Pain - part 2
Ainslie graduated from the New Zealand School of Physiotherapy in 1974 and has been a Member of the New Zealand Society of Physiotherapists (NZSP now called Physiotherapy NZ) since 1975. She completed a Diploma of Educational Studies in 1980 and an Advance Diploma Physiotherapy specialising in paediatrics in 1990. She has been an associate member and later a Member of the New Zealand College of Physiotherapy since 1990. She has also served on the College Board and various NZSP branch committies over the years. Currently she is a Member of the NZ College of Physiotherapists with Advanced Practitioner status in Paediatrics, a Member of Physiotherapy New Zealand and also a member of the neurology and paediatric special interest groups. And holds a current NZ Annual Practising Certificate.

Balance and Co-ordination
Balance and co-ordination may be affected directly or indirectly as a result of an injury. To protect a part that is sore we alter or position and our way of moving. This has an impact on our co-ordination and our balance. Our awareness of our position in space is determined by information from joints and muscles as well as our eyes and the balance mechanism in the ears.
When we have pain we will often use muscles for tasks they were not designed for because of weakness of inhibition of the muscles affected by the injury or its after effects. For example muscles designed primarily for moving a joint may be used as postural muscles instead of the postural muscles designed to stabilise an hold the body upright or vice versa.
Postural Misalignment
When we have pain we adjust our posture to try and minimise the pain. This will over time lead to changes in our posture and the overall alignment of our body. In this way the stress of a localised area is transmitted to the whole body and very rapidly what started as a local problem becomes a whole body problem.
Inflammation
Inflammation or swelling is a normal response to damage. In part it is caused by the extra fluids released into the tissues by the original damage to cell walls. In part it is the body’s need to bring the cells and fluids that will repair of damaged tissues. For a variety of reasons it may remain present long after the damaged tissues have been repaired.
Mirror Neurones
Mirror neurones are cells in the brain that mirror information from one side of the body to the other and also allow us to copy movements and behaviours etc we see in others. The presence of these neurones may cause symptoms initially experienced on one side of the body to be mirrored to the opposite side especially if pain lasts for a long time.
Smudging
In various parts of the brain it is possible to ‘map’ the link between certain brain cells and a corresponding body part. In chronic pain or recurrent pain states this ‘map’ changes significantly. Where in a person without pain the brain cells relating to an individual body part can be clearly defined, the person with chronic or recurrent pain will have a greater overlap with cells that would normally be related to an adjacent body part firing. The number of brain cells relating to the part may also decrease. For example a typist with ‘occupational overuse syndrome’ (or ‘repetitive strain injury’ as it is sometimes called) may have a single group of cells that all respond to stimulus from any finger while someone without the syndrome will have a separate groups of cells each of which responds to one individual finger.
Smudging occurs in many different chronic or recurrent pain states.
Laterality
With severe or repeated injury and long standing pain some people experience a decrease in their ability to recognise their affected body part. Their ability to separate and recognise right and left sides of the body may be altered. Touch sensitivity and the ability to identify the difference between being touched in two places from being touched in just one place may be diminished.
Fight Flight Mechanisms
The body produces chemicals to help us escape from danger by freezing, fighting or fleeing. Normally these chemicals are in balance with those associated with rest and restoration. In chronic pain this chemical balance can be disrupted and either set of chemicals may be over produced causing a long standing response instead of the more appropriate minutes or hours response. This chemical imbalance will have many different effects throughout the body.
When the effects of injury described above are treated and the protective nature of pain is understood it is possible to desensitise the brain and nervous system and eliminate pain that is not truly warning of danger. This can be thought of as resetting the system to the pre injury state.
Fatigue
As a result of chronic pain and the direct effects of pain on sleep patterns we often suffer from fatigue when we ire experiencing pain. We may also suffer fatigue more indirectly from the effort to move using stiff joints or inappropriate muscles. The fear of pain also causes fatigue.
Fatigue will also cause pain when muscles tire and fail to support the joints adequately allowing for collapse of the skeletal system and pressure to come onto structures not designed to absorb those stresses over long periods of time.
Psychological Effects
When we experience pain whether it is relatively minor and short lived like a cut finger or more serious and longer lasting like arthritis we experience loss with its associated grieving process. The pain of a cut finger causes us to loose the freedom to use our hand automatically and freely. If we unthinkingly reach out to grasp or manipulate something we feel pain as the edges of the cut are stressed. This causes us to pause and think before we repeat the activity and places limits on what we do. Whether we recognise it as such or not these limits are a loss of freedom of movement and response and lead to a grieving process.
The grief that is associated with pain is frequently not recognised as such and may be ignored as the more obvious aspects of the injury or limitation overshadow the symptoms of the grief process. Chronic depression and other significant psychological changes may result. These changes may last longer than the pain especially if the loss caused by the pain is not seen as the initial precipitating factor.

Herald Issue 554 09 March
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