Solving the Persistent Pain Puzzle PART 3: Does Persistent Pain Go Away If I Wait Long Enough?

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No!  That’s why it’s persistent!  Rest may help things settle, but doing nothing does not eliminate the underlying causative factors.  Science supports this concept, with the natural history of low back pain being that 75% of first time back pain sufferers will still have their pain or have recurrence of their pain after one year.  This number rises to 85% by three years.

 

One of the all-time great practitioners in manual and rehabilitation medicine, the late Dr Vladimir Janda, made the observation that in persistent pain, the underlying causes have been present for years, usually more than a decade, before you begin to feel pain.  So by the time you actually start to feel sore, the causes have been building up for a long time.

 

Now you might ask “how could that happen and I not notice the problems building in my own body?”  One example would be weakness, where you very slowly lose muscle strength in a particular area (a common area would be the abdominal muscles in low back pain).  The strength didn’t suddenly vanish on you overnight – if it did you’d really notice and wouldn’t believe the impact it has on your body (think of a person who has had a spinal cord injury where they suddenly can’t walk – a pretty noticeable impact on your function).  What normally happens is that for various reasons, the muscles gradually lose strength so that on a day to day basis you don’t notice the loss, but if you were to compare your strength now to say 5 or 10 years ago, you might look back and think: “yeah, I was definitely stronger back then”. 

 

I often say to patients “If I could wave Harry Potter’s wand and make you instantly up to full strength, imagine the difference in pain – but because the weakness has been here for years, and because strength gains occur over months not days, it will take a little while to get strong and prevent your pain recurring”.

 

So the real reason that persistent pain persists is that the underlying causes persist unless you do something about them.  This part is not rocket science!  Upcoming posts will talk about how to find and treat these elusive causes.