Pain is most commonly associated with tissue damage or an injury. Given adequate time and assistance from therapists, doctors etc., those tissues in question inflame, repair and remodel (i.e. heal), and the pain goes away. Occasionally however, despite the tissues healing, pain is still experienced weeks, months and maybe years later. It is at this point that the pain experience can be defined as chronic or persistent.
The use of the word persistent is appropriate here as the term “chronic” (as in “chronically unwell” or “chronic unemployment”), suggests that it’s a problem that has to be dealt with and will never go away. This is not the case. Chronic/persistent pain is very much treatable, but unfortunately most treatment fails – sometimes even surgery and medications fail.
Pain is an output of our brain in response to a perceived threat to the body, and the conclusion that action is needed. It is a vital protective response, and is excellent at keeping us safe. This normally goes a little like this:
– tissue damage at periphery eg. a paper cut
– stimulation of a specialised nerve looking for damage (noxious receptor or nociceptor)
– transmission of this “danger message” up the arm, through the spinal cord and into the brain
– in the brain this combines with information regarding mood, emotion, experiences, context and environment
– if it is decided that there is a threat and that it’s a priority, you have the unpleasant experience that is pain
In a persistent or chronic pain scenario, the tissues have healed and are therefore not creating this danger message, or only creating it at a level that would normally not evoke a painful response. Yet pain is still being felt – why? This happens due to changes in the nervous system (the nerves, spinal cord and the brain), resulting in an almost constant perception of threat and the need to act upon this. In essence, the extended experience of pain makes one more likely to experience pain (the exact physiological, neuroimmune and biological reasons for this are beyond the scope of this post).
The problem with approaches to persistent pain is that they are often directed at the tissue in question. If a person in pain is found to have minimal tissue damage, they are often considered a hypochondriac, a malingerer or looking for an insurance payout. These inferences, that the pain is not real, are definitely not helpful. The concept of “all in your head”, which may be interpreted from the above, is also not necessarily correct – treatment would be as simple as telling someone to “snap out of it”, akin to telling one who is depressed to “cheer up”.
What is best for persistent pain sufferers is to understand why they are in pain, identify the causes and not to be afraid of it. Fear implies danger and thus further pain. Five hundred (five thousand or fifty thousand) words are not enough to fully understand pain. I suggest a good starting point is to watch the great video below, and look for an Australian published book called Explain Pain by Butler and Moseley. No one truly understands pain and there is no panacea or cure, but the more you can know about your own pain, the more you understand it and the more your can do about it.
As always, throw any questions or comments in the box below and I’d love to hear from anyone regarding their experiences with pain.