Chronic pain – what is it and how does it work?

Chronic pain doesn’t exactly sound good and it’s not something anyone would want to be suffering from – but the chronic part is a bit misunderstood and refers to the fact that it’s been there for a long time (as opposed to an acute injury which is one that happened recently.)

Also called persistent pain, it is sometimes referred to pain that has been present for a long time, sometimes with no clear underlying pathoanatomical anomalies, which in plain English means your scans look fine.

If my scans looks fine why is the pain so bad?

In our last blog we looked at how we detect pain in its most basic form. The pain gets sent from the injury to the brain – referred to as an ascending pathway. At this point, think of your brain like a lifeguard at your local pool (no really, stick with me).

The lifeguard has to keep a close eye on all the people at the pool and ensure their safety and wellbeing. Much as the brain has to monitor all of the different parts of the body (which would mean a very busy pool if we keep stretching this metaphor.) When the brain detects a problem, aided by the previous pain signal there’s something called central sensitisation.

What on earth is central sensitisation?

This is essentially your brain ‘rewiring’ to detect pain at a lower stimulus than it would have previous registered, or registering a pain response to something that it wouldn’t normally have done. As this originates in the brain (as opposed to the peripheries) it is called a descending pathway

Treating chronic pain

The good news is that this is very treatable and the approach is in two stages:

1. Firstly understanding that there are no structural issues and realising the strength – for this example the bone is fine and able to use
2. Start to progressively load the area – obviously don’t jump in at the deep end (somehow we’re sticking with this pool analogy), but to take the wrist example you can start on some smaller weights and build up.

The progressive approach has two benefits – it strengthens the bone and will ensure adequate remodelling (see our previous blog on recovering from a fracture), while reducing central nervous system sensitivity. You’re telling your brain not to worry and that you won’t be doing yourself any damage – and the rewiring back to normal begins.

It’s amazing how quickly you can start to see improvement when you correctly address this central sensitisation. Of course this is a very simplified version of how it happens and our understanding continues to develop in this area, but if you apply these principles you won’t go far wrong. As always, if you’re worried or need more information, just get in touch.