Understanding your pain

Understanding the pain you are experiencing is one of the paths to relief.

It is important to understand that, although you are in pain, you are not doing any physical harm to yourself.

This is a crucial point for people with AS because the main form of treatment is exercise. Over the short term, exercise can sometimes increase the sensation of pain you are experiencing. However, over the long term, regular exercise will benefit you in terms of increased fitness, strength and mobility. All of these will reduce your experience of chronic pain.

What is pain?

Pain is generally divided into two categories: acute and chronic

Acute pain is usually short-term, lasting anything from a few seconds to a few hours or a few days to a few weeks. Acute pain acts as a warning signal that alerts you to possible injury. Some types of acute pain such as back strain or headache may be relieved without any medical treatment as the pain will ease off by itself. Other types of acute pain will be more serious, such as appendicitis, and will require swift medical attention to correct the problem and relieve the pain.

Chronic pain, is pain which occurs on most days and lasts for anything from 3 months to many years. AS is associated with the experience of chronic pain. In AS, the intensity of chronic pain varies within and between people. For example, many people report that they have good days where the pain is minimal, and ‘flare up' days or weeks where the pain is at its most severe.

Different types of chronic pain

Nociceptive ( pronounced: no' si' septive) pain occurs when there is damage to tissue. Nociceptive simply means ‘causing pain'. AS is an example of nociceptive pain.

Neuropathic pain results from damage to the nerves, spinal cord or the brain. A common example of neuropathic pain is shingles, which occurs after an infection with the chicken pox virus. The pain experienced is often described as a burning sensation, a sharp pain or tingling feeling.

Many chronic pain conditions can involve a combination of nociceptive and neuropathic pain.

How we feel pain

There are a number of structures within the body which contribute to our sensations of pain. Within our bodies there are millions of sensors called nocireceptors.

Nocireceptors are, simply, sensory receptors which respond to pain and painful stimuli. When tissue has been damaged, messages are sent along the nerves to the spinal cord.

The spinal cord plays a very important part in our perception of pain. The spinal cord is a collection of specialised nerves and cells that lie within the spine. At the base of the skull the spinal cord is connected to an area we call the brain stem, which is the lower part of the brain. Not every pain message reaches the brain, however, all messages reach the spinal cord which is where some messages may be blocked.

The brain is the main structure involved in the way we try to make sense of pain. The brain helps us to judge where the pain is coming from, which reaction to take towards the pain and how we experience pain. The brain is also the structure where thoughts, anxieties and emotions about pain may start. 

Pain theory

In 1965 two scientists called Professor Melazack and Professor Patrick Wall, suggested that there was a ‘gate' within the spinal cord which allowed messages to pass through to the brain.

This ‘gate' could close in response to other messages sent through the spinal cord. An example is messages sent by the nerves that respond to pressure or touch. Once the ‘gate' is closed pain messages will not reach the brain and the sensation of pain will not be experienced. It is easier to understand with an example.

If we bang our elbow we tend to rub it. This is almost an automatic response. The sensation of rubbing our throbbing elbow takes away or lessens the sensation of pain by striking other nerves which results in the gate closing.

A key thing to remember is that we cannot make the ‘gate' open or close. However, when the brain receives other messages or signals, as in the above example, the pain becomes less intense.

Routes to pain management in AS

In AS pain is managed through a combination of painkilling medication and appropriate exercise. Your first port of call regarding medication is either your GP or your rheumatology team. If your rheumatology team have problems controlling your pain they might suggest referring you on to a pain clinic.

There are around 300 pain clinics in the UK. Most are located in hospitals and have teams of staff from different medical areas, including occupational therapists, psychologists, doctors, nurses and physiotherapists. They all work together to help people with pain.

Pain clinics vary but usually offer a variety of treatments aimed at relieving long-term pain, such as painkilling drugs, injections, hypnotherapy and acupuncture.

You will need to be referred to a pain clinic by your GP or hospital consultant.

Pain management techniques

There are some pain management techniques that are used in pain clinics that can help reduce the intensity of the pain you are experiencing.

