Is being 'Completely Pain Free' a good goal in rehab?

Patrick Avice
EXERCISE PHYSIOLOGIST AND TRAINER
2
Minutes to read

When injuries or pain occur, the first logical step is to remove the source of discomfort. As humans, we want to feel safe and protected. However pain is multifactorial and it is often hard to pinpoint exactly the reasons as to why something hurts (Mosely 2007). In addition, the rehab process is often non linear, with flare ups occurring sometimes out of the blue with no clear explanation. Other times there can be a good indication of why a flare up has occurred such as; doing weights everyday when previously were only performed 2x a week + reduction of sleep + increased stress at work. That’s a lot all of change all at once! However, flare ups can occur without these significant changes and it is important to understand that this is normal (Suri 2012).


If being completely pain free is the goal, every time a flare up or a set back occurs how would that leave you? Probably with thoughts such as “my rehab isn't working….I'm not getting any better…..i've been putting in all of this work only to still have pain.” Feelings of frustration, anger, disappointment, anxiety, sadness and loss of hope may result. This can lead to abandonment of treatment, and leave you stuck in a cycle jumping from treatment to treatment in the hopes of eliminating pain.


What can you focus on instead?

A first step would be to recognise that pain does not always equal damage. The body may produce pain as a protective mechanism to reduce what it perceives as potentially harmful behaviour (Cohen 2018). The magnitude of pain can also be influenced by a large variety of factors such as stress, beliefs about pain and the body, sleep and influences from other people including health professionals (Mosely 2007, Bunzil 2017). Another step maybe to recognise that pain is part of the human experience and therefore being completely pain free is probably unrealistic. In a sense, it is like having a goal of never feeling sad, angry, or anxious. At some point these feelings will occur regardless of how you try to live, it's part of being human and despite the presence of these feelings, you still do the things you enjoy. It might be watching your favourite movie, going for a walk or a number of other things that you find joy or comfort in. The same can be done when dealing with pain; doing things that make you feel better!


So What Next?

With the understanding that pain does not always equal damage, it means that you can still engage in a variety of activities and movements you enjoy despite the presence of some pain. A tolerable level of pain is a good baseline marker and even though pain is present, it does not mean that we are making things worse. Rehab therefore may involve more meaningful activities or variations of them, starting small and building up over time. So perhaps instead of being “completely pain free”, alternative goals could be “to build back to running 5km” or “start taking a dance class” or “deadlift 60kg”.  By changing the focus, accepting that pain does not equal damage and that flare ups in the rehab process are normal then choosing goals focused on what you can/want to do may result in:


  1. Less anxiety/worry when symptoms may pop up
  2. Participation in meaningful activities
  3. Increased enjoyment in rehab
  4. Increased confidence in your body
  5. Increased happiness/fulfillment (all the good stuff)


And as a result, pain will most likely reduce anyway! Of course, being out of pain is great, however, so too is living life on your own terms, doing the things you love and not being held back by pain! Need help addressing your pain or setting your goals? Reach out, we are here to help.



References

Bunzli S, Smith A, Schütze R, Lin I, O'Sullivan P. Making Sense of Low Back Pain and Pain-Related Fear. J Orthop Sports Phys Ther. 2017 Sep;47(9):628-636.

Cohen M,  Quintner J, van Rysewyk S. Reconsidering the International Association for the Study of Pain definition of pain. PAIN Reports. 2018;3(2)

Moseley L. Reconceptualising pain according to modern pain science. Physical Therapy Reviews. 2007;12. pp169-178


Suri P, Saunders KW, Von Korff M. Prevalence and characteristics of flare-ups of chronic nonspecific back pain in primary care: a telephone survey. Clin J Pain. 2012;28(7):573-580.

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