Where does chronic pain come from?

 

 



 

That pain in your back? It’s not coming from your back.

 

It’s coming from your brain.

Why is this important?  Because understanding the source of pain informs how we respond to it and treat it.  Advances in pain science have shown conclusively that all pain is generated in the brain as a protective warning signal trying to keep us safe from potential danger.  Pain is made by the brain, not measured by it.  And there is no such thing as “pain, out there in the body” that exists independently of the brain’s role in generating those warning signals.  And that’s a good thing for us, because we need those warning signals to help us survive moments of physical danger to our bodies: a burn, a fracture, an ulcer, a tumor, a bowel obstruction all require our immediate attention and response, and pain is how we are alerted. Thank you, brain, for sounding the alarm!

But what if it’s a false alarm?  While most acute (short term) pain resolves as tissue injury resolves, some pains persist and become chronic, even after there is no remaining injury or damage to tissue.  In this case, the brain is still working hard to protect us, and the nerve pathways that wired together to warn us of pain continue their habitual firing signals together, and we get pain that won’t go away.  And then we get frustration when all the x-rays and tests are “normal,” and there’s no good explanation for the persistent pain. You may hear this described as neural circuit pain, a central sensitization syndrome, or nociplastic pain.  These are all ways of saying “the pain is real, your suffering is real, and the way to address the pain is to work with the brain, trusting that the body is safe even while it still hurts for now.”  And the good news?  The same brain that is capable of generating habitual false alarms is also capable of down-regulating pain in response to supportive interventions. 

What are the interventions that work?  Pain reprocessing therapy has shown research proven efficacy in these sorts of situations. (https://www.painreprocessingtherapy.com/). Much of my own practice for the past 25 years has focused on children and teens with chronic pain (such as migraines and abdominal pain), using self-hypnosis training.  Clinical hypnosis in pediatrics has been demonstrated by research to be an effective intervention for these pain syndromes in kids, and is understood to be a skills-based solution that enhances developmentally appropriate mastery and autonomy, reducing dependence on medications or professionals.  (https://www.nphti.org/resources).  And there are other non-drug interventions that can work as well: acupuncture, massage, TENS units, vagus nerve stimulation, and more.

If you or someone you know suffers chronic pain, please contact us at AAHH, because we would love to be a part of the solution for you!  Mind-body medicine, acupuncture, and massage are all available with us, and we would love to see you soon.

 

To your health and healing,

 

Robert Pendergrast, MD

 

 

 

 

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