Pain is an unavoidable part of our daily living. Everyone feels pain at some point during the day, some that last for few seconds and others that last a long time. Why does pain sometimes go away quicker while other times it takes a long time? What determines the intensity of pain?


The International Association for the Study of Pain defines pain as “ An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”

There is acute pain and chronic pain.  Pain is a protective mechanism which lets the body take an action against potential damage. The pain that you feel when you are sick or injured is a good thing, it helps your body understand about a potential damage and body will be able to take necessary measures to deal with it.


These types of pain will fade away as soon as you feel better or the potential /actual damage is healed. This is acute pain.


Persistent pain, also known as chronic pain, is the pain that persists even beyond the normal healing time. This pain has no direct connection with physical damage. It does not actually warn your body about any potential damage, so this is more like a false alarm.  Persistent pain can affect one part of the body as in Complex Regional Pain Syndrome, low back pain, pelvic pain, or it could wide spread in the body as in fibromyalgia.

Persisting pain/chronic pain is a very complex situation and is not very easy to treat. But there are many ways to treat/manage persistent pain.


Pain characteristics:-

Pain is subjective. Pain has an intensity which can be graded on Numerical Pain Rating Scale ( NPRS) where ‘0’ is no pain and ‘10’  is the most pain imaginable. Pain also has a character like sharp, dull, burning, throbbing or aching.


How does your body respond to pain?

Nociceptors are special nerve cells that detect signals and chemicals from damaged tissue and  transmits these signals to your spinal cord and up to your brain. This is where these signals are analyzed and pain is perceived. Then the brain will initiate the necessary mechanisms to prevent further tissue damage and to help you to cope with pain. Though this system is similar for everyone, it’s efficacy and sensitivity determines how much you feel the pain and cope with pain. That is why some people feel more pain than others and that is why some develop chronic pain that does not respond to treatment easily while others respond well. This variability in pain brain circuits is important when it comes to treatment for the pain that you are suffering from. Studies have shown that people suffering from anxiety and depression suffers more intensity of pain.


Management of pain:


There are many options for pain management like medication, therapies and mind body technique. Management of acute pain is very easy, acute pain can be effectively managed with medication, exercise, heat/cold therapy and pain gets better once the physical injury/illness heals.


Management of persistent pain is a challenge and it takes time. Biopsychosocial model is a widely accepted model of assessment for persistent pain which considers 3 aspect of the person suffering from persistent pain. The biological aspect is a thorough physical assessment to identify potential physical damage, psychological aspect analyses the aspect of anxiety and depression, social aspect addresses the home and work environment and its effect in the nature of pain. Detailed subjective description of pain, nature of pain, variation of pain during the day and with activity etc. will help the healthcare professional trying to help you manage the pain better.


A combination of medicationn, exercise and education will help in proper management of pain.
Graded exercise routines; where people slowly increase the amount of general exercise they perform to re-condition their muscles, over weeks and months, have been shown to help people with persistent pain. These graded exercise routine has to be done under supervision for your healthcare professional.


 Written By: Ann Pulprakkuzhiyil PT, BSc.PT

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome (CTS)  is a condition of the wrist which presents with numbness and tingling in the thumb, index, middle and ring  finger in the early stages.  In severe cases it could be pain and/or weakness in the same area.



The small bones in the wrist and the ligaments connecting them makes a tunnel, through this tunnel goes some of the tendons to the fingers and a nerve called median nerve. The median nerve takes care of the sensation to the fingers except the little finger and it also helps the fingers and thumb to move.


This tunnel is very narrow and tight, so any swelling of the tendons will cause severe compression of the median nerve resulting in symptoms in the hand.


Factors that causes the symptoms of CTS:


Repeated manual activities

Repeated exposure to vibrations

Acute inflammatory situations like sprain/strain or fracture

Underactive thyroid gland

Pregnancy and secondary water retention (very common in the 2nd and 3rd trimester)

Inflammatory diseases, eg. Rheumatoid arthritis




The early signs of CTS are numbness and tingling in the thumb, index, middle and ring finger at night during sleeping. Patients often complain of waking up at night/early morning with numbness tingling which goes away when they shake/move their hand.  Later these symptoms become more prominent and happen while holding something like a phone, cutting vegetables or typing. As symptoms worsen, patients experience intense pain in the median nerve distribution area with muscle wasting prominent in the thenar muscles which is

the bulky muscle sitting at the base of the thumb which is responsible for thumb movements and a strong grip. Weak grip with weak thumb movements are also symptoms.



Your family doctor or physiotherapist will be able to diagnose CTS from the history and onset/presentation of symptoms. There are orthopedic special tests that can be done easily to confirm the diagnosis. Tests like nerve conduction study, electromyogram or MRI of the wrist will also help in proper diagnosis of the condition.


Not all conditions where there is numbness of the hand is CTS. It is very essential to rule out other possible cause of CTS symptoms like; impingement of the median nerve at the neck or elbow, brachial plexus injury, thoracic outlet syndrome or early signs of multiple sclerosis.




Treatment for CTS should be started immediately once your doctor has ruled out other possible causes of similar symptoms. Patients with early stages of carpal tunnel syndrome can be treated conservatively with the use of a wrist brace worn at night, NSAIDs, and physiotherapy. A physiotherapist will help the patients with activity modification, advice on how to use the brace, tendon and nerve gliding, carpal tunnel mobilisation and proper exercises to be done. They can also help you with tips on how to prevent carpal tunnel symptoms from developing.


In severe cases, patients will be referred for surgical management to decompress the median nerve at the carpal tunnel.




Proper posture while working, ensuring proper wrist position at work, stretching of the forearm muscles and maintaining the strength/endurance of the forearm muscles, taking frequent breaks while performing repetitive manual activities etc. will help in preventing the CTS from developing. An ergonomic assessment of your work station will enable in maintaining a proper natural position of your wrist at work.