Chronic Pain and Scoliosis

The relationship between chronic pain and scoliosis can be confusing. There are conflicting messages that tell us, “Scoliosis doesn’t cause pain,” or, “Children with scoliosis don’t have pain,” or, “your x-rays look great; we can’t see anything wrong.”  Or you might get the opposite message, “You’re lucky to be walking with that kind of curve,” or, “You’ll be in a wheelchair by the time you’re thirty.”  Should I go on? Have you heard one of these? They are two ends of an extreme, aren’t they? One is, “Wow, what’s wrong with you? You shouldn’t have any pain at all.” The other is, “Wow, your life as you know it is almost over.”  So, where are you left with those kinds of statements? You are either left feeling like you are crazy, and it’s all in your head because you ‘shouldn’t have any pain at all.” Or you are left feeling like you are walking on eggshells and waiting to take your last step because you are in “such bad shape.”

Unfortunately, neither of these statements are helpful for decreasing chronic pain. And what is chronic pain, anyway? How is it defined? There are a few definitions out there.

Chronic pain is:

      1. Pain that lasts longer than three months – even if it comes and goes. — Cleveland Clinic
      2. Long-standing pain that lasts longer than a normal recovery period or is associated with an ongoing health condition. – Johns Hopkins
      3. pain that persists past normal healing time and hence lacks the acute warning function of physiological nociception” (Treede, et al. 2015)

Great. We have a definition. Now you know if your pain would be classified as chronic or normal acute pain that is a healthy response to injury.  Now, what do we do about it? Where do we go first? Do we search for the root of the problem, as in what is causing the pain? So we can get in and resolve it? Or is the first question about the body’s pain mechanisms that are out of sync and, therefore firing on too many cylinders – maybe 8 powerful cylinders when a little pony with a comfy saddle would be just fine?

Yes, you should always look for the root of the problem first. The body is sending you pain signals; it is asking for help, and you should listen. Seek out the root of the problem. All the neuroscience on understanding pain isn’t going to help you if you have a broomstick in your eyeball.  With scoliosis, the spine changes over time, and nerves that weren’t irritated before could become irritated. A bursa (a normally happy little sack of cushion-y fluid) that was living its best life before could become bursitis with a shift of the hips over time or a new activity that puts more demand on the bursa. Therefore, your first chat is with a medical professional who can help you sleuth the situation to find a root problem.

If you’ve done all your homework, you’ve done your sleuthing and the medical community is at a loss, then it’s time to dive into pain science. What is pain and why do you have it? Why are somedays better and some worse, with no obvious reason for the difference? Is the pain moving around? Is it changing in quality from day-to-day? Are you on an endless merry-go-round and feeling panicked? Then it is most likely time to study pain science.

There is a renowned pain science school out of Australia, The NOI group. They are leading the pain science industry worldwide. I am not an expert, but I am going to share a little bit here with you in hopes that you’ll seek out their work and, therefore find the help you need. So please bear with me as I try to share the little that I know.

Step one. You have pain. And the pain hasn’t healed. It becomes chronic.

Step two. The nervous system (neuroimmune system) resets itself to be more sensitive. Think about a security system for your home. If someone breaks into your house and the alarm system doesn’t go off, you reset the alarm system to be more sensitive. With pain, the body is experiencing a “break in,” and is therefore resetting the house alarm (the nervous system) to be more sensitive – all in an effort to keep you from getting injured again.

Step three. Keep in mind that the actual injury threshold is much higher than our pain threshold. Pain is there to prevent us from getting to the point of serious injury to the tissues. So first comes pain, but later, if we ignore the pain, comes the actual injury. If we were talking about a 12-story building; pain begins at floor 10 and injury doesn’t start until floor 12. Pain stops you at floor 10 so you don’t reach floor 12 – hopefully. However, if your alarm system has been reset, pain could be starting a much lower floor. Where do you think you are? How sensitive are you to pain? Do you think it’s starting at floor 8? 6? 2? It can change, and the floor can get lower, as over time chronic pain persists. But the actual tissue damage stays the same; it remains at floor 12 – that’s the good news. You aren’t hurting yourself, you aren’t making things worse. You are just listening to and feeling some major alarm bells. The body is just trying to prevent further damage and increased pain. The good news is the alarm system (pain) can be reset so that the pain doesn’t start until a much higher floor.

Resetting the nervous system

We don’t want the nervous system firing at floor 2, or even 6, if we can help it. We want the body to learn to recognize these lower levels as just stuff happening in the body – normal stuff, not dangerous stuff. How do we do that? Well, I’m a movement specialist, so I think you know where I am going to go with this. But first, I recommend these two books (Explain Pain and the Explain Pain Patient Handbook) if you want to know more. And now let’s look at how movement can reset the nervous system’s alarm bells.

Everything I do hurts

Let’s break that down. Is that true? Let’s play a game to find out. First, find the most comfortable position for you – lying down, sitting in your favorite chair, standing, snuggling your favorite puppy and cup of tea. The next step is to calm your nervous system. What does this mean for you? Are you imagining a warm beach? Dinner with people who love you? How about meditation or prayer?  Next, let’s start to explore. Start by closing your eyes and moving them right to left, up and down. Does that hurt? I’m not exaggerating or making fun here, it’s a serious question. If it doesn’t hurt, be aware that by moving your eyes, the muscles of the neck and therefore the spine have also started firing. If you can move your eyes without pain, we know you can begin to fire the spine muscles without pain while they are in a stable position –such as lying down.  This is good news. Next, let’s move through the body one joint at a time. How about the jaw? Next, the toes, ankles and the knees. These movements should be small and exploratory, not “I’m at the gym and I have something to prove.” Stay small, explore, play, and most importantly move.

Try this with me. It’s free

I’d like a chance to walk you through the movement process above. We have two short 20-minute classes to offer you that will help you explore a change to chronic pain levels. The first class will help to calm the nervous system and the second will help you begin to explore movement. Join me here. The first class is free, and the second class is also free on our Scolio-Pilates On Demand program –where your first two weeks are free, so you can have a lot of opportunity to explore over 100 movement videos that are specific to scoliosis. Please do join us and please find a freedom of movement that has never been gone, only very well hidden at times. Are you ready? Yes, Let’s do this.

 

References

  1. Cocks, Timothy. “When ‘Chronic’ Pain Isn’t Just ‘Chronic Pain.’” Noigroup, 7 July 2023, www.noigroup.com/noijam/when-chronic-pain-isnt-just-chronic-pain/.
  2. Treede R-D, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, et al. A classification of chronic pain for ICD-11. PAIN. 2015;156(6):1003-7.
  3. Treede R-D, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, et al. Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). pain. 2019;160(1):19-27.

 

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Chronic Pain and Scoliosis