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Dr Rachel ZoffnessAdam Gray for the sunday times<\/p>\n
Because of what we\u2019ve been told, though, most of us do assume that our aches, twinges and pain are caused purely by that old running injury or a herniated disc. \u201cPeople can really struggle to wrap their heads around the fact that pain can be caused by a much more complex set of processes than bodily injury,\u201d says Dr Lafina Diamandis, a GP and lifestyle medicine physician who specialises in helping people with chronic pain at her clinic Deia Health in London. <\/p>\n
\u201cPainkillers are good for acute short-term pain \u2014 you\u2019ve sprained something, done your back in, you have a headache, period pain. They absolutely have a role. But painkillers are often not so effective for treating chronic pain,\u201d she says. \u201cConsider whether they are giving you a window of opportunity to move or function better, or are they masking an underlying problem? We should not demonise painkillers \u2014 they offer relief to many \u2014 but we should always ask ourselves what else we might need to address or consider?\u201d<\/p>\n
Knowing that there are many ingredients to pain gives us the agency, and hope, to help ourselves to get better. Here, these two leading pain experts give their advice.<\/p>\n
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Dr Lafina DiamandisSTE MARQUES<\/p>\n
Pain is a mixture of physical and psychological factors<\/p>\n
\u201cBack pain affects an estimated 80 per cent of people in the US at some point in life,\u201d says Zoffness, citing studies indexed by the National Library of Medicine. Meanwhile, the Health Survey for England 2024, published this year, indicates that back pain affects around 10 million people annually. \u201cEveryone will be told that the cause of their back pain is the finding on the back scan \u2014 it\u2019s the slipped disc, spine degeneration,\u201d Zoffness says. \u201cThat messaging will amplify the brain\u2019s pain alarm.\u201d Meanwhile, she explains, research consistently shows that MRI findings of bulging and degenerated discs rarely correlate with the intensity or even the presence of back pain.<\/p>\n
Embodying the fact that harm (tissue damage or anatomical abnormality) and hurt (pain) aren\u2019t the same\u00a0is the elite athlete Usain Bolt, who has scoliosis. \u201cUsain Bolt has the most twisted and abnormal spine, and he\u2019s the fastest man alive and he has very little pain.\u201d Zoffness says. <\/p>\n
Pain is never just the physical damage, she adds \u2014 it\u2019s a mix of physical, psychological and social factors. \u201cHurt is the subjective experience of pain we have \u2014 harm is the damage done to our bodies.\u201d But if a doctor tells you your hurt is caused only by the harm \u2014 \u201cIf you believe that your knee pain is because it\u2019s \u2018bone on bone\u2019, you\u2019ll believe movement is dangerous\u201d \u2014 you won\u2019t do the things (be active, socialise, build confidence) that help to quieten the pain alarm.<\/p>\n
Never push through pain with exercise \u2014 know when to rest<\/p>\n
Acute pain (usually sharp, sudden, intense and short term) tends to be caused by injury or illness, and you must rest and heal, says Diamandis, though she notes: \u201cOften the necessary period of complete rest is shorter than people expect, which is why physio and rehab and getting a diagnosis is so important.\u201d But what about niggles \u2014 neither chronic pain nor acute injury \u2014 that flare up, usually after exercise<\/a>? If your back aches after deadlifts, is it madness to continue without investigating why? \u201cI would always consult with a physio or personal trainer if there is a history of significant or recurrent pain or injury,\u201d Diamandis says.<\/p>\n Working out alone, she experienced terrible back spasms after deadlifts so stopped doing them. \u201cNever push through a high level of pain.\u201d She subsequently found a personal trainer, who noted that she was hyper-mobile in her lower back, and overextending. \u201cNow I just take the dumbbells to my knees. And I start with a lighter weight and build up.\u201d Train around the \u201cniggle\u201d by changing technique, load, or range of movement, she suggests. \u201cOr try a different movement that works the same muscle \u2014 like glute bridges or hip thrusts.\u201d She notes, \u201cA little niggle or stiffness, that\u2019s a signal from your body to \u2018just be mindful here\u2019. It can be something as simple as, \u2018That joint hasn\u2019t warmed up yet.\u2019\u201d<\/p>\n Why pain continues after an injury heals \u2014 and what to do about it<\/p>\n An estimated 43 per cent of adults in the UK live with chronic pain, defined as pain lasting more than three months, according to a 2016 study published in BMJ Open. Why does pain so often persist after injury heals? Zoffness recalls learning to play the piano, practising until it became intuitive. Similarly, the longer we have pain \u2014 the longer our brain and spinal cord, our central nervous system \u201cpractise\u201d it \u2014 the better we get at producing it, she says. Our pain no longer reflects tissue damage, \u201cIt is stuck in this high-alert mode.\u201d Thankfully the brain can change, which means our pain can change, she says. We \u201cunlearn\u201d it by \u201cpacing for pain\u201d.\u00a0<\/p>\n \u201cPacing is so effective because it changes your central nervous system,\u201d Zoffness explains. \u201cIt changes the input your brain is getting.\u201d Broadly, it teaches your brain that you\u2019re safe. First, Zoffness tells patients, \u201cI need you to move your body. But we start where it\u2019s comfortable for you.\u201d Pacing for pain is like pacing for a marathon. You increase activity over time. She asks: \u201cWhat\u2019s an activity you miss, that pain has taken away?\u201d It might be dancing, sport or cooking. \u201cThen we put together a pacing plan to aim towards achieving that. I find that to be magic for my patients. They\u2019re motivated.\u201d One patient, bedridden for four years, wanted to play football again. Week one entailed standing on his porch in the sun for five minutes. Week two was walking to the post box. (Activity, daylight, chatting to neighbours all helped.) Eventually he got back to playing football.<\/p>\n Your brain can be overprotective \u2014 and catastrophise your pain<\/p>\n You lift a box, and tweak your back. You start panicking and swearing internally. \u201cI call that voice Pain Voice,\u201d Zoffness says. \u201cIt says, \u2018Shit, shit, it\u2019s happening again, I\u2019m not going to be able to exercise or have sex\u2026\u2019\u201d These thoughts are normal and come from our overprotective brain. \u201cBut anxious, catastrophic thoughts will amplify pain volume in the brain.\u201d The result is you\u2019ll do less, move less, then think more anxiously and catastrophically \u2014 and repeat the cycle.<\/p>\n Learn to recognise your\u00a0pain voice, Zoffness advises (she calls hers \u201cPetunia\u201d) and ask yourself: \u201cWhen it goes off, how am I feeling? Scared, anxious, sad? Are my muscles tensing?\u201d Also, \u201cWhat are the behaviours I\u2019m engaging in as a result of this twinge?\u201d And crucially, \u201cHow can I take care of my brain and body in this moment to keep pain volume low?\u201d<\/p>\n Laughter can help to beat pain<\/p>\n
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Getty images<\/p>\n