Knee Pain Management

Knee Pain Management

An excerpt from:

Master Chronic Pain Book

What is this Pain ‘Volume Dial’?

Years ago, my brother had a massive red ghetto blaster radio. The radio was quite a simple device; it just had an on/off switch and a volume dial. At times, my brother turned the radio up so loud the radio shook. Now I want you to imagine that your pain is this radio. Perhaps your pain has been so intense and loud that it has vibrated and driven you to distraction. Unfortunately, as I have said several times, medical science hasn’t shown us how we can turn this radio off, or cure, or turn off your pain completely. But we do know a lot about how to amplify the pain messages or how to turn the volume up on your pain. Thankfully, we also know quite a bit about dampening down the pain messages, thereby turning down the volume on your pain.

Really good illustrations of how the volume can be turned down on your pain are highlighted in the stories below.

A physiotherapy colleague of mine was doing some cross-country running in a local forest. He was running alone but had his new dog with him. He tripped on a branch and fell badly. Immediately, he felt pain in his ankle and knew he had injured himself, but fortunately, the pain was not too bad. He was far away from his car; his mobile phone had no signal, and his dog had run away. He was immediately consumed with thoughts of finding his dog and returning to his car. He managed to walk slowly back to his car and thankfully he found his dog on the way. As he approached his car, his pain went through the roof! It turned out that he had fractured his ankle and he needed surgery to fix it. Why did he not feel intense pain at the time of the accident? His brain had turned the volume down on his pain because his priority was getting back to the safety of his car and finding his dog. When his brain was sure he was safe (he could see his car), it turned up the volume of his pain as his survival was no longer a priority.

Another colleague told me a story that illustrates just how powerful our brain is in turning down the volume of our pain.

My colleague’s sister-in-law was at a fancy, black-tie work event. She was strutting her stuff on the dance floor when she slipped and fell. People gathered around to assist her. Very quickly, she realised that she had lost a front tooth and rushed to the toilet. She was distraught! A colleague’s wife, who happened to be a dentist, assisted her and ultimately managed to save her tooth. When the dental drama was settling down, her friend told her that she would call an ambulance. She couldn’t understand why an ambulance was needed – didn’t dentists deal with teeth? It was only then that she realised that she had broken both of her wrists in the fall. She had not been aware of any pain in her wrist. What had happened? Her brain had carried out its assessment, prioritised her tooth, and turned down the volume on her wrist pain.

Dislocated Knee

The role that the brain plays in the pain experience can also explain how the rugby player, Joe Westerman, could continue to play an important rugby game despite sustaining a dislocated knee in the match.

In June 2019, Joe Westerman was playing for Hull FC in the British Super League (Rugby League). Playing against Hull Kingston Rovers, Westerman’s knee was dislocated when his studs caught in the ground as he was tackled After carrying out ‘an assessment’ – his brain decided that the rugby match was more important than the pain in his knee, and as a result, the volume was turned down on his knee pain and Westerman smacked his dislocated knee back into place allowing him to play on despite his injury!

What all of these stories demonstrate is the fact that the brain seems able to turn down the volume of pain signals when it is distracted, or if it decides that other issues are more important.

Turning Up and Down the Pain Volume Dial 

Scientists can be heard saying that ‘our nervous system is plastic’, by which they mean that it can adapt and change. This ‘neuroplasticity’ is illustrated when a person is recovering from a stroke. After a stroke, brain cells can regenerate, re-establish, and rearrange neural connections in response to the damage caused by the stroke. This is what happens when people who have suffered a stroke recover quite well, even after they initially lose the ability to move certain body parts or speak. The nervous system can adapt and change.

With regard to persistent pain, it has been shown that the more you understand your pain, and practise the skills that help in its management, the more your nervous system can adapt and change – in a good way. Now that we know that pain signals are released by our bodies to respond to what it believes to be a ‘threat’, reassuring our brains that the level of threat is minimal should help to manage the pain.

There are several other ways in which we can turn down the pain volume

  • Very gradual increases in activity and exercise levels can turn the volume down on your pain. When you exercise, your body releases chemicals called endorphins. These endorphins trigger a positive feeling in the body, similar to morphine. The endorphins also interact with the receptors in your brain and reduce your perception of pain. If we can release more of the chemicals that feel good, we are giving our brain information that there is less threat. This reduction in threat can turn down the volume of your pain. I fully appreciate that when you live with persistent pain, it is not easy to become more active or increase your exercise level, so I have dedicated another chapter (Chapter 4) of this book to this.
  • Understanding and education about pain are very helpful to turn the volume down on your pain.
  • A large body of research evidence has shown that mindfulness meditation can turn the volume down (I have written more about that in Chapter 6).
  • The appropriate pacing of activity can turn down the volume (and Chapter 5 is all about that).
  • Relaxation can ‘wind down’ the nervous system and dampen pain messages.
  • Engaging in hobbies can distract and turn the volume down.
  • Socialising and having fun with family and friends can dampen down pain messages.

On the other hand, there are also things that can turn the volume up on your pain:

  • Stress can turn the volume up on your pain.
  • Anxiety about your pain can make your pain worse.
  • Anxiety about life in general (for example, how you are going to pay your mortgage), can turn up the volume on your pain.
  • Low mood and depression have been shown to turn the volume up.
  • Lack of sleep makes pain worse.
  • Feeling angry and frustrated can amplify pain messages.
  • This is just a flavour of some of the things we have learned about pain management in recent years. These topics will be explored in more detail throughout this book.

An excerpt from:

Master Chronic Pain Book

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