Understanding Chronic Pain

Central Sensitization

Chronic pain can come from an ongoing condition, such as arthritis. It may also come from nerve damage due to an accident, surgery or medical condition. This is called neuropathic pain, when the damaged nerve misfires and sends pain signals even after the injury has healed. Often, no reason for the chronic pain can be found. Research suggests that many chronic pain conditions arise from a process called sensitization. In this process, the brain and other parts of the nervous system over-react to pain signals. Sensitization can be compared to a volume dial, which turns up the intensity of pain signals, making them stronger than they normally would be. As pain signals travel through the nervous system, they turn on pain circuits. The more the circuits turn on, the easier it is for them to turn on again. It is normal for the brain to adjust to repeated signals because this can be helpful. For example, when you first learned to drive it took a lot of concentration. After a while, you can operate the vehicle while listening to the radio. Unfortunately, the same thing can happen when the sensory input is pain. As more of the brain processes pain, pain becomes the instinctive, hard-wired response.

This can lead to:

• Pain that hurts more or lasts longer than is usual for an injury or illness
• Pain from something that typically does not cause physical pain, such as moderate activity, a light touch or a hug • Pain that spreads to other parts of the bod
• Pain with no known trigger
• Burning or tingling sensations without underlying nerve damage

Over time, chronic pain can affect all parts of your body and lead to other symptoms and conditions such as: Depression, Anxiety, Fatigue, Poor Sleep, Digestive problems (like irritable bowel syndrome), and others.

Pain Behaviors

Many people with chronic pain develop pain behaviors – things they do when they are in pain, such as limping, wincing, grimacing, or staying away from other people. These behaviors do not improve or make pain go away. In fact, focusing on the pain can make it more intense. You may not even know you have pain behaviors, but asking a friend or loved one to help identify them can lead you to changing behavior and substituting pain behaviors with positive actions.

Developing a personalized pain plan with positive actions is key to breaking the chronic pain and pain behavior cycle: Stay active. Regular physical activity improves flexibility, strength and stamina. In addition, during physical activity, your body releases chemicals that block pain signals from reaching your brain.

Reduce Stress

Stress management and relaxation skills can help give you mental, emotional and physical energy to cope with chronic symptoms.

Pace yourself. If you do too much or too little, your pain may increase. Daily planning and moderation skills help you balance work, leisure activities, time with other people, and daily tasks.

Adopt a positive outlook. If you have a negative outlook and see yourself as a victim of pain, pain will control you and become the focus of your life and energy. A positive outlook and being open to change increase your chance of managing pain well.

Decrease pain behaviors. These keep the focus on pain and what you can’t do. Instead, direct your thoughts and actions toward what you can do.

Move away from seeking medical answers. Reduce or stop pain medicine and reliance on medical therapies.

Get the sleep you need. Poor sleep can make you more sensitive to pain. It is important to take part in therapies known to benefit patients with chronic pain, such as: cognitive behavioral therapy, physical therapy, biofeedback, and mind-body methods. Important: Medications such as opioids seldom relieve chronic pain and often result in side effects which worsen quality of life. Learning to manage chronic pain without medications or other substances is the best way to improve function.