Retrain Your Brain to Help Your Chronic Pain

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During 2021, an estimated 20.9% of adults United States (51.6 million people) experienced chronic pain (pain lasting > or = 3 months).1 You may ask yourself why does chronic pain happen and why is it extremely prevalent? The best way understand chronic pain is to learn about the anatomy behind pain.

According to the International Association for the Study of Pain, pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.2 There are three different types of pain: nociceptive, neuropathic, and nociplastic. Nociceptive pain is caused by damage to non-nervous system tissue like muscles, bones, and joints. For example, you may experience nociceptive pain if you tear a muscle or have arthritis in a joint. Neuropathic pain is caused by damage to the nervous system like brainstem, spinal cord, and peripheral nerves. For example, you may experience neuropathic pain if you have neuropathy or a pinched nerve in the spine. Nociplastic pain occurs from an altered perception of pain caused by activation of pain receptors without any evidence of actual or threatened tissue damage. Someone with chronic, persistent, intractable pain may be experiencing chronic pain.

Let’s dive into the anatomy behind pain. Our peripheral nervous system sends signals from our extremities to our spinal cord and brain (central nervous system), so we become aware of this sensory input. There are different types of nervous system fibers that mediates a range of sensory input including light touch, pressure, vibration, position sense, heat/cold, and pain. As discussed previously, nociplastic pain is caused by a dysregulation of the central nervous systems that leads to pain being sensed without a painful stimulus. This type of pain is characterized by either increased responsiveness of the pain nervous system fibers or decreased inhibition of those pain nervous system fibers causing consistent perception of pain. There are natural mechanisms in place designed to modulate our pain response. Pain is modulated from periphery mechanisms such as inhibition from other sensory input (i.e., vibration) or central mechanisms from regions in our brain that are involved in pain modulation. People who experience chronic pain might be experiencing nociplastic pain where they are experiencing either a heightened response to a painful stimulus, a pain response to non-painful stimuli (i.e. bed sheet or cotton swab), or our inhibition mechanisms are not modulating pain appropriately. One common analogy for chronic pain involves a fire and a smoke detector. In this analogy the painful stimulus is the fire which sets off the smoke detector which is our pain response which signals firefighters to put out the fire. This is an example of a normal pain response. On occasion even if the fire is gone (painful stimulus), the smoke detector (pain response) is still signaling that there is a fire, and our perception of pain continues. This is a dysregulated pain response and could be the cause of chronic pain.  

The good news is that physical therapy can help with your chronic pain symptoms. Education, TENS (transcutaneous electrical nerve stimulation), exercises, manual therapy, and much more are all proven to be physical therapy interventions to help with chronic pain symptoms. If you or loved one is experiencing chronic pain, contact us today to learn how our physical therapy services can relieve your chronic pain symptoms!

References

1Rikard SM. Chronic Pain Among Adults — United States, 2019–2021. MMWR Morbidity and Mortality Weekly Report. 2023;72(15). doi:https://doi.org/10.15585/mmwr.mm7215a1  

2Raja SN, Carr DB, Cohen M, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;161(9):1976-1982. doi:10.1097/j.pain.0000000000001939

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