information to create change from this vantage point a plan that can benefit the patient who feels completely disabled by his/her pain.

The cognitive behavioral analysis, gives us insight into problem and their consequences. We help the patient identify beliefs and expectations associated with problem behaviors and develop an understanding of these relationships. We can then set a plan of goals for the patient to overcome their disability. These goals are broken down into steps that can help patients eventually be able to deal with their overwhelming reaction to pain.

A recovery plan is implemented that will engage the patient in overcoming activities previously avoided due to fear of pain, or re-injury. The set of skills needed for recovery are taught, helps patients achieve independence, to deal with their limitations and cope with relapses.

Dr. David Butler and Dr. Lorimar Moseley have studied pain extensively over the past 20 years. They have written a book called, “Explain Pain”, where they provide instructions and ideas regarding this subject. Through their research they have been able to document practical steps in resolving patients’ response to pain, and thereby restore activity with pain reduction. They have also founded the Neuro Orthopedic Institute where they continue to research and create newsletters with updates.

This approach to restore function and reduce pain requires experience and the art of communication. Applying the tool of a graded motor activity program we can begin to recapture ADL’s and general life activities, including return to work. This is done within patients’ tolerance, but is progressive and can restore a quality of life that has been lost. I have observed people become convinced that they are disabled because they experience pain, relying heavily on diagnoses such as spondylolisthesis or fibromyalgia. For example, often patients are convinced that their MRI results have concluded them disabled. They become hopelessly distraught, depressed and disabled. Our mind is a great tool in aiding us back to health. With the help of resources such as the book, “Explain Pain”, describing the application of the bio psycho social approach, I believe almost all patients can overcome most of their disability.

The following are excerpts from the Explain Pain book
by David Butler and Lorimer Moseley:

“All pain experiences are normal response to what your brain thinks is a threat.”

“The amount of pain you experience does not necessarily relate to the amount of tissue damage.”

“The construction of the pain experience of the brain relies on many sensory cues.”

“Danger sensors are scattered all over the body.”

“If enough danger signals go through the spinal cord to the brain to the sensory cortex of the brain will conclude if you are in danger and need to take action it is the brain that activates several systems that work together to get you out of danger.”

“Tissue damage causes inflammation which activates danger sensors and makes the neurons more sensitive. Inflammation in the short-term promote healing and tissue healing depends are blood supply it all tissue can heal.”

“Pain persists the danger alarm system becomes more sensitive.”

“The danger messenger neurons become more excitable and manufacture more sensors for excitatory chemicals. The brain starts activating your neurons that release excitatory chemicals at the dorsal horn of the spinal cord. Response systems become more involved thoughts and beliefs become more involved and the brain starts adapting and becoming better at producing the neuro tag for pain. Your sensors in the tissue contribute less and less to the danger message arriving at the brain.”

“The management model shows focus not solely on the tissue we must also recognize the alarm system sensitivity fears, attitudes, and beliefs, and how each individual copes with their pain. Complete avoidance of pain or the opposite pain is undesirable and can contribute to going limitations.”

“Education and understanding are critical for you to overcome pain and return to life. Understanding that your hurts and pain won’t hurt me and that the nervous system is trying to protect you but is no longer able to inform you about danger. By being patient and persistent you could use graded motor activity to slowly restore ourselves to movement in life’s activities. We can seek out activities that produce danger reducing chemicals.”

“Research has shown that is best for your situation and planning your return to normal life with this graded motor activity and understanding the mechanism of the danger system and the function of the nerves in the brain.”

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Dallmeyer Physical Therapy treats Chronic Pain