What Is Chronic Pain?
What is Chronic Pain?
Pain is considered “chronic” when it exceeds the normal expected healing time (typically more than 3 to 6 months). Over 25 million adults (11%) in the United States report experiencing chronic pain in 2019. Back pain is the most common type of chronic pain, but chronic pain can be located in any part of the body.
Plain Pain or Brain Pain
Chronic pain often develops following injury to tissue, muscle, bone, or nerves. Sometimes complex tissue damage results in long-lasting pain that can be linked to ongoing problems with the injury or healing. We’ll call this “plain pain”. Plain pain can be disheartening, but can usually be medically treated. In cases where treatment options have been exhausted, people can desensitize to the pain and use accommodations to minimize the impact of the plain pain on their lives.
Unfortunately, pain from an injury can morph into “brain pain” and the cause of the pain becomes convoluted. Neuroscientists like to say, “neurons that fire together, wire together”. This means that the neuro pathways associated with the pain from the original injury become stronger and stronger. Pretty soon related sensations (like pressure or discomfort or even just movement) gravitate towards that pathway and are interpreted as pain in the brain. When pain is the result of misfiring of the pain pathways we call this neuroplastic pain.
People often believe their pain is structural because they initially experienced an injury or because they have been told they have a bulging disc or a curvature in their spine, but lots of people have these ailments with only minor discomfort or no pain at all. Neuroplastic pain is much more common than long-lasting structural (plain) pain, and is very much treatable! However, determining whether pain is neuroplastic is not simple or straightforward and must be assessed on a case by case basis. Although there is no formula to diagnose neuropathic pain some questions to consider are:
Have medical treatments been ineffective or just given you temporary relief?
Did the pain come on during a time of stress?
Is the pain experienced in multiple parts of the body?
Does the pain fluctuate in terms of where and when it appears?
Is the pain the source of worry or distress?
The Fear Feedback Loop
Pain’s essential function is to protect the body from further harm. So it’s normal to feel afraid when we experience pain. Unfortunately, in some sort of biologic design error, pain is intensified by negative emotions, such as fear. (We have imaging studies that demonstrate this.) So pain causes fear, fear causes more pain, which leads to more fear, which leads to more pain. Fear is pain fuel! Fear is the emotion that gets us stuck in this vicious cycle, but the emotion can (and often does) morph into despair, loss, or helplessness. The emotion may change but the negative feedback loop stays the same. Any distressing emotion can reinforce the vicious cycle.
There is Hope
As I mentioned, neuroplastic pain is treatable. The Boulder Back Pain Study (2022) found that 75% of participants indicated they were pain-free or nearly pain-free after a 4-week course of psychological treatment. Relief from pain requires education and utilization of specific techniques such as somatic tracking and creating corrective experiences. It means learning about and being prepared for extinction bursts and other setbacks. Treatment is individualized and takes into consideration the myriad of complex factors that keep a person stuck in chronic pain. But treatment is effective and freedom from pain is possible.
Looking to learn more about chronic pain? Get connected with a member of our team below!
Resources
Ashar, Y. K., Gordon, A., Schubiner, H., Uipi, C., Knight, K., Anderson, Z., ... & Wager, T. D. (2022). Effect of pain reprocessing therapy vs placebo and usual care for patients with chronic back pain: a randomized clinical trial. JAMA psychiatry, 79(1), 13-23.
Zelaya, C. E., Dahlhamer, J. M., Lucas, J. W., & Connor, E. M. (2020). Chronic pain and high-impact chronic pain among US adults, 2019.