Dealing with chronic pain can be a frustrating experience. The pain persists after an initial injury, if there was even an initial injury, which often leads to an exhausting search for the cause of pain. X-rays, MRIs, CT scans are often negative. Massage, acupuncture, chiropractic, physical therapy, injections, and medications might have helped in the short term, but didn’t create lasting change.
All of this frequently leads to people thinking that the pain system is broken. But is the pain system actually broken? This post will discuss chronic pain and give a different perspective of why there is pain.
Is chronic pain caused by a malfunctioning system?
Chronic pain is commonly blamed on a faulty or broken pain system. What this really means is that the pain system is responding inappropriately to something.
Seasonal allergies is a prime example of a system responding inappropriately to a stimulus. The immune system is responding to the pollen in the air causing the person to sneeze, have a runny nose, etc… Pollen isn’t harmful to your body, but the immune system is reacting to the foreign pollen. The immune system isn’t broken or faulty. In fact, it is responding how you would want it to when it encounters a foreign object. The immune system is working to protect you.
Similarly with chronic pain, the pain system is being stimulated to protect your body. Bending, twisting, jumping, and running aren’t normally painful movements. However, when your body feels like there is a potential for injury, the pain system is triggered to protect you. The pain you feel is real. But the pain you feel isn’t because of a malfunctioning pain system, it is functioning as it should.
Why is this important for someone experiencing chronic pain?
The emphasis of treatment changes. Instead of searching for the damaged area (either muscle, tendon, ligament, etc… or malfunctioning portion of the pain system), the focus becomes why is the pain system being activated?
Can the pain system be activated because of tissue damage? Absolutely. But generally chronic pain has outlasted the healing time of tissues (about 6-8 weeks). This means most of the time chronic pain has more to do with sensitivity than it does tissue damage.
To illustrate an increased sensitivity of the pain system, let me tell you about my New Year’s Eve morning.
At around 6:00 am, I suddenly woke up to the sound of a car horn. When I looked out the window, I realized that it was my car alarm going off. Someone had broken into my car. Now whenever I hear a noise coming from the parking lot, I immediately think someone is trying to break into the car again. I have become sensitized to the noises trying to protect my car.
A sensitized pain system parallels the story above. Typically bending, twisting, and lifting are not painful movements, because the body does not feel there is a threat of injury. However when the threat of injury is high, the pain system is triggered to protect the body from injury.
In the short term, this is beneficial for the body. Being in “high alert” mode helps to prevent you from causing further injury. However, the benefit of a sensitized pain system decreases with time. Once it is safe and the body has healed, the high alert should decrease so the person can return to daily activities.
The treatment approach for chronic musculoskeletal pain would therefore focus on movements that the body feels safe performing. This might mean that the movements need to be performed on the ground, or with exercise bands, or the aid from a healthcare professional. But as the body adapts to the movements and feels safer performing them, the exercises can gradually progress until there is no pain with the original problem.