Pain Mechanisms

Maybe a difficult subject, but I am going to give it a try.

Nowadays, chronic pains seem to be an important part in our daily practice of professionals. In my case, particularly pains in joints and soft tissues.

So what are we talking about?
Chronic pain is ‘different’, in comparison to hitting your finger with a hammer. In that case you will trigger nerve endings (by certain neurotransmitters), there is actual damage and an inflammation reaction will start. This is often a short period of time and the body acts adequately in its healing.

But there are cases where there is no damage (anymore) or inflammation, and still there is pain?!
To put it simply, the nerve system contains several layers: a spinal cord, the brainstem and the brain. These are connected. In an acute state you will find a spinal reflex, e.g. retraction of a hand in a fire. You do not think about that. But in a prolonged phase, you will start thinking about your pains (i.e. the brain), you might limit yourself, and as a consequence the nerve system starts to ‘change’.

But there are cases where there is no damage (anymore) or inflammation, and still there is pain?!
To put it simply, the nerve system contains several layers: a spinal cord, the brainstem and the brain. These are connected. In an acute state you will find a spinal reflex, e.g. retraction of a hand in a fire. You do not think about that. But in a prolonged phase, you will start thinking about your pains (i.e. the brain), you might limit yourself, and as a consequence the nerve system starts to ‘change’.

Our nerve system is a constantly changing system. We learn, remember and therefore we ‘grow’. Of course that’s positive, but can also have a dark side.
The nerve system can ‘create ‘pain. If there are a lot of pain-stimuli, the nerve system will anticipate, e.g. by producing pain-reducing substances or to avoid negative coping strategies (fear of moving). If that does not happen, the nerve system has the ability to create new nerve-routes (=neuroplasticity), and will interpretate normal sensations as pain. In this case, there is now no underlying ‘real’ cause, like an inflammation, limitation of movement or any other physical cause. It is important to mention that we do not speak here about clear medical conditions.

Does this mean that chronic pain is psychological? Yes and no.
Yes, because the mental-emotional reaction on pain decides which route the nerve system takes. In case of a negative reaction, like fear of moving or being depressed about the pain, the brain will not create enough substances (e.g. serotonin, endorphins) to balance the whole pain mechanism. No, because the nerve system does its own thing. It anticipates on the present situation of pain and the reaction of the patient (fear, depression) and creates new nerve-routes.

What to do?
Important: break out of the negative circle of pain, passive behavior or fear! Find a therapist that understands the concept of pain mechanisms. Sometimes an anti-depressant (e.g. amyltriptillin) helps; it is a known remedy in treating chronic pain mechanisms and has a positive effect on ‘pain perception’. Also, cognitive training might be advised to learn how to cope with chronic pains. It sounds simple, but often is not! Above mentioned methods do not work always, and disappointment might be a logical reaction. But doing nothing will not change it for sure…