Chronic Pain is defined as persistent pain which lasts from weeks to years even after the tissue injury has healed. This pain is caused by the brain as the nerves become hypersensitive and thus give constant signals from different areas of the body to the brain. Brain continues to perceive that as a threat and then continues to generate pain. The goal to resolve chronic pain is to rewire the brain and nervous system by looking at a broader perspective on all the factors contributing to sensitivity in the nervous system and the brain and with that awareness working on all different contributing factors at the same time to rewire and get back to living an empowered life.
The most common treatment for chronic pain currently is pain medications, electrical stimulation, acupuncture, cognitive behavioral therapy or surgery. All these treatments are just useful as symptom relief rather than really guiding the patients to find the root cause of the pain so that there is more awareness and thus less dependency on all the temporary methods to mask the symptoms.
Different factors leading to chronic pain :
Fear and Catastrophization
Pain due to faulty cognitions like fear and catastrophization (inability to foresee anything other than the worst possible outcome, however unlikely or experiencing a situation as unbearable or impossible when it is uncomfortable). Both fear and catastrophization lead to patients unable to move, in turn affecting every single system of the body and most importantly circulation leading to worsening of symptoms.
Example : Injury causes Pain experience (stress, anxiety, depression, etc) which leads to pain catastrophization that causes pain related fear which leads to avoidance and leading to disuse, depression and disability.
2. Impaired beliefs
A lot of impaired beliefs like :
Pain is always bad.
All pain must be gone before engaging in normal activity, movement and therapy.
Passive treatment is the answer
Pain will increase with any or all activities
Work is potentially harmful
Negating emotions like fear of increased pain, depression, irritability, anxiety and stress
It is very common for people in pain to get into poor behaviors like extended rest, poor compliance, extreme pain ratings, excessive reliance on aids/devices, sleep irregularity, high intake of alcohol, drugs, medication and smoking
It is very hard for patients to make health cognitive decisions if they have family members who are very overprotective or helicopter parents who are overindulgent in a child’s life leading to lack of resilience to face pain.
People who are manual workers have a poor work history, belief that work is harmful, unhappy at work, low educational background, night shifts, negative previous experience at work with pain, lack of financial incentive to return to work, extended time off, previous history of injury/pain (mold exposure, low back pain, etc)
7. Diagnosis and Treatment
People who get sanctioned disability, conflicting diagnoses from different doctors, passive treatments, number of healthcare providers, and general statements like “If it hurts - Don’t do it”
A lot of healthcare providers think pain = tissue injury and injury = pain. There are two examples that prove this wrong.
1. A man found with a nail in his skull after 4 years :
This man never realized until the X Ray was taken that he shot himself in the head with the nailgun.
2. A contractor with a nail in his boot :
On the contrary, This contractor while he was walking saw the nail piercing his boot and screamed out of excruciating pain. He was rushed to the ER and when the Drs. cut the boot they realized the nail never hit his foot but went through between his toes.
These examples simply show how pain does not equal tissue injury nor injury equals pain. The power lies within an individual. The more you are aware of what factors might be involved in your pain the more control you have to take charge of those factors and heal yourself.
In the following articles I will address what happens physiologically within different systems in the body with chronic pain and how multidisciplinary approaches including manual therapy can help rewire the brain and the nervous system.