Ask most people what they think causes ongoing pain that lasts months, a few years or even decades. I’m sure that 90% or more will say persistent pain is caused by an injury that hasn’t healed.
But this is very wrong.
And being wrong on this point is no laughing matter. It’s what keeps people locked in a cycle of pain. Believing that something is wrong with their body, patients become afraid of certain actions, aka triggers.
That fear unconsciously reinforces to your pain system that pain is necessary and the pain will not stop until the cycle is broken.
Hold on, you’re probably thinking: “How can someone still be in pain if there’s no injury?”
Two routes (or even a combination of these two factors):
1. Long-lasting stress, a chemical imbalance (often initially caused by stress), or other emotional factors cause the body to create pain as a defense mechanism to the emotions that are not being addressed/released.
Think migraines, fibromyalgia and sciatica. These conditions can be compounded by biological and environmental factors (think a poor diet, sleep and living conditions). However, stress will most often be the biggest contributor. Once patients eliminate deep-rooted and long-lasting stressors, they often see a big reduction in their pain. Some even go on to becoming completely pain free!
The human body is not developed to ensure long-lasting stress. Stress is useful – for example, when it needs to spur you into action. But long-lasting stress can and will damage many parts of your body.
2. An injury that has healed by left behind a neural pain pathway. Common examples of injuries that have healed but left behind a pain pathway are back pain, repetitive strain injury (RSI), shoulder pain and neck pain. Injuries in these areas usually take a maximum of 6 months to get better. But if you’re feeling pain after that, the chances are your body is in the habit of creating pain in a certain area.
Think of it like this. Pain is a protective mechanism. If you originally developed RSI because of excessive typing, even if the injury has healed your unconscious mind could think typing is a dangerous activity and cause pain whenever you try to type. Your pain system just wants to keep you safe. And if creating pain is keeping you off the computer – something a part of your brain considers a dangerous activity – your brain has no reason to stop.
Got it? OK – now how is the pain cycle broken?
The patient needs to objectively assess pain creating emotions and behaviors, and then replace these with positive behaviors and emotions. For example, here are some of the most common emotions and behaviors that create or reinforce the need for pain:
Expectations of pain
Lack of movement
Lack of sleep
Most people would have experienced all of these emotions at some time in their life. But the difference for those in chronic pain is that they will most likely feel and exhibit several traits from both the behaviors and emotions tab. And these would be directly related to the pain that they feel.
It takes work and dedication, but by stopping pain creating emotions and behaviors patients change the physical chemistry in their body. Think less cortisol and other stress hormones, and ‘better’ hormones such as dopamine.
When in pain, patients will be in the physiological ‘flight-or-fight’ state. But by controlling and influencing their emotions when they feel pain, patients will be able to activate the ‘rest-and-digest’ response that forms a part of their nervous system. The ‘rest-and-digest’ state allows their body to relax, heal and activate neural pathways that aren’t associated with pain. And when neural pathways aren’t used, they become weaker.
When calming an overactive pain system, it’s also critical that patients are proactive when they expect pain, when they feel pain creeping up, and when they’re in pain.
Thoughts and behaviors vary at all three points, and patients need to consciously influence these often automatic thoughts to minimize pain. Not just to prevent the discomfort associated with pain, but also so that they stop using neural pathways responsible for the pain they’re experiencing.
Pain is still thought of as the symptom of an injury – whereas pain, and especially chronic pain, needs to be thought of as a problem in itself. Only then will doctors and patients be able to address the real cause of most cases of chronic pain.