After doing my interview with Dr. Andrea Furlan, she sent me her book “8 Steps to Conquer Chronic Pain: A Doctor’s Guide to Lifelong Relief”. I was so excited to read this book because I am always looking for more ways to learn about chronic pain. I learned so much from her book that I had not previously known. I love how she simplified treating chronic pain into eight steps. She provides her readers with options, resources, and hope that they can heal from their pain. Below I listed five things that I learned from this book, but in reality, I could probably list 100 things that I learned. I highly recommend that anyone with chronic pain or anyone who works with chronic pain patients takes the time to read this book. 

5 Things I Learned:

1. Pain is not an accurate measure of how much damage there is in any part of the body.

When we’re in pain, it is only natural to believe that the pain is being caused by some sort of damage within the body. We often convince ourselves that if the pain is severe then the injury must also be severe. Yet research has proven that there is no correlation between pain intensity and the degree of harm.

For example, a person could be having a heart attack while experiencing very little pain. A heart attack inflicts severe harm to a person that could result in death. A person could also experience a stroke and have little to no pain. Yet we know that strokes are incredibly dangerous. A person with an amputated limb may experience a lot of pain on the non-existent limb. The limb isn’t there so it’s not possible for any damage to happen to the limb.

1. There are three types of pain: Nociceptive, neuropathic, and nociplastic

People with chronic pain are rarely educated on the different types of pain. This information can help you understand how treating your pain should be approached. Think of pain as an alarm system. It is letting you know that there is damage somewhere within the body.

Nociceptive pain is an injury or disease such as a broken bone, appendicitis, or inflammatory arthritis. The pain system alerts the brain to do something to resolve the damage. Once the injury or disease has been successfully treated, the alarm system will turn off and the pain will stop.

Neuropathic pain is an injury or illness to the nerve system itself. It can be compared to the wires of the alarm system being damaged. Examples include strokes, spinal cord injuries, multiple sclerosis, shingles, and nerve pain caused by diabetes.

Nociplastic pain is the most common form of chronic pain. This is where the injury has healed, the nerves are intact, but the alarm system itself is broken. The alarm system continues to go off even though there is no longer damage. It often starts as nociceptive or neuroplastic pain, but as the nervous system becomes sensitized, it turns into nociplastic pain.

1. Fear-avoidance behaviors can increase pain

Pain is scary and it’s completely normal to be afraid of it. People with chronic pain often get stuck in the fear-avoidance-pain cycle. It starts with pain and developing negative thoughts and emotions around the pain. These thoughts can lead to a fear of movement and avoiding movement. The result is isolation, weakness, depression, and low self-esteem. These emotions will increase the intensity of the pain and the cycle will continue.

This fear that we develop as the pain continues is unhelpful and paralyzing. To reduce this fear, you need to do regular, daily, low-intensity, and short-duration exercises. Over time, you will regain trust in your body and decrease the fear surrounding movement and physical activity. Going through this process will decrease the amount of pain you feel.

1. Improving the quality of sleep can decrease pain

Chronic pain and a decreased quality of sleep are deeply interconnected. Chronic pain often leads to poor sleeping habits that allow them to experience superficial sleep so they are easily awoken. They think it’s their pain waking them up each night, but if they were able to sleep deeper, the pain would not be able to reach their conscious mind and wake them up.

There are several interventions that can improve a person’s quality of sleep. This includes but is not limited to getting sunlight during the day time, having complete and total darkness at night, limiting caffeine intake, avoiding alcohol in the evening, avoiding heavy meals before bedtime, being active, not taking long naps during the day, and mind-body therapies before bedtime.

Supplements such as melatonin and magnesium are also known to improve sleep. Don’t take melatonin for longer than 3 weeks because the effects will become less noticeable.

On a personal note, I struggled with insomnia for months until my doctor prescribed me a medication called trazodone. I also found that Yin yoga before bed is helpful.

1. The 5 M’s of decreasing pain: mind-body therapies, movement, modalities, manual therapies, and medications

Mind-body therapies can be highly effective at decreasing pain as well as anxiety and depression. The mind is capable of creating and erasing symptoms. We cannot separate the body from the mind. Mind-body therapies include but are not limited to, cognitive behavioral therapy, biofeedback, acceptance and commitment therapy, mindfulness-based therapy, meditation, relaxation, hypnosis, guided imagery, mirror therapy, pain neuroscience education, and somatic tracking.

We are designed for movement and physical activity. Movement can be scary if you have chronic pain because we tend to associate movement with pain and flare-ups. When done correctly, movement can decrease pain. Start with choosing a form of exercise that you genuinely enjoy. This could be gym workouts, dancing, kayaking, hiking, playing soccer with your kids, etc. Start with light exercises and gradually progress to moderate intensity and do this for ten minutes a day. Eventually, you’ll be able to do it for 30 minutes at a time and then 60 minutes at a time. 

Modalities refer to physical modalities such as temperature, pressure, light, sound, or electricity. Cold can be used to reduce inflammation. Heat relaxes the muscles. Light therapy includes superficial heat and laser therapies. These are ideal for tendon and muscle repair. Studies have shown that music therapy can relax the mind and muscles, reduce stress, and improve sleep quality. Electricity refers to the use of a TENs unit which can modify neuronal activity.

Manual therapies include massage, mobilization, and manipulation. These therapies can work for some types of chronic pain such as neck and lower back pain, myofascial pain, and arthritis-related pain.

Medications are meant to be used when the other 4 M’s have not provided enough pain relief. Talk to your pharmacist and doctor about which medications might be best for you.