Working as a medical practitioner and psychotherapist over the last forty years I have learnt from many people who have suffered from chronic pain. I have also had direct experience of living with chronic pain.
Two years after graduation in medicine I had a car accident and suffered a hyperextension injury to my neck – whip lash. I lost control of my car on a slippery surface, the car spun around, and the rear of the car struck a tree. During the accident everything was in slow motion, (the mind speeds up when there is danger creating the experience of time slowing) I felt a surreal sense of surprise and thought “I might die now” I felt the back of my head hit my upper back and thought “I didn’t think it could go back that far”. I ruptured the fourth and fifth disc in my neck and had months in a neck brace and many sessions of traction and physiotherapy. I have had long periods of chronic neck pain which have been made worse by other injuries, illness, or stress. I am fortunate and these days I am mainly pain-free although, over work, poor posture, and stress trigger episodes of pain. Exercise, yoga, meditation, stress management and neuroplasticity training have been very helpful for me.
Acute pain arises from damage to the cells of our body. It serves a protective function; it triggers reflex actions that remove our body from harm such as when we automatically pull our hand away from something hot. Pain also stops us from moving a damaged area and promotes healing, for example if we try to walk on a badly sprained ankle or a foot with a cracked bone it is very painful, this makes us keep the damaged area still and promotes quicker and stronger healing.
Acute pain is a process which has four stages:
1. Transduction: When there is a mechanical, thermal, or chemical injury, cells in the damaged tissue release chemicals that bind to and activate pain receptors in the nerve endings, producing an electrical signal.
2. Transmission: The signal is transmitted from the pain receptors in the peripheral nerves, to the spinal cord and then to the brain.
3. Perception: Once the signal reaches the brain, it is processed by multiple regions, including those involved in physical sensation, emotional responses, and cognitive processes. The experience of pain arises from this complex process.
4. Modulation: The brain sends signals back down to the spinal cord, modulating or altering the pain signal. This can either amplify or dampen the perception of pain. If we are in danger pain is reduced so we can run on an injured leg. When we are stressed, or anxious pain is amplified and our distress alerts others in our group to care for us.
Chronic pain is a complex condition that often persists for months or even years. Unlike acute pain which serves as a protective function, chronic pain occurs when there is no acute tissue damage. It's often associated with conditions such as fibromyalgia, migraine, back pain, or after an injury or trauma.
The process of chronic pain involves molecular, cellular, and network level changes in the peripheral and central nervous systems. Chronic pain often begins with an injury or illness that triggers inflammatory responses. This inflammatory process increases sensitivity in the pain fibres, a phenomenon known as peripheral sensitization.
In the central nervous system (the spinal cord and brain), chronic pain leads to a phenomenon known as central sensitization. This is where neurons in the spinal cord become so used to receiving pain signals that they become overly responsive. They may start to respond to normal touch or pressure as if it's a painful stimulus.
Chronic pain has a negative impact on neuroplasticity, the brain's ability to reorganize and form new neural connections throughout life. In chronic pain states, the brain undergoes negative neuroplastic changes, including the reorganization of the areas of the cerebral cortex responsible for sensation and pain, and alterations in the pain inhibitory pathways. This means the pain system becomes more efficient at transmitting pain signals, contributing to the persistent nature of chronic pain.
There are several approaches to treatment which include pharmacological, physical, psychological therapies, and more recent neuroplasticity-based treatments.
Pharmacological treatments often involve medications such as non-steroidal anti-inflammatory drugs (NSAIDs), opioids, antidepressants, and anticonvulsants. These drugs aim to reduce pain and inflammation and improve function.
Physical therapies include exercises and activities that aim to improve mobility, strength, and function. Techniques may include physiotherapy, exercise therapy, and occupational therapy.
Psychological therapies focus on managing the mental and emotional components of chronic pain. Cognitive-behavioural therapy (CBT) aims to help people understand and manage their thoughts, emotions, and behaviours related to pain.
Neuroplasticity-based treatments aim to reverse the maladaptive changes that occur in the nervous system. Approaches include mental exercises such as motor imagery and mirror therapy which aim to normalize the body representation in the brain.
Other techniques such as mindfulness meditation and neurofeedback also produce positive neuroplastic changes. These methods help people to develop more adaptive pain coping strategies and can result in reduced pain perception.
If you have pain talk with your GP about approachs that you can try.
Infomation and resources to help with chronic pain
