{"id":78,"date":"2023-01-19T16:22:39","date_gmt":"2023-01-19T21:22:39","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/rebootyourresiliencywithselfcare\/?post_type=chapter&p=78"},"modified":"2023-11-01T18:56:23","modified_gmt":"2023-11-01T22:56:23","slug":"chronic-pain-the-mind-body-connection","status":"web-only","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/rebootyourresiliencywithselfcare\/chapter\/chronic-pain-the-mind-body-connection\/","title":{"raw":"Chronic Pain: The Mind-Body Connection","rendered":"Chronic Pain: The Mind-Body Connection"},"content":{"raw":"[caption id=\"attachment_367\" align=\"aligncenter\" width=\"846\"]\"\"<\/a> Figure 11.1 Chronic Pain Word Cloud[\/caption]\r\n\r\nWe've all had pain of one sort or another. Pain is the most common reason why people look for medical care.[footnote]National Center for Complementary and Integrative Health. (2023). Pain. Retrieved from: https:\/\/www.nccih.nih.gov\/health\/pain[\/footnote] Ever twist your ankle? Stub your toe? Break a bone? Acute pain<\/strong> usually comes on suddenly and is caused by something specific.\u00a0 Chronic pain<\/strong>, or what is also termed persistent pain<\/strong>, 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.[footnote]Kam, K. (2011). Is Your Pain Acute or Chronic? WebMD. Retrieved from: https:\/\/www.webmd.com\/pain-management\/features\/types-pain[\/footnote] Globally, the most common type of chronic pain is headaches, with low back and neck pain being the leading causes of chronic pain disability[footnote]Mills, S., Nicolson, K. P., & Smith, B. H. (2019). Chronic pain: a review of its epidemiology and associated factors in population-based studies. British journal of anaesthesia, 123(2), e273\u2013e283. Retrieved from: https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6676152\/[\/footnote]. \u00a030% of the world\u2019s population experiences chronic pain<\/span>,[footnote]Cohen, S., Vase, L., Hooten, W. (2021). Chronic Pain: an update on burden, best practices, and new advances. The Lancet. 397 (102898), 2082-2097. Retrieved from: https:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(21)00393-7\/fulltext[\/footnote] leaving them to face an enormous range of physical, mental, emotional, social, and financial challenges.\r\n\r\nPain is an invisible condition and one\u2019s 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.\r\n\r\nPain is whatever the experiencing person says it is.<\/em><\/strong>\r\n\r\nSome 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\u2019s 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[footnote]Daniell, J. R., & Osti, O. L. (2018). Failed Back Surgery Syndrome: A Review Article. Asian spine journal, 12(2), 372\u2013379. Retrieved from: https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5913031\/#__sec2title[\/footnote].\r\n\r\nDid you know pain IS in your brain?<\/strong>\r\n\r\nThe concept of [pb_glossary id=\"369\"]neuroplasticity[\/pb_glossary] or \u201cbrain plasticity\u201d has been researched extensively in regards to its role in chronic pain. Our brain has the ability to change or \u201crewire\u201d 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. \u00a0Thus, neuroplasticity has made the brain and the nervous system extremely sensitive and hyperactive to otherwise normal sensations.\r\n\r\nPain that continues after injuries have healed or pain that has no clear physical cause is usually what\u2019s called neuroplastic pain<\/strong>. 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.[footnote]Hashmi JA, Baliki MN, Huang L, et al. (2013). Shape shifting pain: chronification of back pain shifts brain representation from nociceptive to emotional circuits. Brain, 136(Pt 9), 2751-2768.[\/footnote] 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 \u2018flares\u2019 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: \u201cWill it ever go away?<\/em>\u201d, \u201cI can't do this due to my pain<\/em>\u201d, \u201cI don't want to live like this anymore<\/em>\u201d. Thinking this way can actually worsen symptoms as a preoccupation around the pain reinforces it in the brain.\r\n\r\nWatch this 2 minute overview of The Fear Avoidance Model of Pain<\/a>:\r\n\r\n \r\n\r\nhttps:\/\/youtu.be\/DkCU4M0THT0\r\n\r\n \r\n\r\nSo ultimately, the disparaging remark \u201cit's all in your head\u201d is actually fundamentally true. Chronic pain is indeed in your brain. That being said, chronic pain is NOT imaginary<\/span>. The pain is very real \u2013 it\u2019s a normal body response like blushing, crying or an increased heart rate to emotional stimuli.\u00a0The pain perception is literally constructed in your brain<\/span>. Copious amounts of research have been done on MRI studies on the different aspects of pain.[footnote]Baliki, M. N., Chialvo, D. R., Geha, P. Y., Levy, R. M., Harden, R. N., Parrish, T. B., & Apkarian, A. V. (2006). Chronic pain and the emotional brain: specific brain activity associated with spontaneous fluctuations of intensity of chronic back pain. The Journal of neuroscience : the official journal of the Society for Neuroscience, 26(47), 12165\u201312173. Retrieved from: https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4177069\/[\/footnote] Studies of the MRI\u2019s show that chronic pain acts differently, responds to treatment differently, and even involves different parts of the brain than acute pain.[footnote]Hashmi, J., Baliki, M.N., Huang, L., Baria, A., Torbey, S., Hermann, K., Schnitzer, T., Apkarian, A.V. (2013). Shape shifting pain: chronification of back pain shifts brain representation from nociceptive to emotional circuits. Brain. 136 (9), 2751\u20132768. Retrieved from: https:\/\/academic.oup.com\/brain\/article\/136\/9\/2751\/291636[\/footnote] [footnote]Woo, C.W., Schmidt, L., Krishnan, A. et al. (2017). Quantifying cerebral contributions to pain beyond nociception. Nat Commun 8, 14211. Retrieved from: https:\/\/www.nature.com\/articles\/ncomms14211[\/footnote] In a sense this is good news because if your brain can give you pain, it can also take it away.\r\n
We know that spinal discs degenerate over our lifespan, with 90% of the population showing some degeneration by age 60.[footnote]Columbia University Irving Medical Center. (2023). Columbia Neurosurgery. Degenerative Disc Disease. Retrieved from: https:\/\/www.neurosurgery.columbia.edu\/patient-care\/conditions\/degenerative-disc-disease[\/footnote] However, this does not mean that all of these people experience pain.[footnote]Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., Halabi, S., Turner, J. A., Avins, A. L., James, K., Wald, J. T., Kallmes, D. F., & Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR. American journal of neuroradiology, 36(4), 811\u2013816. Retrieved from: https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4464797\/[\/footnote]One study reviewed the MRI scans of 98 people with no back pain and discovered that 64 percent had disk abnormalities.[footnote]Jensen, M.C., Brant-Zawadzki, M.N., Obuchowsk,i N., et al. (1994). Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. 331:69\u201373. Retrieved from: https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJM199407143310201#article_citing_articles[\/footnote] More and more of this kind of research is showing that physical abnormalities found on scans does not necessarily correlate with pain.<\/div>\r\n \r\n\r\nA 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\".[footnote]University of Colorado Science. (2023). Tor Wagner. Institute of Cognitive Science. Retrieved from: https:\/\/www.colorado.edu\/ics\/tor-wager[\/footnote] 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.\r\n\r\nYou can watch Tor's 36 minute discussion on \"Healing Pain by Treating the Mind<\/a>\", as well as read a transcript of a podcast where he discusses Pain and the Neuroscience of Nociception<\/a>.\r\n\r\n \r\n\r\nhttps:\/\/youtu.be\/AM38qIaaxeM\r\n\r\nOf 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.","rendered":"
\"\"<\/a>
Figure 11.1 Chronic Pain Word Cloud<\/figcaption><\/figure>\n

