Pain is unavoidable, it’s something that we’ve all felt before. It’s actually really important that we do feel pain, it protects us. But sometimes when we have an injury, the pain doesn’t just go away! A recent study found that 50.2 million people reported pain on most days or every day. That means 1 in 5 people are dealing with chronic pain right now! That’s a lot, right?! Let’s take a look at why this is…and most importantly, how to get rid of it!
When is pain GOOD? Wait...what?
I know, nobody likes pain. But believe it or not, we need it! Pain is our alarm system alerting us to the potential for tissue damage if we don’t take action. For example, if you touch a hot stove…it hurts. That tells you to get your hand away or there will be more damage (burning) to your skin. Or if your stomach hurts really bad. That’s your alarm telling you to go to the doctor before more damage happens, like your appendix bursting. See how pain can be good? It's our built-in warning system... it keeps us alive! It’s meant to protect us, and for the most part it does a good job. But sometimes our pain system goes a little haywire. The alarm keeps going off even after the tissue damage has healed, and even starts going off on its own! Let’s take a look at why this happens, and why 20% of the US population struggles with chronic pain!
How does chronic pain start? When the system fails...
When we strain a muscle or joint, for example, the nerves at the injury site send pain signals into our spinal cord and up to our brain. Our brain processes these signals and will produce the sensation of pain. That process takes a split second, which is why there's a brief delay between the time you stub your toe until the pain sets in! In this example, our brain will soon realize no actual damage has been done (usually), and within minutes stop producing the sensation of pain.
But when we have a more significant injury, these signals are sent over and over again. When that happens, chemicals will build up around the pain nerves along the whole pathway. This causes them to become more and more sensitive. Which means it takes less and less of a stimulus from that muscle or joint to set off the nerve and feel pain! So even when the injury heals, the pain nerves are still being activated by things that aren't supposed to be painful. The pain nerves are like toddlers...they have a low threshold, it doesn't take much to set them off! The fancy name for this is called ‘central sensitization’. And it's not good.
This would be like your smoke detectors in your home going off every time you cook. A little bit of steam and smoke is normal. It doesn’t mean the house is burning down! But the smoke alarm system is going off anyway. The same thing happens in your body with chronic pain. Things like massage or even light touch become painful, clothing or bed sheets can hurt! The pain pathway is too sensitive and the alarm is going off after very little stimulus. Even when we know light touch doesn’t actually damage anything, it still hurts for some people! This can be a frustrating process for anyone experiencing chronic pain. But just know, it’s not all in your head! This is the physiological reason why you're feeling what you're feeling!
If this is making sense so far...great! But as with anything in life, it gets more complicated. Did you know that just like we store muscle memories, our brain also remembers painful experiences and actually stores them as pain memories?!
What is a Pain Memory?
Unfortunately, our brain is smart! After a painful experience, the brain 'remembers' it and stores it as a pain memory. We know that muscle memory is automatic, right? For example, when we walk we don't have to think about putting one foot in front of the other...it just happens. Pain memories are exactly the same! Here’s what that means. Let’s say you have back pain and bending forward hurts. The next time you see a sock on the floor, your brain will remember that bending hurts. The pain centers start to become active BEFORE you even go to do the movement! Essentially priming you to feel pain for bending before you even start to do it. Pretty crazy, huh?
Your brain is essentially learning how to get better at feeling pain! This learned response happens throughout our lives. As kids and young adults, we see how other people respond to pain. Our brain uses this info to begin to form patterns that determine how we will respond to pain ourselves...when the time inevitably comes. In this way, our past experiences will factor into how we develop and store these pain memories as well. So, yes, if you have chronic pain, you can blame your parents…at least a little bit…maybe!
Does stress cause pain? Why does pain go everywhere?
So we’ve discussed two main processes that contribute to chronic pain - the pain nerves becoming more sensitized and the brain storing pain memories. When we have pain for a long time, it's not just the pain nerves that become sensitive...it puts our entire nervous system on edge, in a state of hypervigilance. Like that crazy neighbor that pays way too much attention to what everyone else is doing! As a result, we become more sensitive to ANY other inputs to our nervous system…things like emotional states (stress and anxiety), lack of sleep, illness, or poor diet. They all provide inputs to a sensitive nervous system, and therefore all can create more pain! When chronic pain goes on for even longer, this sensitivity starts to spread to other pain nerves in other areas of our bodies as well. This is why pain can start to spread to other areas, even to the other side of your body!
So is there any hope for getting rid of chronic pain???
All of this sounds extremely scary...I know. We can see that a lot of things can contribute to the alarm system going haywire. Here's the take home message: there's a physiological reason that you feel the way you do. Yes! It is complicated. And you’re not going crazy or just ‘getting old’!
BUT(and that’s a big but)...there’s good news too! All of the things we just talked about are reversible! And so is chronic pain. We'll discuss this in more details in another blog. But even if you've failed other treatments before and feel like it's a lost cause, I can promise you that it's not! I've seen it countless times over the years. You just need a provider that understands all of these complexities as well as you now do! Unfortunately, that can be rare. But I'll do my best to help you along here!
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