Transcrição completa de Understanding Chronic Pain: A Physiotherapy Perspective

00:00:00:03 - 00:00:02:17 Unknown What do physios mean by chronic pain? 00:00:02:19 - 00:00:23:20 Unknown Chronic pain generally refers to pain that has continued or persisted for more than about three months. It may affect one area or several areas. It could be the back of the neck, the knees, shoulder. Some physiotherapists use the term persistent pain. Because the word chronic can sound a bit permanent. The terms are often used in a very similar way. 00:00:23:22 - 00:00:35:24 Unknown The important point is that chronic pain describes how long the pains been there. It doesn't tell us exactly why the pain has continued, how much it will affect the person in the future, or whether they can improve. 00:00:36:01 - 00:00:39:24 Unknown Does chronic pain always begin with a particular injury? 00:00:40:01 - 00:01:02:05 Unknown No there are several ways it can develop. For some people, it begins with a clear injury, such as a back injury, sporting injury, or for the original problem improves, but some pain remains. For others, the symptoms gradually develop. This might occur with repeated physical demands, reduce physical capacity or a musculoskeletal condition that changes over time. 00:01:02:07 - 00:01:22:18 Unknown Sometimes a person can identify one event that caused the pain. Other times they cannot. From a physiotherapy perspective, knowing how the problem began is useful, but it's only a part of the assessment. We also need to understand how the symptoms behave now and what they are preventing the person from doing. 00:01:22:20 - 00:01:27:11 Unknown How is chronic pain different from pain following a recent injury? 00:01:27:13 - 00:01:34:06 Unknown Pain associated with a recent injury is usually described as acute. If someone sprains an ankle, for example, 00:01:34:09 - 00:01:34:19 Unknown pain 00:01:34:21 - 00:01:46:17 Unknown may encourage them to protect the area while the injured tissues begin their recovery process. As that changes, we would usually expect the person to regain movement, strength, and function. 00:01:46:19 - 00:02:14:08 Unknown When pain has continued for several months or years. The presentation can become more complicated. The original injury may lo longer explain everything the person is experiencing. Their movement, strength and tolerance for activity may also have changed during that time. This means physiotherapy for longer term pain cannot simply follow the same approach used during the first few days of an injury. 00:02:14:10 - 00:02:22:11 Unknown We need to assess the person's current symptoms, their physical capacity, rather than treating the problem as though it only just happened. 00:02:22:13 - 00:02:28:00 Unknown What physical changes can occur when someone has been living with pain for a long time? 00:02:28:02 - 00:02:45:07 Unknown It differs between people, but pain can gradually change how someone uses their body. They may avoid particular movements, place less weight through one side, or even rely more heavily on other parts of their body to do particular activities. The activity remains reduced for long enough. 00:02:45:07 - 00:03:09:04 Unknown Strength, mobility, and general physical capacity can also decrease. The person may find that work exercise everyday tasks. They require more effort than they previously did. Activities that were once routine may begin to fatigue them or increase their symptoms. This does not mean that every person with chronic pain is weak or unfit. Some may remain very active. 00:03:09:10 - 00:03:15:13 Unknown However, these are physical changes that the physiotherapist should assess rather than assume. 00:03:15:15 - 00:03:20:02 Unknown are their common activity patterns you notice in people with chronic pain? 00:03:20:04 - 00:03:41:20 Unknown One common pattern is avoiding movement because it becomes associated with the pain or concern about further injury. Avoiding a movement temporarily can be sensible, particularly following a recent injury. It helps the tissues heal and the body recover. The problem is when this avoidance continues and gradually reduces the ability to move normally. 00:03:41:22 - 00:04:04:24 Unknown Another common pattern is doing too much on the days when you feel better. Someone may attempt to catch up on work, housework, exercise, things of that nature because their pain is lower and they're feeling better that day. The symptoms then increase and they spend the next few days recovering from that activity. This is often called a boom bust cycle. 00:04:05:01 - 00:04:22:13 Unknown Neither pattern means the person has done anything foolish. They are understandable responses to how they are feeling and an unpredictable pain pattern. Recognizing the pattern gives us an opportunity to manage the activity more consistently. We will cover pacing and flare ups properly later in this series. 00:04:22:15 - 00:04:28:21 Unknown When someone has experienced pain for months or years, what would a physiotherapist want to assess? 00:04:28:23 - 00:04:49:00 Unknown We look at much more than the location of the pain. We begin with a history of the problem, how the symptoms have changed, and what activities aggravate or settle those symptoms. The physical assessment should look at mobility, movement, strength, control, sensitivity and tolerance for particular tasks. 00:04:49:02 - 00:04:55:11 Unknown We also want to understand the person, what the person has stopped to or reduce because of the pain. 00:04:55:13 - 00:05:09:23 Unknown Two people can report the same pain intensity, but have very different physical abilities and limitations. One person may still be working and exercising, while the other struggles to get up and do daily activities. 00:05:10:00 - 00:05:25:05 Unknown A physiotherapy assessment should connect the physical findings with the activities that matter most to that individual. This allows rehabilitation to be directed towards something more meaningful for that person, rather than simply changing that pain intensity scale. 00:05:25:07 - 00:05:30:08 Unknown If pain has already continued for a long time, does that mean it is permanent? 00:05:30:10 - 00:05:57:24 Unknown No. The word chronic describes duration, not the person's future. Some people experience a significant reduction in pain. Others continue to have some symptoms but improve their movement, strength, confidence, and ability to participate in their daily lives. Improvement might mean walking further, returning to exercise, completing a workday more comfortably, or recovering more quickly after a flare up. 00:05:58:01 - 00:06:20:03 Unknown Pain reduction can be an important goal, but it should not be the only way that your progress to recovery is measured. Someone can be improving physically even if they are still experiencing pain. Progress is also rarely in a straight line. A temporary increase in symptoms does not necessarily mean that previous improvement has been lost. 00:06:20:05 - 00:06:26:11 Unknown What is one useful thing? Someone with chronic pain can do for themselves? After watching this episode. 00:06:26:13 - 00:06:52:02 Unknown Start by identifying one meaningful activity that pain has made difficult. It could be walking, gardening, working, exercise, doing housework tasks, or playing with your children. Next, write down what you can currently do with reasonable consistency. The aim is not to test your maximum or push until the pain becomes severe. 00:06:52:04 - 00:07:20:21 Unknown You are simply establishing an honest starting point. Then write down what you would eventually like to regain. For example, I can currently walk about ten minutes. I would like to be able to walk around my local park, which will take about half an hour. Do not immediately try to double the amount you are doing. For now, the goal is to simply understand your starting point and identify what matters to you. 00:07:20:23 - 00:07:29:04 Unknown Later in the series, we will discuss how physiotherapists and pacing and gradual progression can help people rebuild that activity level.