In part two we discussed the concept of central sensitization and how over time a smaller and smaller stimulus was necessary to create the same pain experience.
Another process that occurs as chronic pain continues is a gradual loss of body awareness. What I mean by this is your ability to really feel that part of your body. Your ability to relax a muscle or to activate a muscle or make very smooth or minute movements are all a function of your body awareness. As chronic pain continues and your body awareness decreases muscle tone (muscle tension) around that area begins to distort, so you have hyperactivity of some muscles and inhibition of others. This changes your biomechanics during movement and adds additional stress to the area already in pain.
In addition, poor body awareness alters your autonomic nervous system output to that area. So the same area that you can’t feel very well (even with the peripheral nerves being intact) is also going to sweat more and have decreased blood flow further delaying the healing process.
An enormous part of my treatment plans are purely for the purpose of improving body awareness. Improving patient’s abilities to feel the tension they’re holding, to relax that tension and how to move smoothly and fluidly. As this is happening, patients often immediately feel a rush of blood flow to that area that was previously being denied and often the pain experience diminishes considerably. Often, they’ll say that that body part “feels alive” for the first time in ages.
And last, which we’ll discuss in part 4, poor body awareness can directly amplify pain independent of all the other factors mentioned. Another reason why it’s such a priority in my treatment plans.