Advice from a Certified Hand Therapist on Central Sensitization: Why do I still have pain?

Why do I have pain?

Pain, in its most basic form, is a protective response the body uses to survive. Responses and reactions to pain can vary from person to person. Our brain interprets the signals from our body as either non harmful or harmful (pain). Pain is not always an indicator of damage. For example, recall how painful a paper cut is!

Why has my pain lasted so long?

While pain can be a good, protective response in the body, sometimes our pain experience can last longer or be more intense than a typical pain response to an injury or surgery.

Typically, when we get hurt, say a cut to the finger, our body interprets this as a ‘flight or fight’ response. This response includes increased blood flow, pain, swelling and redness to the area temporarily until the threat passes. This is controlled by something called the sympathetic nervous system. Once the threat passes, the body calms down. As it returns to a normal state, the pain and swelling also decrease.

Think of this sympathetic nervous system as a faucet system. For example, when we cut our fingers, the faucet flow is turned on. Once the threat passes (i.e. the cut stops bleeding), the faucet turns off; however, sometimes our body becomes a ‘leaky faucet’ of sensation, keeping that loop of pain persistent. When this happens, the brain will interpret even normal sensation, such as movement or the air moving over the skin, as pain.

What can be done to help my pain?

Knowledge is power! So, educate yourself on pain. Life stressors can contribute to your pain. Developing healthy coping skills for reducing stress can help manage your pain.

Maybe you’ve heard someone say to you, “Your pain is in your brain.” This is what we refer to as central sensitization. Due to this leaky faucet effect, your brain has heightened sensitivity to threats. Prior to your injury, perhaps an action you never thought anything about now becomes painful even just to think about. Some pain can be reduced by specific exercises to re-map the brain into recognizing appropriate threat levels. A certified hand therapist can evaluate you to determine the steps to take and exercises needed to progress you through this pain response.

More research is coming out to support meditation as a supplement to pain reduction as well. Find a local meditation group or practice on your own at home:

• Simply start with a comfortable seat in a quiet area, close your eyes and begin to count your breaths. Count 10 breaths, then begin again. If you get lost in the count, just begin again. Try not to control your breath; instead, just take notice on the texture, rhythm and temperature of your breath. Perform this counting and recounting 4-5 minutes at least once a day.

Other modalities can be helpful in providing temporary pain relief including heat, ice, contrast baths and electrical stimulation. The clinical training of a certified hand therapist can help guide you through a treatment plan for you. If you have concerns about the length of time and intensity of your hand pain, talk with your hand specialist.

Additional resources for information on pain: https://www.youtube.com/watch?v=3QVAY5stO3U&feature=youtu.be and http://www.noigroup.com.

Kerri Kitchens, MOT, OTR/L, CHT is a certified hand therapist and a member of the American Society of Hand Therapists (ASHT).