Science of Chronic Pain Quiz – What Do You Really Know?!

Pain, and especially chronic pain, is an often misunderstood topic. And it’s not surprising! Pain is a strange and often misleading sensation.

These bites of knowledge are from chronic pain therapy app – Pathways. If you’re someone that suffers from chronic pain, or you want to learn more about pain science and therapy – app download links are at the bottom of this post.

But first, let’s get to those questions and see what you really know about pain!

The correct answer is FALSE. Pain does not mean there’s something mechanically wrong or injured in the body. Pain is a protective mechanism and while pain often does give us the prompt to stop doing something or seek treatment, for those with chronic pain, the pain sensation is not useful.


Many studies have shown that a large percentages of people with pain free backs, shoulders and knees have significant tissue damage in these areas that can be seen on an MRI – such as herniated discs and torn rotator cuffs. This highlights that even though you may have tissue damage, you may not feel any pain.


A more dramatic example of tissue damage without pain has been commonly reported when a soldier is wounded in battle. In this situation, there is a good chance the soldier will not feel any pain until the emergency is over. Pain is a survival mechanism, and in cases where pain makes survival harder, we shouldn’t be surprised that there is no pain.


On the other hand, many people suffer from pain when there is no tissue damage at all. Allodynia is a condition where even normal stimuli such as a light touch of the skin can cause excruciating pain.The nervous system can become hypersensitive to what it thinks are potential threats, and send warning signals to the brain even when no real threat is present.


For those in chronic pain, the pain often starts from a legitimate injury. Almost all injuries heal within 6 months, however, our pain system can become over-sensitized and continue creating pain long after the normal healing period.


The longer pain goes on, the easier it becomes to feel the pain. This is a consequence of a very basic neural process called long term potentiation, which basically means that the more times the brain uses a certain neural pathway, the easier it becomes to activate that pathway again.


For those in chronic pain, patients can start feeling 100% real pain without any physical stimulus. Thoughts, situations and expectations alone can be enough to create pain.

The correct answer is FALSE. The brain decides how much pain to create and where. When nerve endings sense something potentially dangerous they send warning signals to the brain.


No pain is felt until the brain interprets this information and decides that pain may protect you in some way – and if it’s not sure, the brain will err on the side of caution and create pain anyway.


The brain considers a huge number of factors in making this decision to create pain and no two people will feel exactly the same amount of pain. Many different parts of the brain help process the pain response, including areas that govern emotions, past memories, future intentions and your vision. This whole process occurs incredibly fast and it’s complex – but the only thing you’ll notice is the end result (a level of pain).


Scientists used to believe that the brain passively perceived already formed sensations that arrive from the body. But we now know that is very wrong.


For those in chronic pain, patients can start feeling 100% real pain without any physical stimulus. Thoughts, situations and expectations alone can be enough to create pain.

The correct answer is TRUE. Chronic pain not only takes its toll on your body, but it can also result in real physical changes to your brain. Various studies over the years have found changes to the hippocampus, in addition to reduction of gray matter in several areas of the brain.


As a result, long-lasting chronic pain can negatively affect your memory, reasoning skills and concentration skills.


But it’s not all doom and gloom thanks to a little something called neuroplasticity. That’s the brain’s ability to change, and become stronger, at any age.


Scientists once thought that the brain stopped developing after the first few years of life. They thought that connections were formed between the brain’s nerve cells during an early “critical period” and were then fixed in place as we age. Because of this belief, scientists also thought that if a particular area of the adult brain was damaged, the nerve cells could not form new connections or regenerate, and the functions controlled by that area of the brain would be permanently lost.


However, new research on animals and humans has overturned this mistaken old view: today we recognize that the brain continues to reorganize itself by forming new neural connections throughout life. This allows the neurons in the brain to compensate for injury and adjust their activity in response to new situations or changes in their environment.


