In this article we are going to look at some of the major questions around the chronic pain cycle such as:
What Is Pain?
What Is Chronic Pain?
What Causes Chronic Pain?
What Is The Chronic Pain Cycle?
The Science Behind Pain And The Link To Depression
How Does The Chronic Pain Cycle Start?
How Can You Stop The Chronic Pain Cycle?
How Is Chronic Pain Diagnosed?
What Is Pain?
Pain is a very useful tool that our bodies use to tell us that something is wrong. Pain tells us that something is not right with our bodies - that there is an illness or an injury present that needs our attention and some special care.
This is very useful when the pain is acute and we need to rest a broken bone or a torn ligament. Acute pain like this usually has a specific underlying cause and lasts anywhere from a few days to a few months, clearing up when the injury or illness is gone. Some causes of acute pain include:
Broken bones
Cuts
Burns
Surgery
Unfortunately there is another type of pain that is a lot trickier to manage and that can have long lasting implications on our health and wellness. Chronic pain.
What Is Chronic Pain?
Chronic pain is typically defined as “(an unpleasant sense of discomfort) that persists or progresses over a long period of time. In contrast to acute pain that arises suddenly in response to a specific injury and is usually treatable, chronic pain persists over time and is often resistant to medical treatments.”
Chronic pain tends to last longer than 6 months and can be active in the nervous system for months and years. This type of pain persists even when the original cause of the pain has gone and some people even experience this type of pain when no apparent cause can be found.
Some chronic pain conditions include:
Headache
Back pain
Osteoarthritis
What Causes Chronic Pain?
Sometimes chronic pain may have an obvious cause such as cancer or shingles. In other situations, injuries or diseases can cause your body to have a heightened sensitivity to pain. This increased sensitivity can continue long after the injury or disease has passed.
A third type of chronic pain can be completely without a physical cause. This is known as psychogenic or psychosomatic pain. This type of chronic pain can be caused by psychological factors such as stress, anxiety, or depression.
One thing that we do know about pain is that it is extremely subjective and this can make it difficult for doctors to truly understand the extent, or cause, of pain that a person might be experiencing.
What Is The Chronic Pain Cycle?
Chronic pain is a major public health issue with studies reporting that around one fifth of the population in the USA and Europe are affected by it. When researchers started to dig deeper into this condition, they found that chronic pain often induced depression and that up to 85% of patients who were chronic pain sufferers, also suffered from severe depression.
Why is this important? Well in order to treat chronic pain it is important to know what factors might be influencing this condition and what outcomes might be associated with it.
Researchers went on to discover that patients who suffered from chronic pain-induced depression have a poorer prognosis for their condition that those who did not have depression and who only had pain.
It seems that chronic pain and depression are more closely linked than we had ever considered and that, when they are present together, it can be even more challenging for patients.
The Science Behind Pain And the Link To Depression
Certain injury sensory pathways of bodily pains have been shown to share the same brain regions (hippocampus, thalamus, and amygdala) that affect mood management.
This connection creates the foundation for pain and depression to be linked in our bodies. Research has even found that the hippocampus and prefrontal cortex of depressed patients are smaller than those in patients who are not depressed.
Chronic pain has also been found to damage dopamine activity in the brain. Dopamine is an important neurotransmitter that your body makes and uses to send messages between nerve cells.
It plays a starring role in how we experience and feel pleasure. When dopamine activity is damaged, we don’t experience pleasure as much and can have increased experiences of pain.
Another way that depression can affect our brains is that it can reduce something called Brain-derived-neurotropic factor (BDNF). BDNF is another protein that is important for carrying messages between nerve cells. Extensive studies have confirmed the important role that BDNF plays in pain regulation and development.
How Does The Chronic Pain Cycle Start?
The Chronic Pain Cycle normally stems from some sort of injury. When we experience an injury it is common to change the way we walk, or run, or even sleep. The body has an amazing capacity to compensate for injured parts.
