Chronic Pain: The Mind-Body Connection

We’ve all had pain of one sort or another. Pain is the most common reason why people look for medical care.^[1] Ever twist your ankle? Stub your toe? Break a bone? Acute pain usually comes on suddenly and is caused by something specific.  Chronic pain, or what is also termed persistent pain, lasts longer than three months and can happen after an injury has healed or a condition has been treated, and can even occur without a known cause.^[2] Globally, the most common type of chronic pain is headaches, with low back and neck pain being the leading causes of chronic pain disability^[3].  30% of the world’s population experiences chronic pain,^[4] leaving them to face an enormous range of physical, mental, emotional, social, and financial challenges.

Pain is an invisible condition and one’s unique pain experience can cause individuals to feel stigmatized and isolated, especially when others can’t understand the pain or even believe the pain is real.

Pain is whatever the experiencing person says it is.

Some people may have constant levels of pain intensity while others have pain that fluctuates. Difficulty in finding a concrete cause or an official diagnosis causes frustration for both patients and doctors. Often individuals are prescribed painkillers, physical therapy, rest, changes to diet or lifestyle to no avail. Surgery for chronic pain conditions such as back pain unfortunately has low success rates. In fact, failed back surgery is so common that there’s even a name for it: failed back surgery syndrome. Research tells us that about half of initial back surgeries are successful; however, that number drops to 30 percent, then 15 percent, then 5 percent after the second, third and fourth surgeries^[5].

Did you know pain IS in your brain?

The concept of neuroplasticity or “brain plasticity” has been researched extensively in regards to its role in chronic pain. Our brain has the ability to change or “rewire” itself to function in a way that differs from how it previously functioned. We know that pain is a protective mechanism and that when we injure ourselves our body sends signals to the brain to tell us of the potential damage resulting in the sensation of pain. Sometimes however, the brain misfires along the pain circuits and misinterprets safe messages from the body as if they were still dangerous.  Thus, neuroplasticity has made the brain and the nervous system extremely sensitive and hyperactive to otherwise normal sensations.

Pain that continues after injuries have healed or pain that has no clear physical cause is usually what’s called neuroplastic pain. Neuroplastic pain results from the brain misinterpreting messages from the body as if they were dangerous, not coming from structural causes, but from psycho-physiologic processes that can be reversed.^[6] For example, the brain of people with chronic pain might have created an association between walking and back pain, or lifting something moderately heavy and neck pain. Some people experience increased pain or ‘flares’ when they experience a stressful event or even just think about it. Living with pain every minute, every day, can cause pain sufferers to think about their symptoms constantly from a fearful perspective: “Will it ever go away?”, “I can’t do this due to my pain”, “I don’t want to live like this anymore”. Thinking this way can actually worsen symptoms as a preoccupation around the pain reinforces it in the brain.

Watch this 2 minute overview of The Fear Avoidance Model of Pain:

So ultimately, the disparaging remark “it’s all in your head” is actually fundamentally true. Chronic pain is indeed in your brain. That being said, chronic pain is NOT imaginary. The pain is very real – it’s a normal body response like blushing, crying or an increased heart rate to emotional stimuli. The pain perception is literally constructed in your brain. Copious amounts of research have been done on MRI studies on the different aspects of pain.^[7] Studies of the MRI’s show that chronic pain acts differently, responds to treatment differently, and even involves different parts of the brain than acute pain.^{[8] [9]} In a sense this is good news because if your brain can give you pain, it can also take it away.

A prominent researcher and professor in Neuroscience, Tor Wagner, “researches our underlying expectations and placebo effects and their influences on the parts of our brain involved in pain, emotion, and motivation”.^[13] He looks at what the relationships between emotions and pain are, why pain is a learned experience, and the steps we can take to unlearn our pain.

You can watch Tor’s 36 minute discussion on “Healing Pain by Treating the Mind“, as well as read a transcript of a podcast where he discusses Pain and the Neuroscience of Nociception.

Of course, practicing self-care is vital when one has chronic pain. Making time for movement and for rest, engaging in professional treatments, nurturing mental health through doing what gives one pleasure, and maintaining social connections are keys to building resiliency.