A 2009 study reported that there are indeed “Gray matter abnormalities found in chronic pain”. However, reassuringly, they concluded that it does not “…reflect brain damage, but rather are a reversible consequence … which normalizes when the pain is adequately treated.”


A 2011 study concurred, suggesting that “treating chronic pain can restore normal brain function in humans.”

The correct answer is FALSE. There is now much scientific research and patient studies proving that mind-body techniques help reduce or even eliminate chronic pain. These techniques can be practiced through an online program – such as the Pathways app – or by visiting an experienced pain therapist.


Here is some of the research on mind-body techniques:


  • 2017 Research by the University of Utah published in the Journal of General Internal Medicine concluded: “After participating in a single, 15-minute session of certain mind-body therapies, patients reported an immediate decrease in pain levels similar to what one might expect from an opioid painkiller.”


  • A 2015 study from the University of Pittsburgh School of Medicine resulted in this conclusion: “A mind-body program for chronic LBP [lower back pain] improved short­ term function and long­-term current and most severe pain…”


  • 2011 research titled “Pain and Emotion: A Biopsychosocial Review of Recent Research” concluded that “Emotions are integral to the conceptualization, assessment, and treatment of persistent pain…”


  • The 2010 study by Howard Schubiner, MD at the Department of Internal Medicine found that: “The affective self-awareness intervention improved pain, tenderness, and self-reported physical function for at least 6 months in women with fibromyalgia compared to wait-list control."


  • The Department of Psychology at the University of North Carolina, Charlotte conducted a study in 2009 on the effect of brief mindfulness meditation on pain and concluded with: “Our findings indicate that a brief 3-day mindfulness meditation intervention was effective at reducing pain ratings and anxiety scores when compared with baseline testing and other cognitive manipulations”


  • A study led by David Schechter, MD, in 2007 concluded with this: “We believe that a mind-­body approach is more effective and involves much less risk and expense than conventional approaches in appropriately diagnosed cases.”

The correct answer is TRUE. The longer pain goes on, the easier it becomes to feel the pain.


This is a consequence of a very basic neural process called long term potentiation, which basically means that the more times the brain uses a certain neural pathway, the easier it becomes to activate that pathway again. It’s like carving a path through a grassy field. The more times the same path is traveled the easier it is to use that path again. This is the same process by which we learn habits or develop skills. In the context of pain, it means that the more times we feel a certain pain, the less stimulus is required to trigger the pain.


If you’ve had pain for a long time – let’s say at least a year – it’s safe to say that much or potentially even all of the pain that you feel is activating on auto-pilot. Pain can start occurring even without physical stimuli or any damage being present. It then becomes key to use brain retraining techniques to de-sensitize your pain system.

The correct answer is TRUE. This is often referred to as the nocebo effect. It’s the opposite of placebo effect where expectations of pain relief or an improvement in health leads to that.


One of the most popular examples of the nocebo effect was a published in “New Scientist.” According to the account, late one night an Alabama man, referred to as Vance, went to a cemetery and met up with a witch doctor who told Vance that he was going to die soon. Believing the witch doctor’s prediction, Vance soon fell ill and within a matter of weeks was emaciated and close to death. Vance was taken to the hospital but the doctors could find nothing wrong with him.


Finally, Vance’s wife told the physician, Dr. Doherty, about the encounter with the witch doctor, which gave the creative physician an idea. The next day, Dr. Doherty told the couple he had tracked down the witch doctor and physically threatened him until the medicine man admitted he had put a lizard inside Vance that was eating him from the inside. Of course, the Doctor’s story was completely fabricated, yet he made a big show of injecting the patient with a mysterious substance and snuck in a genuine, green lizard that he pretended to extract from Vance. The next day, Vance awoke alert, hungry, and it didn’t take long before he fully recovered.


The story was corroborated by four other medical professionals, and is often cited when explaining why Voodoo sometimes works (i.e. not because of magic, but because of the nocebo effect). This highlights the incredibly powerful effect the mind has on the body.

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