Learning to relax

Learning to relax is something that everyone can benefit from. The feeling of being relaxed and calm can benefit many aspects of life including; sleep, concentrating on complex tasks and reducing tension and stress. If you are in pain, relaxation is even more important.

Pain can often result in a lot of muscle tension. The more tense you are the more likely you will feel the pain getting worse. Learning to relax can help reduce tension and help stop pain getting worse.

Pain can often make you feel upset, anxious and helpless and consequently make it harder to manage the pain. Learning to relax will help you feel more calm and in control regardless of the pain.

Pain can affect your ability to sleep. Learning to relax can help you get to sleep and make it easier to get back to sleep if your pain wakes you.

Breathing correctly is a vital part of relaxation. The aim of breathing correctly is to fill your lungs with air as effectively as possible. As you breathe in a muscle called the diaphragm should push your tummy out allowing your lungs to expand and collect all the air.

Exercise: Put one hand on your chest and one hand on your stomach. As you take a deep breath try and keep the hand on the top part of your chest still, while pushing the hand on your stomach out. If you are using your diaphragm to breathe, you should not need to use your shoulders or chest, and this can help to relieve tension around your neck and shoulders.

Muscle relaxation

First of all find yourself a comfortable lying or sitting position and close your eyes if you wish.

Stage 1

Take a deep breath, hold it for a moment and then let it out slowly.

As you breathe out let your body go as loose and floppy as you can.

Take another deep breath and again breath out slowly.

Now return to normal breathing. Try not to take too many deep breaths in a row as you can become dizzy.

Stage 2

When you feel ready try and let go of the tension in the muscles of your face, neck, shoulders, arms, hand and legs. Go through each body part one by one.

As you let yourself relax try and let go of your tension each time you breathe out.

Try and imagine that every time you breathe out the tension is just flowing away.

Stage 3

Whilst you are relaxing your muscles try to repeat the words relax or calm to yourself.

Try picturing a relaxing, peaceful or happy scene such as a holiday you have been on.

If you find it hard to imagine a scene then focus on a particular part of the room and stare at it in a calm way.


Remember:

Learning to relax is a skill and like any other skill it requires some practice to get it right. So be patient with yourself. Try practicing these techniques every day and you will soon notice that you are getting better and better. Eventually you should be able to do these techniques anywhere that you need to; on a bus, in the office or when you are walking.

Pain distraction techniques

Distraction techniques can be a useful way to help you cope with your pain. They don't take away the pain completely but can help take the edge off it. At the very least distraction techniques can help you take your mind off the pain. The more senses you use whilst practicing these techniques the easier you will find it to block out the pain signals.

Taking your mind away from the pain

Close your eyes and think of a pleasant, happy or relaxing scene. Maybe you are in your garden on a warm sunny day or on a beach on a tropical island. Now imagine that you are really there and focus on;

What can you see?
Are you alone? 
Who is there with you? 
What can you smell? 
What can you hear? 
Do you feel warm? 
How do you feel?

If you are looking forward to an event such as a holiday or a dinner party with friends, try planning what you will do. Go into every detail and focus on all the pleasant aspects of the event. Concentrate on the visual aspects of the environment you are in. Now try to describe to yourself things that you see, for example, the wallpaper, carpet pattern, what people are wearing.

Play word or number games in your head; such as counting backwards in 3's or creating anagrams from the names of people you know.

Read a book or listen to music and try hard to focus on words and the story they tell.

Focusing on the pain

Imagine that you can see your pain from a great distance away. Do not think about how much it hurts but just focus on describing it to yourself. What are the sensations, where are they coming from. It is almost as if you are observing the pain from someone else's body. Try not to get upset about the pain. Instead try and describe it as if it does not belong to you. This technique can be helpful whilst practicing your relaxation.

Try imagining your pain as a shape with colour, texture and sound. Focus hard on this shape and try and make it smaller, lighter, softer and quieter until it floats away.

Some people find it easier to ‘re-label' their pain by imagining it as something other than pain or distress. For example if the pain is warm and throbbing it may feel similar to how you feel when the hot sun is on you.

Last reviewed: June 2010