Chronic Pain

– by Lee Smith, Ph.D.

In many cases chronic pain is another example of how brains and bodies change through the repeated interplay of several systems. If you do something over and over, you’ll get better at it. Chronic pain can be the neuroplastic outcome of a brain and body that has learned to be in pain and to suffer.

The question might arise of whether chronic pain has a legitimate physical basis or whether it’s a psychological issue, and the answer is, yes. Many ingredients are needed to bake a cake, and a lot is baked in to chronic pain as well. The experience of acute physical pain is a result of injury to or illness in some tissue(s) of the body. Pain sensations also activate stress responses, emotions and thoughts.

Acute pain is a good thing because it tells us when something is doing us harm. It’s a protective signal that says, “Look out! Something is harming me”!! Because harm is also a threat, pain signals bring in our old friend, the stress system. Pain and stress are the dynamic duo of survival. Stress activates the immune and inflammatory systems, and it gets us energized, tense, edgy and on the look out.

A lasting, painful injury can recruit a cast of players. They rehearse their lines together, polishing their act, playing off of one another. And wouldn’t you know it; chronic stress can sensitize our nervous systems to pain signals.

In some cases chronic pain can become a case of ‘brain’s gone wild’. The mind-brain can become unintentionally ‘talented’ at being in pain as the cast of players become interlinked, ‘texting’ each other like teenagers.

When we have a pain-evoking and ongoing injury, we are exposed to ongoing and repeated pain messages about the injury. Our nervous systems can become increasingly on guard, watching for pain, and increased sensitization to pain can develop. Neurochemical changes can lead to nonharmful stimulation producing intense pain. An overprotectiveness develops from these private lessons, and the body-brain learns to react with the same stress and threat, emotion and thought, from a mere nudge or light touch.

As this learning settles in, any one of the players can set the others to howling. A new financial or social surprise can produce stress and pain. The persisting pain and stress can cultivate mood changes. Chronic pain may take centre stage, but there is a strong cast of players also at work.

Stress plays a critical role in the development and maintenance of chronic pain. People who are chronically stressed from childhood maltreatment, trauma, loss or difficult circumstances are understandably more vulnerable to developing chronic pain conditions.

Research shows that when we are more accepting of the presence and existence of pain, we’re much less catastrophic and feel more control of our life.

It’s not a matter of just saying to yourself, “Just stop feeling the pain”. That’s about as helpful as telling a novice to just play piano. And being hard on yourself just adds to the stress.

Chronic pain following an injury is very real. Damage to tissue is real and may not be subject to complete resolution. Learning to live with chronic pain equates to finding ways to accept it’s presence in your life and working with your pain to reduce it’s interference. Living with chronic pain involves learning about your stress reactions and facing all of the facets of the experience of pain. Through this exploration, through unwinding the chronic pain learning with new adaptive learning about what’s going on, through learning how to regulate your stress, the mind-body can be retrained. Yoga, mindfulness training, relaxation skills, and cognitive therapy are all helpful routes to better living through neuroplasticity.