Chronic Pain Defined
What is pain?
There is a famous drawing from the 1600’s that claims to show the pathway of pain, starting from the flame stimulating the skin and travelling directly to the brain to be perceived. That seems easy to understand.
The problem is that the drawing is oversimplified. New research shows more pieces of this complicated puzzle and dramatically changes how we answer the question of what pain is. The answer depends on which part of the research you are looking at. Here are some of the new points we have learned. Keep in mind there are more hidden pieces to this puzzle than the ones that we have uncovered. I try not to get too stuck on a particular opinion because it may change in a few months.
We certainly know now that how we feel pain is much more complicated than we used to believe. Many things affect the sum total of our experience of chronic pain.
Game theories of chronic pain
Snakes and Ladders
Some things in the nerve pathway make us feel more pain and others make us feel less pain. There can even be overriding circuits which help the brain make an executive decision to ignore pain, as with a football player who completes the play on a broken ankle. Sometimes a simple, straightforward injury like a cut on the finger can cause a rapid slide down to misery if the injury turns on the nervous system in a certain way. We do not understand why this happens. We call this phenomenon CRPS (Chronic Regional Pain Syndrome). Other times, however, a devastating injury involving severe tissue damage can heal quickly, and you can scoot steadily up the path out of pain and impairment.
When we look at all the different systems in our bodies, all the natural chemicals we make to run the systems smoothly, and how all these systems affect each other, we can appreciate the miracle of engineering that allows all these functions fit together. Our bodies also allow a lot of slack. We can miss a few pieces and still stay in the game. We can miss some sleep, eat some junk food, get over-stressed, and have some injuries. Our bodies will keep doing the daily work of repairing tissues and preparing for the next day. But if the indiscretions start to pile up too quickly – too many physical injuries, chronic sleeplessness, chronic stress, too muc junk food and sugar all the time – the body won’t keep up. Unlike the game of Tetris, it takes more than pushing the start button to get back to a clean slate.
Is the solution to chronic pain like Solitaire? Well, it is in part. You are the most important player and, really, the only consistent player in the game. No one can fix you without your participation. All the professionals who try to help you heal are only your consultants. You would not expect to have healthy teeth if you never brushed them and just went to the dentist twice a year. You know you have to be responsible for your dental health. The same holds for recovery from painful conditions. We can help, but you are the main player.
The list of things that have been shown to have an impact on our pain and how it affects us is very long. Our stress hormones and sex hormones all play a role too. So does the chemistry of the body — how acidic our body is, the availability of vitamins, minerals, and antioxidants, and the presence of harmful or irritating substances such as heavy metal and pollutants. Each of these factors is worthy of a lengthy chapter of explanation. Each one alone may seem minor but all of them together have a great impact. Most importantly, you change your body chemistry every time you eat. Your diet makes your body more or less inflamed, and inflammation is not trivial.
We do not yet have a healthcare system that fully integrates all the strategies we have and makes use of all the healthcare disciplines in a coordinated team. It would be great to have doctors, massage therapists, chiropractors, psychologists, osteopaths, physical therapists and many others all working together and sharing information to help you heal. In the meantime, you have to try to put together your own team, and to the extent that you can, be the coordinator of your own care. Sometimes a professional group won’t understand how other groups can help your progress and can have very strong feelings about it. That is where the diplomacy comes in.
For the longest time, our main responses to pain have been drugs, procedures, and surgeries, all of which are high risk and expensive. Opinions are changing. The shift started with the Army Surgeon General’s report in 2010 and another report by the Institute of Medicine. The prescription for improving outcomes is to have integrative care that uses more than drugs, procedures, and surgery.
FAQ on chronic pain:
Is pain a symptom or a disease?
Well, the simplest answer to that question is “yes.” That is also the most confusing answer, with good reason. The topic is confusing. Sometimes pain is the symptom of damaged tissues and body parts like a torn ligament, a kidney stone, or recent surgery. Other times, the injury occurred long ago and everything seems to have healed. That is when the debate begins. Are we missing something? Has pain become a disease? Are changes in the brain and nerves the cause of the pain now? Are they the only cause? Sometimes ‘”yes” seems to be the best answer.
In chronic pain cases, it is best to use strategies that help the “pain as a disease” condition: improve your diet, cut sugar and junk foods, stay active as much as you are able, deal with stress, and get enough sleep. Even if we think there is a hidden injury, these things help you stay in good physical shape and improve your function.
What is the difference between acute and chronic pain?
Acute pain is meant to help us survive by alerting us to the fire we just touched or making sure we know a bone has broken and that we need rest. It is usually a sign of injury and mostly heals in several weeks or months.
Most chronic pain does not signal danger. Pain is called chronic when it has lasted over six months. It’s not just about timing, though. Chronic pain is transmitted differently through our tissues, nerves, and brain. Sometimes hypersensitivity can develop and make ordinary sensations feel painful.
Chew on this
You can reduce your chronic pain. Here’s what you need to do: eat well, sleep enough, and stay active. You don’t have to depend on expensive drugs and you can – and have to – play the biggest role in becoming more healthy