It all starts from when you are young!

As a chiropractor, I work with people living with chronic pain. In many cases, chronic pain patients will blame specific injuries or “bad” posture or muscle imbalance as the cause of their pain. While these “causes” of pain may make sense to us, studies show that they poorly correlate with pain experiences.

In other words, these factors rarely contribute to one’s chronic pain. In fact, most of the contributors to one’s pain experience is usually fairly insidious. This is why a whole-person pain solution is important.

Rethinking pain with a bio-psycho-social model

When I talk about a whole-person pain solution, I am not thinking of the new age “positive vibes only”. I am referring to taking a more holistic approach to what it means to be healthy.

In a Lancet chronic pain paper published last year, the researchers specifically highlight that there is often no tissue damage when it comes to persistent pain (any pain that last for more than 12 weeks).

The factors involved in a pain experience is more complex. It can range from your pain threshold to your job satisfaction and cognitive beliefs. Yes, research has shown that people with better belief systems (e.g., self efficacy) have superior recovery outcomes to those who don’t.

A study has even gone as far as to suggest that it’s possible for self-efficacy to have a protective effect against pain! How wonderful is that?

How does a healthy pain response turn into an endless pain vicious cycle?

The biggest challenge with treating persistent pain is, well, it’s persistency. Ask anyone who have lived with pain for many years. They will be able to tell you that most treatments do help but the pain always come back.

No, they are not exaggerating and you may also have experienced it yourself. Your pain always comes back.

The reason this happens is quite simple. The way you perceive your pain experience leads you to certain behaviour. The behaviour you engage in, for whatever reasons, keeps you in a recurring pain vicious cycle.

For you to achieve a full recovery, it’s no longer just about treating an injury or making yourself stronger. It goes much deeper than that.

How does fear avoidance behaviour look like?

Take for example Client A. Client A came to us with low back pain and knee pain (very common combination). After working together for a couple of sessions, we noticed there is no improvements in his knee symptom experience while climbing down stairs. This didn’t really make sense to us.

We got him to climb up a flight of stairs and then make his way down so we can observe his movements as well as the pain that he has. It turns out that he was afraid of putting weight into his knees. Whenever he was to take a downward step, he would rotate his body 90 degrees, and very cautiously place his foot on the lower step. He was afraid that it would hurt! When we asked him to try walking down the stairs square on (i.e., no rotation), there was actually no pain!

This is a classic fear avoidance behaviour where the behaviour is motivated by his fear of pain rather than the pain itself.

No, we are not saying that he would never get pain from climbing up and down a flight of stairs. We are saying that his overly cautious, overly protective behaviour towards his knee is doing more harm than good.

Following our little experiment, we got him to do a couple of mini hopping exercises. In his first attempt, his hop distance was only a couple of centimeters. Yes, a couple of centimeters. He was afraid of the impact hopping would do to his knees!

After some encouragement and experimenting with various hopping strategies, we manage to increase his hop distance to 80+cm. Pretty impressive improvements for just 10 minutes of work! All of this were done 100% pain-free!

Chronic pain never goes away on its own

The whole point of chronic pain being chronic is that it never goes away. Really. Even with passive treatments such as acupuncture, chiropractic adjustments, etc. They just tend to always come back. This is why the recovery solution for you will need to be radical.

It’s not just about exercising for fitness. Fitness goals such as strength, endurance, mobility, flexibility, etc can make you fitter but on their own is not enough to achieve full symptom resolution. This is why people who are extremely fit can still experience chronic pain!

In order for you to achieve outstanding recovery results, you will need to go beyond physical factors and consider the less observable contributors to your symptom experience.

Consider your lifestyle: Are you engaging in good health behaviours?

For you to get good physical health, you will need to engage in healthy behaviours that promote health.

Do you sleep between 7 to 9 hours every night?

Are you getting your two fruits and two vegetables every day?

Do you participate in 150 minutes of moderate-intensity (or 75 minutes of vigorous intensity) exercise per week?

On top of aerobic or cardio exercises, are you engaging in muscle strengthening exercises twice a week?

Are you limiting the amount of time you spent in front of screens?

Is your BMI in a healthy range?

Sure, none of these behaviour will directly “cure” your pain. Yet at the same time, we know all of these behaviours will make you more healthy and set you up for a successful recovery!

In a study published this month investigating weight status, physical activity, sleep, and screen-time among children, it was reported that only 9.9% of healthy weight children meet current guideline recommendations. 5.7% of overweight children meet guideline recommendations and only a mere 3.5% of obese children meet guideline recommendations.

There is no other way to look at this. We are inherently an unhealthy society.

Yes, your pain is way more deep rooted than you think

Singapore may have the highest life expectancy in the world. Yet at the same time, we spend more time in ill health. To put this in perspective, GSK Global Pain Index reported that 85% of Singaporeans suffer from head and body pain!

This comes as no surprise given Singapore is also one of the most overworked cities with the most unhappy workforce in the world. Suicide cases are also at an all time high.

With all of this in view, recovery is no longer just a case of “fixing” your back pain or neck pain. It’s really about doing a deep dive into your lifestyle, and taking the steps necessary for you to find freedom from pain.