It has been previously described that chronic pain is like the alarm system in the house. This annoying tune/noise keeps ringing for a long period of time. The alarm sound misinforms you about burglars entering the house. It turns on in every sound or light movement. You don’t have the ability to turn it off when you push the turn-off button on your keys anymore, or when you try the deactivation code on the panel. As a result, you are afraid to get in or out of the house because you don’t want to hear this noise again. You have even stopped inviting your friends or your kids’ friends to your house. Perhaps you think that  not activating the alarm would be the best solution. Can you see the half of the puzzle yet? It’s like your brain. The sensitivity increases even though there is no more danger. Your whole life is disturbed by this. Emotions, feelings, beliefs and memory. Your beliefs about pain are increased; the fear increases every time you move. You may think or you’re sure that the alarm/pain will start the annoying noise. In addition, your family’s and friends’ involvement is inevitable . You had to give up all your hobbies because of this pain. Sometimes you had to take a sick leave from your work because you could not turn off the alarm the night before. All your emotions, feelings and memories are strongly connected to your pain. Maybe is time to try something new and different. It’s obvious that you don’t wanna sell your house. For a long period of your life the pain defined you. It’s time for you to define your pain.  You have already known why this is happening. It’s time to desensitize the alarm/pain.

Remember what was the initial reason for setting up the alarm? To protect you-even though it became over protecting. Now have in mind that when the alarm gets sensitize does NOT mean that there is a burglar in your house. If you can understand this you will already know that hurt does not always equal harm. To simplify this, if you are performing a movement and you have a new pain does not mean that you have injured or damaged a new tissue. This is due to sensitivity of your brain. Do not panic or get stressed.

 The final pieces of the puzzle

 It is totally acceptable that you had to give up your hobbies or your favorite activities because of your pain. Once you have understood why the pain persists you would like to return back to your activities and social life. Be careful though this transition should be made smoothly. At first, choose your favorite activity, the one you used to do before you were in pain. I will use the dog example! (Love dogs:))  Let’s assume that before your pain you used to take the dog for a half an hour walk.  At the moment the dog is a bit disappointed by you as you no longer take it for a walk. You think that you can’t do that because if you walk the dog for 30 minutes you will be in pain. Well, actually you are able to walk the dog! If you know that the duration will cause you pain then you don’t have to push your limits.Ask yourselves, what is the most likely duration that I can do these activities without pain? Is that duration 10 or 15 minutes? If you think that with 10 minutes you will be pain free then go for it! But remember this is your first attempt. Don’t push your limits. You can gradually increase this duration by adding 1 or 2 minutes each time. It is the same as if you were going for shopping or for a drink with your friends.  Plan your progression!!

Connect the final piece of the puzzle

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As a consequence of your pain, you are afraid to perform specific movements. It is normal. You know that if you do a particular movement you will be in pain. What if you try to achieve the movement with an alternative way? Your brain knows that if you bend forward or if you turn your head you will encounter pain. As a consequence you avoid this particular movement. You can trick your brain by performing the movement in a more different and pain free way. In this way, your brain will not recognize the movements as painful, plus it would be a new safe, pain free movement for the brain. For this reason we will use some of Lorimer’s suggestions.  

Bending forward is painful. Alternatively you can sit on a chair and bend forward. Is the same movement but your legs and half of your body are not in tension; they are relaxed on the chair. You can also do this in front of a mirror-the visual input will deceive your brain that this movement is no longer painful. You can also use other parts of your body to perform a movement. When standing up you can use the legs first, by moving forward one leg each time or if you want to turn your head, try to rotate your body while you’re looking at a particular object. Finally you can use these techniques in your everyday life. Once you have understood that pain does not equal harm you can gradually return to your activities. Congratulations, you have made a new friend. Your friend can be tough sometimes but with the appropriate manipulations he can be your best friend.

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What you  will gain if you understand why the pain persists

• Learning the naked truth about your pain will improve your attitudes and perceptions around pain

• Your quality of life will be revised

• You will experience less pain

• By learning about pain you can reduce your disability

• Your physical performance will be better

• If you decrease your fears you will boost your activity

• Your coping skills will raise

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References 

  1. Butler, D.S. and Moseley, L.G. (2013) Explain pain. 2nd edn. Melbourne, Australia: Noigroup Publications.
  2. Moseley, L. (2002) ‘Combined physiotherapy and education is efficacious for chronic low back pain’, Australian Journal of Physiotherapy, 48(4), pp. 297–302. doi: 10.1016/s0004-9514(14)60169-0.
  3. Waddell, G., Newton, M., Henderson, I., Somerville, D. and Main, C.J. (1993) ‘A fear-avoidance beliefs questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability’, Pain, 52(2), pp. 157–168. doi: 10.1016/0304-3959(93)90127-b.

Pictures 

Figure 1. puzzle :   https://www.pinterest.com/gingerdoll123/fibromyalgia-3/ 
Figure 2.bending forward : http://www.cgcube.ir/tutorial-article/animation-basics/408-understanding-the-12-principles-of-animation
Figure 3.sit to stand : http://blog.digitaltutors.com/animation-body-mechanics-ease-in-and-ease-out/
Figure 4.exit pain : http://www.nationalelfservice.net/musculoskeletal/musculoskeletal-pain/cost-effectiveness-of-self-management-for-chronic-pain-in-an-aging-population/