Cathy Ruprecht, a physical therapist at UP Rehab who treats chronic pain, explains the complexities of chronic pain — and how to treat it through self-management techniques to attendees of a Your Health talk she gave Wednesday at the Peter White Public Library. (Journal photo by Cecilia Brown)

MARQUETTE — How is it possible to have long-lasting pain when an injury is long healed? Why do some people with severe injuries experience minimal pain, while others experience excruciating pain from minor injuries, or even non-painful stimuli?

While it was thought for hundreds of years that pain was always directly related to tissue pathology, researchers have learned in recent years that tissue pathology can be present without pain — and pain can occur without tissue pathology.

This was discussed during a For Your Health talk delivered at the Peter White Public library Wednesday by Cathy Ruprecht, a physical therapist at UP Rehab Services who treats chronic pain.

“In medicine, we always thought that if you had pain, you must have tissue damage somewhere,” Ruprecht said. “Why else would we have pain? For hundreds of years, we operated on that assumption that: if we have pain, there’s something wrong, we have to fix it.”

While this assumption generally holds up well for cases of acute pain — an immediate, temporary pain that alerts us of tissue damage when we stub a toe or burn a finger — it doesn’t hold up so well for chronic pain, which persists for months or years after a wound has healed, or sometimes even in the absence of tissue damage, Ruprecht said.

This is because chronic pain is fundamentally different than acute pain, she said.

In cases of chronic pain, levels of tissue pathology and pain aren’t always connected — chronic pain can occur in the absence of tissue damage and can be influenced by fear, stress, beliefs and attitudes about pain itself.

It’s important to recognize, Ruprecht said, that pain is processed in the brain — not only in sensory centers, but also emotional and memory centers — which determines how pain is perceived and experienced, particularly in cases of chronic pain.

“With our pain, the body’s saying, ‘Hey, I’m protecting you: there was something here that was aggravating and I let you know about it. And you know what? We started worrying about it, didn’t we? We started wondering about it. We started giving it a little more attention because, dang, we had that there and we made a few trips to the doctor.’ And it still doesn’t go away in spite of our pills or procedures or what we’ve done for it in physical therapy.

So now the nervous system goes: ‘Oh you’re worried about it now too. You make more of those mechanical, and chemical and temperature sensors and not only can you make more of them, you make them more sensitive. Your body gets really good at protecting you. So now, things that wouldn’t normally cause you pain can cause you great pain.”

Chronic pain can essentially be learned and remembered by the body over time. Much like we learn and remember how to type or ride a bike, our bodies can learn and remember the pain from an injury, as well as the accompanying emotional distress, causing the pain to persist long after healing is complete.

“Our body remembers, she said. “And it gets good at reporting (pain).”

While chronic pain can make emotional,mental and physical aspects of day-to-day life challenging, there is some good news, Ruprecht said: “The power is in you.”

“Persistent pain becomes a self-management issue,” she said. “Things that you do for yourself can help calm your nervous system and rewire it to retrain your brain that it doesn’t have to worry so much about that old injury, that old ache and pain — that you can still function quite well and live with it.”

Chronic pain can be self-managed through physical therapy, breathing, stress-reduction and self-distraction techniques, better sleep and exercise, she said.

As a physical therapist treating those with chronic pain, Ruprecht works to help her patients by educating them on pain, providing them with long-term fitness plans and empowering them to manage their pain, all in an aim to break the pain cycle.

Ruprecht emphasized that exercise — particularly cardio — can help reduce pain and calm the nervous system and body by essentially keeping it busy, reducing stress hormone levels and increasing levels of neurotransmitters such as serotonin, dopamine and norepinephrine.

While it can be difficult to get started on an exercise routine, Ruprecht emphasized that it pays off it terms of less pain, less stress and anxiety, better sleep and improved health. She encourages people to start off with small steps and gradually work up to exercising more.

Beyond exercise, she recommends consistent bed and waking times, avoiding electronics in the period before going to bed and keeping your room dark and quite to get more sleep.

Deep breathing, positive thinking, meditation and other stress reduction techniques are also helpful, she said, as these techniques can calm the nervous system.

Learning more about pain and how it’s processed is also key, she said, noting researchers have found pain education can help reduce chronic pain.

“We’ve learned by teaching people what pain is and isn’t, we can reduce your fear of it. And we can see that by your functional MRI,” she said.

Overall, she emphasized that it’s important to understand that chronic pain comes from the brain — and the brain can be retrained.

“Your brain got really good at focusing on pain. We can change that. We can have it focus on new things and learn new strategies to help make you feel better,” she said.

To learn more about UP Rehab Services’ chronic pain program and other services, call 906-225-5900.

For more information and resources on how to understand and self-manage chronic pain, Ruprecht recommends visiting https://www.retrainpain.org.

Cecilia Brown can be reached at 906-228-2500, ext. 248.