By Jill Phelan, DPT

Everyone at one point in time has had a day in which they suffer pain, whether it be "tweaking" your back golfing, recovering from a recent knee replacement or stubbing your toe on the coffee table. Pain is natural and normal. It is your body's way of alerting you to either actual or potential risk of tissue damage. Pain can be intermittent or constant, mild or debilitating, slightly annoying or completely crippling. So when does pain become an acute response to an adverse stimuli and transform into a long lasting, persistent issue? Pain becomes a problem when symptoms remain unchanged despite failed intervention tactics, persists longer than expected tissue healing time and ultimately begins to effect and alter one's lifestyle and function.

Pain is an "output" and requires interpretation of the brain to be perceived. First, possible tissue injury must be signaled up the chain of the central nervous system to the brain to be identified. Peripheral sensitization then occurs, going into "protection mode," causing your body to be heightened in it's response to stimuli. Lastly, the brain assesses the threat level and begins to diminish the signal with time. When it comes to chronic pain, there tends to be altered sensory processing in the brain with malfunctioning of descending pathways. Meaning the signal does not begin to become reduced in a timely fashion and pain continues.

There are three main types of pain: nociceptive, peripheral neurogenic and central sensitivity. Nociceptive pain is localized to an area of injury, with clear aggravating and easing factors such as when you sprain your ankle. Peripheral neurogenic is associated with history or evidence of nerve injury or pathology. It can be provoked with certain movement testing and follows a nerve root pattern, as with carpal tunnel. Central sensitivity is identified as error in processing or output related. With central sensitivity, there tends to be a variable quality of pain, fear avoidance with certain activities, possible onset of anxiety and/or depression and pain can often be perceived as uncontrollable.

Based on an individual's pain presentation, physical therapists can trial multiple approaches in attempt to reduce and hopefully abolish one's pain so that he or she can complete his or her normal daily activities, return to recreational sports or hobbies or sleep more comfortably with less irritability. Whether it be pain management modalities (ice, heat, phonophoresis, electrical stimulation), exercise and activity modification or manual therapy techniques, patients can also benefit from education to further understand the biology behind pain that culminates in four main concepts:

1. Pain does not provide a measure of the state of the tissue.
2. Pain can be modulated by many factors across many domains, not just physical sources. Stress and outside environmental factors play a big role too!
3. The relationship between tissue state and pain becomes weaker as pain persists.
4. Pain does not always mean there is tissue damage.

Every individual is different as is their pain. We as physical therapists at Professional Rehabilitation Services treat each and every patient with an impairment based approach, meaning the focus of each patient's care is centered around their own specific limitations and restricitions.

So if you or someone you know is having musculoskeletal pain and would like to know more about physical therapy options for chronic pain, seek the consultation of a physical therapist at one of our four locations or see your physician for a referral to one of our facilities. For further information on this or other related topics you can contact Richard A. Owens, PT, MS, OCS, Cert. SHT, CWcHP, Cert DN and Jill Phelan, DPT (Surfside) (843) 831-0163, Richard DeFalco, DPT, OCS, CSCS, CWcHP, Cert. DN (Myrtle Beach) (843) 839-1300, Kristin Lies, DPT (Murrells Inlet) (843) 314-3224 or Brian P. Kinmartin, PT, DPT, MTC, OCS, STC, CWcHP, Cert. DN, and Nathan Watts, DPT (Pawleys Island) (843) 235-0200, or visit our website at www.prsrehabservices.com where you can learn more about the company and even download a referral form for your physician to fill out. You can also call and schedule a free 15-minute consultation!