Why pain persists - Understanding chronic pain
A lot of the time we forget that pain is normal and helpful! Pain is actually an adaptive strategy that alerts us when we are in danger. Pain is the body’s way of communicating with the brain that it is in danger and/or injured and physical action is required. For example, you are playing soccer and fall and break your leg. The pain from your broken leg lets you know that you are injured and you need to go to the hospital. However, all pain is not this simple. This is when we start to see the aspects of chronic/persistent pain arise.
Chronic pain actually has a lot less to do with the body’s tissues, muscles, and joints than you might think. If you have experienced chronic pain you might find this impossible to believe. You feel the pain in your tissues, muscles, and/or joints, so how can it not be the root cause? In order to understand this we have to look at how the nervous system reacts to an injury. After an injury or an accident, your body can go into a state that is commonly referred to as “fight-or-flight” mode. When you enter in this state your body releases the stress chemicals adrenalin and cortisol. These stress chemicals have the purpose of communicating to the brain that you are in danger and that action is required. Eventually, once you are safe again, i.e. after receiving appropriate treatment at the hospital, this fight or flight mode is meant to “turn-off”, and thus stop producing stress hormones. However, in people who develop chronic and persistent pain these stress chemicals often don’t stop being produced and this “fight or flight” mode continues. This causes an issue for the body because these hormones are only meant to be activated for small periods of time in order to produce a physical response. When a person continuously operates in “fight or flight” mode as a result of a painful injury, the brain is being told that the person is still not safe. This means that the brain still views the injury as needing attention and continues to amplify the pain. The continuous stress chemicals being released cause the nervous system to become highly sensitized – this causes persistent increased heart rate, increased blood pressure, shallower breathing, digestive issues, and muscle tension! Your body cannot heal when your nervous system is this sensitized as dealing with this perceived ‘threat’ is your body’s first priority – and so the injury continues to persist in pain.
Our society still tends to view the body and mind as two separate entities. However, our whole body is interconnected and extremely reliant and influenced on the state of operations of other systems in the body. When your body is in a state of constant pain, it is no surprise that it affects your emotions and cognition! People experiencing chronic pain are more likely to suffer from anxiety and depression. When your body is releasing stress hormones, it causes you to be ‘on-edge’ because your brain is perceiving that there is a potential threat to your safety. This means that your brain is constantly looking for a threat and thus remains stressed. The mind begins to worry and perceive danger in events that would normally be unreasonable or unlikely to perceive a danger or a threat from. For example, normal movement can become stressful as you now consider it to be extremely painful. You may then become more isolated and inactive as going into the community may overwhelm you with stress, fear, and pain. This can cause you to feel hopeless, angry, and/or sad because you are living in a state with persistent pain and anxiety with no alleviation of your symptoms.
So how can you help break this cycle?
Believe it or not, reading this article has already helped you! Learning about the pain system often improves a person’s pain because the brain now understands what is triggering the persistence of pain. Think about it - how can someone know how to fix a problem if they don’t know what the real problem is?
The release of endorphins in your body is also seen as a vital way to break the chronic pain “cycle”. Endorphins have an inhibiting effect to cortisol and adrenaline as they stop the transmission of pain signals. Endorphins are released in your body as a result of activities such as laughter and aerobic exercise. Their release puts your body and mind in a more relaxed and happier state, allowing your brain to feel safe and no longer perceive a danger or threat.
Cognitive behavioural therapy (CBT) and mindfulness strategies are also a very good way to help with the persistence of pain. These two therapies help change cognitive processing in your brain by changing your thought patterns. Negative and pessimistic thought patterns create more anxiety and depressive reactions in your body, which helps to propel the persistent pain cycle. By changing these thought patterns to more positive, constructive thoughts, you have the ability to help control the production of stress chemicals and calm the sensitized nervous system.
Physiotherapy can also help to correct malalignment in the body and reduce inflammation. Myofascial Release and Craniosacral Therapy can release abnormal restrictions in the connective tissues (fascia) in order for restore proper alignment and ease restrictions on nerves.
Overall, breaking the cycle of persistent pain can be very hard to do on your own. Finding a healthcare professional in your area who understands the pain system can be a very important and valuable step. They will be able to provide continued education, guidance, and support to improving your functional living. It can be an investment in time, money, and energy, but at the end of the day everyone deserves the chance to live pain free!