Approximately 1 in 5 adults in the United States suffers from chronic pain. While pain can be your body’s normal response to an injury or illness, chronic pain can persist after healing and is defined as lasting three months or more. It is no surprise that this distressing and difficult-to-treat condition is commonly associated with emotional difficulties.
Before jumping into the complicated topic of chronic pain, let’s discuss the basics of pain.
The International Association for the Study of Pain (IASP) recently redefined pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. They also expanded the definition to include the following key points:
Let’s dive deeper into this last point about the difference between nociception and pain. Nociception refers to your body’s processing of stimuli or information through the central nervous system (your brain and spinal cord) and peripheral nervous system (nerves outside your brain and spinal cord).
Nociception and the experience of pain are not the same for everybody and can change due to a person’s individual experiences. Each person’s brain can process the information sent by nociceptors differently, leading to the generation of more or less pain sensitivity. Functional MRI studies have demonstrated that patients report different pain levels for standard stimuli. These differences can be caused by neuroplasticity, the adaptive changes that can occur in the brain as a response to stimuli such as an injury. In the case of chronic pain, neuroplasticity leads to central sensitization, the negative consequence of nociceptive pathways becoming enhanced.
When a structural cause (e.g., joint damage, joint inflammation, etc.) can not be identified in a diagnostic workup, many people face the challenge of their chronic pain not being perceived as valid. Neuroplasticity and central sensitization theory can help us understand why many forms of chronic pain do not have these clear structural origins. As pain becomes chronic, it can start to impact multiple areas of a person’s life. Chronic stress can induce negative emotions such as avoidance, stress, lack of motivation, anxiety, and depression.
This does not mean that the pain a person may experience is not real or exaggerated. Many of our body’s reactions, such as a fast heart rate, sweating, or blushing, are based on emotional stimuli. This “fight or flight” response is an automatic physiological reaction your body has to stressful stimuli such as pain.
Because of this phenomenon, it is essential for doctors not to dismiss a patient’s pain when an anatomical or structural cause can not be identified in the diagnostic workup for the pain.
The cause of chronic pain is specific to each person and can be a combination of factors such as:
Chronic pain is often classified into primary and secondary causes.
Symptoms of chronic pain include:
The first step in evaluating chronic pain is for your doctor to perform a comprehensive history and physical to determine the nature of the pain and its impact on your life. Your doctor will then order imaging and diagnostic testing based on your physical exam findings (if your physical exam is normal, additional testing is likely not required). Further testing may include:
A multidisciplinary approach is always best when treating the symptoms of chronic pain. Chronic pain does not respond to medications alone. Ideally, a team that includes a primary care physician, pain specialist, psychologist, and physical therapist can work together to provide education, therapy and monitor symptom progression. Specific treatment options include:
Unfortunately, most of these therapies focus on improving a person’s day-to-day function and provide limited benefits for reducing a person’s felt pain.
include acupuncture, aromatherapy, biofeedback, mindfulness training, and relaxation techniques, such as massage and meditation.
include reducing stress, exercising, a healthy diet, and getting enough sleep.
Researchers are now looking into the role of neuroplasticity in chronic pain and how to create new therapies that focus on central factors like psychosocial processes. Therapies such as psychophysiologic symptom relief therapy (PSRT) and pain reprocessing therapy (PRT) focus on rewiring the brain’s neural pathways to reinterpret pain as a neutral sensation coming from the brain rather than dangerous or stressful. In other words, it teaches your brain to redefine chronic pain as a false alarm. Therapies often focus on the following areas:
What have researchers found on psychophysiological treatments like PSRT and PRT? While most studies have focused on patients with chronic back pain, the results show these therapies have a high potential to benefit patients with chronic pain. Researchers at Harvard Medical School found patients enrolled in PSRT reported significantly less pain and pain-related anxiety than patients who received usual care, or care solely under the guidance of their physician. After 26 weeks of therapy, 63% of patients who received PSRT were pain-free, compared to 17% of patients who received usual care.
re-origin is a science-based, self-directed neuroplasticity training program and supportive community designed to help people suffering from chronic conditions. The goal of re-origin is to educate and guide you through the concepts of neuroplasticity and how to retrain your brain to respond differently to adverse stimuli.
Understanding neuroplasticity. The training program includes interactive modules, specially designed worksheets, and self-assessment quizzes where you’ll learn:
Connecting with a Community. You’ll join a curated uplifting community with weekly group coaching calls, live Q&As and online events.
Group coaching or “Momentum Sessions” to inspire motivation & accountability through weekly “momentum group” coaching calls.
It is important to understand the content in re-origin is for informational purposes only and is not a substitute for a medical diagnosis, treatment, or advice. Your doctor should always be involved in the management of any health conditions. Consult with your doctor prior to starting re-origin to discuss a plan for your overall health.
If you are having thoughts of suicide or self-harm, a mental health professional can help. If you are having thoughts of suicide, a mental health professional can help. The American Society for Suicide Prevention provides direct services dedicated to crisis intervention. The Lifeline provides 24/7, free and confidential support for people in distress, prevention and crisis resources for you or your loved ones. Call or text 988 or text TALK to 741741.
The cause of chronic pain is specific to each person. It can be a combination of a chronic underlying illness (such as rheumatological and autoimmune diseases) and physical, psychological factors.
Approximately 40% of people with chronic pain experience depression. Chronic pain often affects sleep and increases stress levels which can contribute to depression.
People living with chronic pain are at heightened risk for mental health problems, including depression, anxiety, and substance use disorders.
The range and severity of symptoms vary from person to person, but can include joint and muscular pains, a burning pain sensation, fatigue and sleep disturbance, anxiety, depression, and mood swings.
People who suffer from chronic pain need the support from their loved ones. Chronic pain can put a strain on your relationships if others fail to understand your perspective and challenges associated with chronic pain