Chronic pain isn’t just an injury that won’t get better. Remember: damage doesn’t really ’cause’ pain.
In fact, chronic pain is often defined as pain that lasts longer than the expected time of healing.
One of the reasons pain persists is that the brain re-wires itself to change pain perception. This is known as ‘Central Sensitization’. The changes are actually significant enough that they can be detected through brain imaging! 1
It’s almost like a ‘pain memory’ 2. Like an over-reaction of your brains job to protect you from danger by giving you pain. It can make safely moving in a certain way cause pain, because your brain remembers that being a painful movement before.
But don’t let this worry you. Fascinating (and exciting) new research has shown that not only is this pain treatable, but these changes in the brain can actually be reversed!
The idea of a pain memory can sound scary. You might wonder “how are we supposed to erase a memory?” Well, that’s not exactly what we are trying to do. It’s more like trying to help you forget something!
This sounds easy! After all, I forget things all the time! Important things!
Maybe that’s why Homer don’t have chronic pain after all his ridiculous injuries.
But the thing about chronic pain is that the things that remind you of pain are really hard to avoid. If you have chronic low back pain, the things that set off that ‘alarm’ in your brain could be every-day activities. Simple things like bending over to look in the fridge, doing laundry, or sitting for a long time (like driving to work). Speaking of driving, people with chronic neck pain from a car accident (whiplash) can get pain simply from sitting in a car! Even weird things like being in a certain environment (like one where you were hurt before) can set off the alarm and cause pain.
These things just increase the fear and stress associated with pain, which can make it worse. Pain will also cause you to avoid normal activities, which can decrease your physical functioning.
All of these little ‘pain reminders’ keep making your brain re-wire itself to be more sensitive to pain. The biology of a ‘pain memory’ is quite complex 3, so we won’t get into the details here. All you need to know is that it happens. Now, we can figure out how to deal with it.
Like G.I. Joe says: “Knowing is half the battle!”
So what do we do?
First, we have to treat the pain.
This could include manual (hands-on) therapy from a Physical Therapist, Massage Therapist, etc. It could also include proper medications. Movement therapy in the form of safe exercises (like graded exposure) that don’t ‘set off the alarm’ are very helpful.
Furthermore, we have to address those so-called ‘psycho-social’ factors. Pain physiology education, so you can understand pain, can decrease fear and stress associated with pain, decreasing avoidance 4. Anything that relieves stress is very helpful.
Clearly, treating pain involves many factors, and each is important. You should try it all, and a good therapist should know this!
The brain CAN change back!
Here’s the cool part:
If we can consistently treat pain effectively, the brain will eventually reverse the changes that made it more sensitive. That’s right, we can ‘desensitize’ the brain.
In 2010, a study was performed on patients who had chronic hip pain due to osteoarthritis 5. Before hip surgery, their brains were scanned and compared to ‘normal’ people. The people with hip pain had significantly reduced grey matter in the Thalamus. But about nine months after surgery, the grey matter had returned to normal!
But do these positive changes correlate with pain relief too?
Another study in 2011 studied people with low back pain 6. This time the people with chronic pain had decreased cortical thickness in a few areas: the left dorsolateral prefrontal cortex (DLPFC), the primary motor cortex, and the right anterior insula. These changes were correlated with pain and physical disability. Plus, these people performed poorly on an ‘attention-demanding cognitive task’.
The pain patients were treated with either ‘spine surgery’ or ‘facet joint injections’. About six months later, the same brain areas were similar to ‘normal’ people, their pain and disability decreased, and they performed normally on the cognitive task.
Hope for People with Chronic Pain
This is good news for people who used to think: “well <insert pain treatment here> only works temporarily and then the pain comes back, so what’s the point?” There is a point! It can eventually become permanent relief.
The message is this: hang in there. The worlds scientists are hard at work figuring out the brain. People are beginning to appreciate pain and it’s complexity.
For now, do whatever you find helpful for your pain.
Don’t be afraid of pain. Keep moving stay active. Reduce stress and anxiety in any way you can. Don’t let pain be the first thing on your mind. Enjoy your life.
Be consistent, and don’t give up.