WHEN PAIN BECOMES CHRONIC
Pain is our most loyal guardian, always keeping a watchful eye out for us. More than anything, it wants to keep us safe, protected, and out of harms way. Just imagine a life without it - we would be constantly discovering cuts, burns and bruises on our bodies! Having a pain response is vital for our survival as it prompts us to stay clear of danger (most people don’t like being in pain, so we do what we can to avoid it!). It encourages us to act in ways that promote our well being (i.e. putting down the hot lasagne tray, moving the foot off the sharp Lego piece), rapidly change our course of action when needed in order to prevent any significant tissue damage from occurring.
The pain pathway works via signals which are sent from the pain-specific sensory receptors, known as nociceptors. These signals travel up the nerve fibers, through the spinal cord and into the brain, where the information is processed and the brain decides on an appropriate response (pay particular attention to the wording “the brain decides”…). The command is then sent from the brain to the muscles in order to execute a response that returns us to safety and relieves the pain.
In the instance of an acute injury such as a sprained ankle, pain signals persist beyond the initial moment of injury because there is damage to the tissues which elicit a chemical, inflammatory response. This encourages us to immobilize / rest that area in order to allow the chance for the tissues to repair themselves. As the inflammatory response resolves and the body completes it’s patch work process, the pain also resolves. For some people however, this may not be the case and a pain response may continue in the absence of true, ongoing tissue injury.
In theory, all tissue damage should heal within 3 months, assuming it is not being repeatedly re-injured. If pain persists beyond this, it gains the classification of ‘chronic pain’, and things can start to get a bit more interesting…
Back to the brain for a moment. The information being sent from the pain receptors is processed at the brain, but also in conjunction with a broader span of information relating to the external and internal cues of the environment. The brain is constantly seeking information to detect elements of risk or danger around you, making sure that you are safe. If it determines the presence of danger, even at a subconscious level, it can become hyper-vigilant and on high alert. And when it comes to pain, this means that sometimes the normal, non-threatening sensory feedback can be misinterpreted as pain, and pain signals can become amplified.
When I say that the brain “decides” on a response, I don’t mean that you are making a conscious decision to respond to the pain in one way or another. I am not saying that pain is a choice! Rather that the brain is the ‘central processor’ of all the input signals being delivered, as well as being responsible for executing the response. Pain is - in a literal sense - “in the head”, but not “in the mind”, if that makes sense!
Many people suffering from chronic pain will find that their symptoms are worse under times of stress, such as when under financial pressures, relationship stress, the death or illness of close friends of family. Our thoughts, expectations around pain and understanding of the pain can also have a huge influence on the pain experience. The brain interprets all of this information collectively before determining it’s response. And if our brain is primed and hypervigilant to pain, or if our brain believes that movement is unsafe, then it is quick to trigger the warning bells (pain signals) to keep us “safe”. Our psychology and belief systems relating to our pain carry so much weight in the case of chronic pain that pain education often takes center stage in recovery.
Exercise can play a vital role in pain management by providing a form of natural analgesia (pain relief) via the opioids released post exercise. As well as the biochemical benefits, a well designed exercise program can allow you to gently re-introduce movement in a non-threatening way. When coupled with a pain education approach, we can retrain the brain to accept movements as being ‘safe’ once again, thereby gradually unraveling the pain response!
Chronic pain is a prime example of the fact that the mind and body can not be considered as distinct entities. Our emotions and psychology impacts on our physical sensations, and our physical sensations impact on our psychology and emotions. People must therefore be treated holistically - taking into account the psychological factors as much as the biological.
This blog was originally written for Specialised Health, an Australian / NZ based exercise physiology provider. To check it out, as well as heaps of other awesome content, head over to https://specialisedhealth.com.au/ .