How Pain Becomes Chronic
You may have been living with chronic pain for a good long while. Have you ever wondered what to do if the hurt doesn’t stop anytime soon? One concern we consistently hear from our patients is worry that it’s just going to keep on hurting. We certainly hope not, and we will do everything we can to help. To address resistant pain, however, it helps to understand how pain works.
Acute pain is the body’s alarm system
Pretty much all of us have grabbed our elbows to soothe the electric tingle of hitting our funny bones, and many of us have had to deal with the particular, pressing pain of a broken bone, appendicitis or a sprained ankle. Even the slice of a papercut has us wincing.
Those are all forms of urgent pain, electrical impulses streaming through our bodies, yelling at us to STOP whatever we’re doing and protect ourselves. Urgent pain demands a response and doesn’t let us sit still. This is in our long-term favor — after all, if we could routinely keep jogging on a torn calf muscle or “playing through” a dislocated shoulder, we would risk injuring ourselves even more.
The pain associated with those injuries may ebb and flow, but generally disappears as we heal. For some of us, though, pain can become stubbornly lodged in our bodies, lingering long after healing is complete. For others, chronic pain (pain lasting longer than six months) sets in without an obvious reason. An old injury starts throbbing again or a completely new pain shows up.
Chronic pain has a psychological component
It might be difficult to conceptualize, but not all pain has a clear cause. Even more perplexing, pain is not always a sign of ongoing damage.
Dr. Peter O’Sullivan has explored this phenomenon in his research, which delves into clinical imaging and how well it reflects patients’ pain. For a long time, the medical community has accepted the fact that bulging discs or spinal malformations adequately explain patients’ long-lasting neck or back pain. When Dr. O’Sullivan began questioning this assumption, he examined X-rays, MRI images and other forms of imaging for clinical patients who reported chronic pain. He also examined similar records for patients who did not report pain. He found that the images are actually very similar.
Alan Gordon echoes this work. Together with a team of neuroscience researchers, he has performed similar imaging studies, with similar conclusions: the abnormalities we thought were responsible for so much pain apparently aren’t. Instead, most of us exhibit malformations of one sort or another, many of which correct themselves with time.
While it’s true that some bulging discs or biomechanical irregularities could be causing persistent pain, the more science looks into it, the more it appears that pain is a little more mysterious.
What might be going on?
Some of us are more vulnerable to chronic pain than others
Meta-reviews suggest that patients with chronic pain often have certain other traits in common as well, including:
- A particularly stressful childhood background with a higher-than-average number of Adverse Childhood Events (ACES)
- Genetic markers related to pain excitability (these markers don’t mean a person will be in pain, but the pain-reporting systems in their bodies may be more easily activated, may report more severe levels of pain, and may stay activated for longer)
- Cognitive habits that involve rumination (dwelling on a troubling topic), catastrophizing (believing the worst might be happening) or general pessimism
- Nervousness, anxiety, depression or similar, stress-related conditions
- Unresolved trauma, including PTSD or complex PTSD
When someone with these kinds of characteristics gets stressed, higher levels of cortisol show up in their blood. Cortisol, along with other hormones such as epinephrine and norepinephrine, activates cascades of emergency response functions in the body. These responses hike adrenalin levels, shift blood away from the digestive system, and increase inflammatory responses to help deal with any potential pending threats or injuries.
Chronic pain is deeply related to stress and fear
It’s great we have these (often very efficient) emergency responses. We’re typically best, however, at handling short-term threats. If a threat can’t be dealt with quickly (as is the case with chronic stress), the body gets stuck in a state of alarm. That means it doesn’t get as much of a chance to calm itself, digest properly or repair cells. So stressed-out people often have higher levels of inflammation along with weaker immune systems.
As stress persists, we start to become more exhausted and afraid. Fear is one way we try to guard against bad outcomes, but it can also restrict us. For those of us with chronic pain, fear often prompts us to clench our muscles harder, avoid moving much, and think more often about avoiding yet more pain. Unsurprisingly, this increases pain, both mechanically, through tightened, unexercised muscles, and psychologically, through fear-based patterns of thinking.
Worry, criticism and pressure from others or from ourselves —the Big Three, as Alan Gordon calls them—can also aggravate “normal” pain and tip it toward turning chronic. As you can see, there are many reasons stress and pain are so linked. It’s no wonder that more than 50 million of us struggle with chronic pain.
A process you can follow at home to lower pain
It’s possible to lower chronic pain, even if you’re very vulnerable to it, by changing some of your thoughts and habits.
Here’s how some people have accomplished that:
- Observe pain without fear. Alan Gordon teaches his patients an approach called Pain Reprocessing Therapy, which helps them learn how to simply observe their pain without judgment. By being curious and not judging your pain as bad, you undermine fear and give yourself a chance to breathe more deeply and recover more fully.
- Notice that you are NOT in immediate danger. Again, fear is meant to protect you, but inappropriate fear just cages you in “protective” pain. Reassure yourself that you are safe to undermine fear. There is no immediate threat. To enhance this feeling of security, you can listen to music you enjoy, watch an amusing video, or find another way to feel “lighter” and more like laughing instead of clenching your muscles or holding your breath.
- Experiment with motion. Biomechanically speaking, many of us with chronic pain are experiencing the psychological and cognitive dimensions of pain, not the pain signals related to ongoing damage. We can test that by doing gentle stretches, for example, when we feel calm and safe and have had a chance to slow our breathing and regard our pain with less fear. Many people find they are able to walk, bend, or just plain move in ways they couldn’t before when they stop fearing and anticipating pain so much.
- Know your stress triggers. Know what gets you more stressed, and therefore more likely to be in pain. Make plans for how to deal with these stressors ahead of time.
Pain can limit our perspectives and make it seem as though we don’t have many options, but that’s just not true.
Exercise: What If?
This exercise poses ‘what if’ questions to see if you can discover creative ways to counter chronic pain that could work for you.
- Ask yourself “What if my pain isn’t going to heal on its own? What if there is no biomechanical explanation for what I’m feeling or no medication or medical procedure that will take the pain away?
- Write down all your thoughts in response. See if you notice any patterns. Could you find any way at all to feel a little acceptance or curiosity about what’s happening to you?
- Then ask yourself “What am I willing to do now?”
- Write down those responses.
Do you find you can be curious about some of these possibilities? Does Pain Reprocessing Therapy sound meaningful to you as a way to decrease your fears and learn how to move with and through chronic pain?
- If so, take five deep breaths.
- Reassure yourself, saying “I am safe” out loud. Repeat it a few more times.
- If you’re comfortable, slowly move in a way that usually hurts.
- If the pain shows up, acknowledge it: “I see you, pain. What are you up to?” Mentally ask it what it’s trying to do for you.
- Soothe yourself, repeating “I am safe. I am allowed to explore my pain.” See if you can get your muscles to relax.
A little encouragement
Words from the poet Maggie Smith may be encouraging, too: “Trust that everything will be okay, but that doesn’t mean that everything will be restored. Start making yourself at home in your life as it is. Look around and look ahead.”
This article is for informational purposes only and does not constitute professional medical advice. Always seek the advice of your healthcare professional with any questions or concerns you may have regarding your individual needs and medical conditions.