We’ve all had pain of one sort or another. Pain is the most common reason why people look for medical care.[1]<\/sup><\/a> Ever twist your ankle? Stub your toe? Break a bone? Acute pain<\/strong> usually comes on suddenly and is caused by something specific.\u00a0 Chronic pain<\/strong>, or what is also termed persistent pain<\/strong>, 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]<\/sup><\/a> 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]<\/sup><\/a>. \u00a030% of the world\u2019s population experiences chronic pain<\/span>,[4]<\/sup><\/a> leaving them to face an enormous range of physical, mental, emotional, social, and financial challenges.<\/p>\n

Pain is an invisible condition and one\u2019s 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.<\/p>\n

Pain is whatever the experiencing person says it is.<\/em><\/strong><\/p>\n

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\u2019s 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]<\/sup><\/a>.<\/p>\n

Did you know pain IS in your brain?<\/strong><\/p>\n

The concept of neuroplasticity<\/a> or \u201cbrain plasticity\u201d has been researched extensively in regards to its role in chronic pain. Our brain has the ability to change or \u201crewire\u201d 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. \u00a0Thus, neuroplasticity has made the brain and the nervous system extremely sensitive and hyperactive to otherwise normal sensations.<\/p>\n

Pain that continues after injuries have healed or pain that has no clear physical cause is usually what\u2019s called neuroplastic pain<\/strong>. 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]<\/sup><\/a> 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 \u2018flares\u2019 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: \u201cWill it ever go away?<\/em>\u201d, \u201cI can’t do this due to my pain<\/em>\u201d, \u201cI don’t want to live like this anymore<\/em>\u201d. Thinking this way can actually worsen symptoms as a preoccupation around the pain reinforces it in the brain.<\/p>\n

Watch this 2 minute overview of The Fear Avoidance Model of Pain<\/a>:<\/p>\n

 <\/p>\n