If you hurt your foot you can compensate by leaning more heavily on your opposite foot, or walking more on your heel than your toes. This can also be the start of the pain cycle. If an injury is particularly long lasting, compensating with other body parts, in a way that the body was not originally designed to do, can put pressure on these body parts.
Also, not moving certain muscles or ligaments for a period of time can sometimes train these muscles to work in a new, distorted manner, also cause unintended pain consequences. These new movements can be the cause of chronic pain.
The Role Of Depression
Depression can also be a factor when it is not possible to continue doing the activities that you once loved to do. These activities could be participating in a sport or physical activity, or it could even impact your employment if your injury prevents you from doing your job.
Low back pain is the number one reason for missed work days and disability in the workplace, and the stress associated with potentially losing your job or not being able to return to work can definitely impact your recovery and your experience of pain.
How Can You Stop The Chronic Pain Cycle?
Movement
One way that you can stop the pain cycle is to start moving the painful joints and muscles in your body. International guidelines recommend gentle activity over bed rest for chronic low back pain. Restoring motion and correcting your posture is one way that you can stop the chronic pain cycle and get back to your previous activities.
Physical Therapy
Seeing a physical therapist can also help to ensure that you are using the correct muscles and not putting unnecessary strain on other body parts.
Equipment
Using the proper equipment such as a brace, or crutches can help support your body appropriately while healing takes place.
Mindfulness Based Therapy and Meditation
Mindfulness based meditation has been shown to increase levels of BDNF, helping with pain regulation and your experience of pain. This can also increase your desire to exercise and get moving, and help to reduce concerns around increased feelings of pain.
Healthcare experts often recommend that patients who have physical injuries or disabilities practice meditation based intervention to increase their levels of BDNF.
Mindfulness based therapy has also been shown to improve dopamine levels and reduce chronic pain sensations. While some study results have shown differences, probably owing to the use of different forms of meditation, the general results show increased signals in brain regions related to the regulation and release of dopamine.
How Is Chronic Pain Diagnosed?
Because pain is so subjective it can be very difficult for providers to know exactly how intensely a person is experiencing pain.
Different pain scales such as The McGill Pain Scale, the Wong-Baker Faces Pain Scale, and the Brief Pain Inventory are tools that providers sometimes use to try and understand the levels of pain that chronic pain sufferers are experiencing.
Some general questions that can help your doctor understand your pain a bit better are:
Where is the pain located?
How intense is the pain (number scale of 1-10 or a visual face scale of pain)
What movements affect your pain
How often does your pain occur? Is it constant or intermittent?
What is the effect of your pain on your daily life? Can you still work?
Are you experiencing any type of stress or anxiety?
Diagnostic Tests
While diagnostic tests are often not very useful for diagnosing chronic pain conditions, depending on your medical history your doctor may order tests to rule out any red flags or concerning underlying conditions such as cancer. Test might include:
EMG (electromyography - looking at muscle activation)
X-rays and MRIs
Blood tests
Nerve conduction tests
Reflex and balance tests
Conclusions
While acute pain can be a useful tool for our bodies to protect themselves from an injury or illness, chronic pain can lead to stress and depression which can significantly worsen and prolong pain that no longer serves a purpose to the body.
Increased pain can then lead to increased stress and depression, creating a continuous cycle of depression and pain that can be very hard to manage and that can have major effects on quality of life.
If you are suffering from chronic pain it is important to discuss your concerns with your healthcare provider and to advocate for your condition, especially for individuals with chronic back or neck pain.
Unfortunately there has been a history of treating chronic pain sufferers as medication-seeking or drug abusing, which can lead to more shame and more depression amongst chronic pain sufferers.
It is important for healthcare professionals to screen for depression and anxiety and to look at the person as a whole, taking a biopsychosocial approach to treatment. Once the co-occurring issues are addressed, chronic pain sufferers might be more inclined to try moving again and have less fear of making their pain and injury worse. International guidelines support the use of treatments that don’t involve medication and when we support chronic pain sufferers at all points in their journey then these options are often more enthusiastically approached and have better long term outcomes for people.