As we wrap up the year, it’s a great time to glance back at some stand-out research and academic thinking on chronic pain from the past year. Life often clips along so speedily, we don’t always get to think about what recent pain research might mean for our treatments and everyday lives. 

So we decided to highlight three intriguing articles published in 2021. 

Cognition in the Chronic Pain Experience: Preclinical Insights

This opinion piece compiles findings from animal studies to point out how memories of pain may influence how people feel long after the initial cause of the pain ends. The body may hang onto pain memories and keep acting on them, in other words. 

The authors compared mind-body patterns involved in both chronic pain and cognition, referencing several preclinical (animal model) studies. A few key points they made include:

Memories about past pain can hurt our thinking in the present

Pain demands attention. Paying attention to acute pain often pays off, since immediate pain forces us to change our behavior so we don’t get hurt any more. Pain also encourages us to learn (what not to do), and so pain memories can be helpful, in a way. When pain becomes chronic, however, it can affect our abilities to think, concentrate and perform other cognitive tasks, since it eats up so much of our minds’ bandwidth. 

People with high levels of chronic pain report more difficulty with cognitive tasks like learning, maintaining concentration or exercising short-term memory. These tasks may also be impaired by taking medications for a long time. In addition, neurogenesis, the process of creating new neurons in the brain to help process learning and memory, may slow down with chronic pain, further impairing cognition.

What if the brain could let go of pain memories more quickly?

The brain may also take longer to create memories. It may also create connections between ongoing pain and common pain reactivation triggers, such as simply walking. The brain, in other words, retains a memory about how walking (right after an injury, for example) was painful and cannot always “let these memories go.” Instead, the mind stays vigilant in case walking might cause further pain, leading to the pain processing systems in the mind and body becoming more sensitized, ultimately causing pain to feel even worse.

Rather than being able to appropriately extinguish (“let go of”) the memory, which is what happens to many of our other memories, the pain stays fresh in our minds and keeps contributing to a cycle of pain and cognitive impairment.

There could be clinical opportunities to treat pain by helping better extinguish pain memories. Another treatment option could occur through helping people with chronic pain learn new things faster, possibly creating more mental separation between them and their pain memories. 

Why this matters to Clearing

This study suggests that pain might feel less pressing for people who can direct their attention elsewhere. Attention and learning, then, could prove to be powerful pain management tools. 

Chronic pain patients’ need for recognition and their current struggle

This article draws attention to the social part of the biopsychosocial model while also offering a theoretical framework to explain why people with chronic pain often feel invisible. The article makes the following points: 

The experience of dealing with chronic pain can be accompanied by a sense of invisibility, isolation or even rejection that can happen at the levels of: 1) family and friends, 2) institutions such as healthcare systems, and 3) society overall, when people with chronic pain can’t function the way they feel society expects them to.

Feeling alone also makes pain feel worse

Being overlooked and socially excluded can make chronic pain feel even worse. People with chronic pain can feel an extra pressure, then, to demonstrate that their pain is real and that it does, in fact, impact them greatly. It can be very difficult to face skepticism and accusations or disbelief from others, and people with chronic pain can become very tired of being told they are “attention seeking” or “exaggerating.” 

Some researchers call this refusal to take chronic pain sufferers at their word ‘nonrecognition’ or ‘misrecognition,’ and see it as a form of disrespect that undermines a chronic pain patient’s sense of reality. When the struggles and challenges facing people who have chronic pain are not acknowledged by institutions, including healthcare systems, people can feel “less than” or not entitled to a full level of care and support.

Pain could decrease if people felt less lonely

People with chronic pain sometimes feel they are not “productive” or “useful,” and thus feel left out and as though they cannot contribute (and are therefore “no longer valuable” or no longer part of society). 

Nonrecognition can be combated by continuing to spend time with people who have chronic pain, reaffirming the fact they still belong to society and still possess inherent worth. Systems can also change to treat people with chronic pain as still fully human, entitled to fair and equitable treatment.

Why this matters to Clearing

Isolation is real, and this article helps show why it can be particularly damaging to those with chronic pain. Countering isolation though could help people feel more integrated at all levels of society while also lessening pain.

What we’re doing about it

We’re bringing in chronic pain coaches and other experts with experience in the biopsychosocial model to help us better understand how friends, family, and even pets help us feel less isolated (and in less pain). We’ll be building more social connection tips and elements of social support into Clearing’s communication and programs. 

Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial

This paper features research that tested whether or not altering patients’ pain beliefs could result in lasting pain relief, using a randomized clinical trial. Patients with chronic back pain in this research were randomized to 1) a set of psychological techniques called Pain Reprocessing Therapy, 2) placebo treatment or 3) treatment as usual (the treatment plan they already had in place). The researchers reported that:

Chronic pain can be deeply related to certain thinking patterns

Chronic back pain can be resistant to treatment, and biological causes for it cannot always be identified. Chronic back pain is also strongly linked with fear, avoidance and the belief that feeling pain means active, ongoing injury is happening.

Pain Reprocessing Therapy (PRT) uses cognitive reframing to address patterns in the brain related to fearing pain and to evaluating pain acuity. In PRT, participants were taught that pain does not always indicate ongoing active damage being done to the body and that pain perceptions can be reversed or reframed. Participants used psychological techniques to reduce their fears around pain and to modify how they interpreted pain signals.

Pain reprocessing therapy can significantly lower pain

Of the study participants, 73% reported being pain free or nearly pain free, compared to 20% of the placebo group participants and 10% of the usual care participants. A year later, the PRT patients were still mostly pain-free.

PRT participants also reported improvements in other conditions, such as trouble sleeping, anger and depression. Changing patient beliefs about pain and pain management could result in much less impact from chronic back pain and perhaps from other kinds of chronic pain as well.

Why this matters to Clearing

The mind possesses a lot of influence over the pain perception process, so learning mind techniques like Pain Reprocessing could help recalibrate perceived pain.

What we’re doing about it

We’re learning how techniques like Pain Reprocessing might fit for the Clearing community. Expect to see educational articles about these kinds of techniques coming out soon, and don’t be surprised if one of our health coaches brings it up! 

In a nutshell

Research is an ongoing process, and we’re always learning more. Kudos and congratulations to the leading chronic pain researchers who published research this past year. We’re grateful for their efforts and look forward to incorporating their findings going forward so we can better support you. In the meantime, we wish you a wonderful winter holiday season!