A Pain Physician on Why Chronic Pain is So Confusing and Agonizing

Elisha Peterson, MD, FAAP, FASA, Override Advisor

Have you consulted doctor the pain that affects your ability to enjoy life? Participating in activities you used to enjoy? Even just being with your family and friends?

Have you gotten every lab and imaging test but are still left with more questions than answers? 

Have your complaints of persistent pain been dismissed as psychological or “all in your head”?

If any that resonates, you aren’t alone.  As a pain physician, patients come to me with these frustrations every day. Chronic pain is a common experience of the over 50 million Americans, according to the CDC. What really is chronic pain?

When many people think of pain, they think of acute pain, such as a broken bone or sprain. This type of pain comes from tissue damage.  We can see a broken bone on an X-Ray or deduce a sprain from an MRI but we can’t “see” the pain.  We can also view lab results that suggest inflammation, but we again can’t “see” the pain. We can’t know how another individual experiences it. Pain is more complicated than the simple equation of: broken bone equals pain.   

Soldiers with limbs blown off in combat have dragged other fellow combatants from the battlefield with their remaining limbs.  If pain was tied only to tissue damage, these soldiers would be writhing in pain, unable to do anything except lay there and scream in agony.  The International Association for the Study of Pain defines pain as an unpleasant sensory AND emotional experience associated with actual OR potential tissue damage. Put another way, tissue damage does not have to be present to have pain; pain involves the body and the mind.  To treat pain, we have to address the body and mind. 

Acute pain – pain caused by tissue damage – is easier to understand and is something we are all familiar with.   You might think chronic pain is just a temporal continuation of acute pain – pain that lasts longer than 3 months. There would be good reason to think this; after all Webster’s Dictionary defines acute and chronic as differences in duration and “chronic pain” in its simplest definition is pain that lasts over three months.  But chronic pain is actually an altogether different beast than acute pain.  If acute pain is a small wave; chronic pain is a tsunami.  

Acute pain tends to only affect one part of the body such as a broken or burned leg or arm.  The treatment for this type of pain is staying still to allow the body to heal itself.  Because the source of pain is usually obvious for acute pain, family and friends step up to help with tasks that the injured person can’t do and provide comfort and company during the healing process.   Medications such as anti-inflammatories and opioids can help support the injured person as the body heals.  Once the tissue heals, medications are no longer required and pain recedes. Life returns to its pre-injury state!  In acute pain, the body is supported with rest and mind is supported by social supports. Pain eventually recedes like water from the shoreline.  

Chronic pain, on the other hand, can be in one part of the body but often affects many body parts or even the whole body.  Chronic pain begets more chronic pain; it’s its own disease state.  To understand this, we have to understand that the nervous system transmits all types of sensations from the external environment that is interpreted by your brain in different ways.  What if this nervous system started to hotwire on its own? What if it generated sensations interpreted to your brain as painful without any physical trigger?  This is chronic pain.  

Many people go to a physician when they have pain, but because our diagnostic tests identified structural issues and not signaling problems, one test after another is obtained with no answers.  Patients with chronic pain become frustrated because each normal test invalidates their experience. No way can this amount of pain be normal! Patients are often sent away from doctors’ offices without any better understanding of their symptoms or how they will achieve relief.

But you know what? Many medical professionals do not have an adequate understanding of chronic pain either!  Please forgive the doctor that accused the pain of being all in your head. He or she did not know better.  American medical schools teach medical students on average 11 hours of pain instruction. Override is working to make chronic pain knowledge more accessible to both providers and patients alike.

Chronic pain is truly complex and can affect the whole person. Because chronic pain is a signaling issue, no one can see the problem. As a result, people with chronic pain can feel very isolated. Those around the affected person cannot understand why she isn’t working a normal job, exercising, or socializing like she used to. Without relief in sight and appropriate empathy and validation from close ones, anxiety and depression or frequent results of sustained periods of chronic pain. Just as a tsunami tends to engulf entire cities, chronic pain can engulf entire lives.  

Effective chronic pain treatment is also far less straightforward. The suggested course of action for acute pain – stay still and rest until the pain goes away – doesn’t work for chronic pain.  It can actually be counterproductive. That’s because the nervous system is designed to adapt to the current environment.  If a person avoids moving parts of your body, the nerves don’t receive normal interactions and they adjust to the new normal. They even start causing continued pain sensations to maintain that new normal of not moving the parts of the body they perceived to be injured and damaged. The “hot wiring” of the nerves in that part of the body become even more revved up, which increases the sensitization of the nervous system and leads to continued and amplified pain.

The treatment for chronic pain at its core is a carefully formulated combination of physical activity, pain education, and cognitive behavioral therapy to reset the nervous system.  Medications alone helps acute pain but often not chronic pain.  Other strategies such as injections, acupuncture, and certain types of medications can sometimes be helpful to ease strain in the body, as well as the mind. But in isolation, they will generally fail for chronic pain.  The road to chronic pain recovery is longer than that of acute pain and is not a linear path to progress.

But there is light at the end of the tunnel. I see many patients achieve it.  You, too, can stand triumphant against the tsunami.  

Posted on 
March 14, 2023

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