How to Break the Chronic Pain Cycle and Conquer Your Pain

March 24th, 2021  by  Bijal Toprani – Doctor of Physical Therapy at Hinge Health

Meet Eddie. Eddie is a 50-year-old father of two who works as an accountant. He got into a car accident on his way home from work. No one was hurt, but he had back pain after the accident. He became afraid to bend over. He stopped gardening, canceled his plans with friends, and stopped working on his car. He didn’t want to hurt his back more. The next thing he knew, it had been months and he was still avoiding moving. Why? Because he was afraid.

Eddie’s lack of movement caused him to lose some strength and flexibility in his muscles. Tight and weak muscles don’t make for very comfortable bodies. Since Eddie was uncomfortable, he stopped participating in his weekly poker game. He began to be anxious and sad as he thought about how his relationships with his friends were becoming more distant. Now he’s having unwanted thoughts like, “I’m never going to be able to work on my car without pain again.”

Eddie is stuck in what we call the persistent pain cycle.

Stages of The Pain Cycle

If you or your employees are dealing with chronic pain, it’s important to understand the 5 cycles of chronic pain.

What we now know about chronic pain is that it is not caused only by your car accident five years ago, the hit you took in your high school football game, your job lifting boxes, or sitting in an office chair eight hours a day.

We know that chronic pain is caused by several factors. And that the pain you feel could be due to being stuck in the persistent pain cycle. The good news is, there is a way to break out of this cycle. Here are some questions for chronic pain sufferers to ask:

  • Am I stuck in the pain cycle?
  • Where in the cycle am I stuck?
  • How do I get out?
  • What will I do when I break free of this cycle? Garden, fish, meet my friends for dinner more?

The 5 stages of chronic pain and how to overcome them

Here are the five stages of the persistent pain cycle and how to overcome them and break the cycle.

1. Fear of Injury

Unfortunately, the first thing that happens when people suffer from chronic musculoskeletal pain is they fear injury. This means they stop moving or exercising to avoid hurting themselves. But this lack of movement can spiral down and actually cause more pain.

Tip: Experts know that most injuries heal within three months. So if you or your employees had a musculoskeletal injury that occurred more than three months ago, it’s probably safe for you to move. Hurt does not equal harm, so although your pain is real, it doesn’t mean that something is wrong.

Our bodies are strong and resilient. The idea that resting for pain relief is what we need to heal is a common misconception. But that draws us further into the pain cycle. So remember, our bodies are resilient. If you were injured more than three months ago, your tissues have probably healed. Movement is safe even if you feel discomfort.

2. Decrease in Activity

As mentioned above, when people suffer from chronic musculoskeletal pain, they immediately reduce their activity to avoid pain. But the opposite is actually the better approach.

Tip: MOVE. Movement is actually important to the path of recovery. It helps muscles remain flexible. Early exercise is vital for restoring balance, function and the development of strength and endurance in injured tissue.

Movement doesn’t have to be vigorous exercise it can be daily movement built into your day. Fishing is exercise. Walking is exercise. Going to the zoo with the grandkids is exercise. Parking farther from the entrance at the grocery store is exercise. Taking the stairs instead of the elevator is exercise. These are all ways to move more.

3. Muscle and Flexibility Loss

If you fear injuring yourself and you stop moving, what happens is you lose muscle and flexibility. This actually leads to further weakness and pain in your joints.

Antidote: All the ideas above work if you're stuck in this section of the pain cycle. Here are a few more:

  • Perform five squats during each TV commercial break
  • Play your favorite song and have a mini dance party
  • Do heel raises at the counter while you cook
  • Stand from a seated position without using your hands
  • Do yoga with online videos for flexibility

4. Increase in Pain

Lack of movement and loss of muscle and flexibility, ultimately leads to increased pain. You must reverse this trend to overcome your chronic pain.

Tip: Remember, hurt does not equal harm. You can cope with pain in both active and passive ways. Slowly adding in exercises each day can gradually help build up your strength. This is what I prescribe as part of my physical therapy program for Hinge Health participants. I create a personalized and gradual approach to exercise therapy for each participant. I tell my participants that it is OK to feel a small amount of pain as you work through your exercises.

Here are some active ways to control pain:

  • Physical activity
  • Stress management techniques
  • Seeking education from healthcare professionals about how you're feeling and why

And here are some passive methods of pain control:

  • Wearable technology for pain management that is non-invasive and non-addictive
  • Ice and hot packs
  • Massage

Combining active and passive methods is the best way to treat pain. Passive methods don’t address the root of pain, but they help manage symptoms, so you can start to move again and make key lifestyle changes to reduce your pain over the long-term.

5. Unwanted Thoughts, Depression, and Anxiety

Finally, the last stage of the persistent pain cycle is unwanted thoughts like depression and anxiety. As your pain spirals out of control due to lack of movement, you will likely feel depressed.

Tip: Change your thoughts and beliefs to change your pain. You can change your thoughts and beliefs through reframing. Here are some examples:

  • “I can’t pick up my grandkids; it’ll hurt my back.”
    • Reframe: My back is strong.
  • “I’m never going to join my buddies on the basketball court again; my knee can’t handle that.”
    • Reframe: I’ll shoot around with my friends and see how my knee feels.
  • “My shoulder is messed up; I can’t even reach cans in my kitchen.”
    • Reframe: I wonder what would help my shoulder feel better. I’m going to find out what movements feel good and start moving more.
  • “I don’t want to constantly worry about making the wrong move and injuring my back.”
    • Reframe: There is no right or wrong way to move. My next position is my best position.

You and your employees suffering from chronic back and joint pain can all break out of the persistent pain cycle. So let's get moving!

As a physical therapist at Hinge Health, I work closely with participants to create a personalized exercise therapy plan that gradually builds strength and flexibility. I also team up with their personal Hinge Health health coach who helps them work through changing their mindset, stress, diet and other behavior and lifestyle changes that are equally important to resolving chronic pain. Your physical pain is not isolated from the rest of your body. If you are an employer, to find out more about Hinge Health, request a demo below. If you are an employee, ask your benefits leader if you have Hinge Health.

Hinge Health’s complete clinical model combines 1-on-1 video visits with dedicated physical therapists & health coaches and technology to more effectively reduce chronic back and joint pain at lower spend. To find out how Hinge Health can help you and your members improve outcomes at lower spend, request a demo below.

Bijal Toprani
About the Author

Dr. Bijal Toprani is one of Hinge Health’s physical therapists. She is originally from California and earned a BA in sociology from UCLA and a doctorate of physical therapy from A.T. Still University. She is a movement specialist and an experienced physical therapist with 10 years of combined experience in the fitness and physical therapy industries. When she’s not working, she’s an avid reader and podcast junkie.


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