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What is Chronic Pain

Pain as a warning sign

We all experience pain frequently and accept it as part of our lives. It is a reasonable way of alerting us to disease and injury and to force us to avoid harm to ourselves. Therefore, upon experiencing pain we look for the causes and try to cure these, which normally ends the pain.


Pain is generated in the brain

The experience of pain is generated in our brains. Although we feel the pain at a certain location (sometimes in many parts or even most of our bodies) this is only because of the brain giving us this impression. Pain can be caused locally by injury or inflammation. This stimulates special nerve sensors and the nerves then send signals up our spine to the brain. These signals actually do not differ from signals sent from other nerve cells, which tell us that we are touched or that something feels cold. It is the brain that converts these signals into the feeling and experience of pain. This is important. When nerve cells themselves are injured or irritated the brain assumes that the area, which they are connected to, is painful despite it being absolutely healthy. In sciatica for instance, pain is felt in the leg, but the injury is actually located in the spine. This is called a referred pain. Pain is not always caused were it is felt.


What happens in ongoing pain?

Our body is able to deal with short periods of pain as a warning signal, as outlined above. We accept that pain has a function and can cope with it. In addition, our brain is able to suppress pain signals travelling up our spine. It does so by making receiving cells in the spine less sensiti ve to incoming signals.

  • by sending signals down the spine
  • by producing substances like endorphines, which are natural pain killers


Pain thresholds and pain memory

Unfortunately, these very useful processes fail in ongoing pain. And the contrary can happen. Other substances produced by our nerve cells can make them more susceptible to signals. Spine cells changed by chronic pain can sometimes send signals out on their own, without actually receiving proper orders to do so. And nerve cells controlling them can shrink and die. All this results in a reduced pain threshold. And it can entail pain generated not at the site of harm – which by now might have healed – but rather by the nerve cells themselves, which should only pass on this information to the brain. Because the brain is used to convert any signal from these cells into a painful experience, we continue to feel the pain at the original site. These changes in our nervous system are not easily reversible. As a general rule, the longer the pain exists the lower the chance of full normalisation. As a result, pain is still felt even after the cause is finally healed, a fact called Pain Memory.

Coping with and understanding pain has a tremendous influence as well. While we know about and therefore accept short-lived pain after injury or operation, we are irritated and anxious about pain that persists. This anxiety can influence how our brain copes with pain and further decreases the pain threshold, starting a cycle negative reinforcement.


Why does pain sometimes persist?

Immediately following the onset of pain there can be various different reasons:

  • the cause might not be curable
  • the cause can recur after successful treatment
  • the healing process can be complicated by infections
  • scar tissue affecting normal function
  • reduced blood and oxygen supply
  • injuries or irritation of nerves

This ongoing pain can then lead to the changes in our nervous system described above which maintain the pain even after complete healing has occurred.

As a result of all these changes, the close association between pain and its cause is broken. Even if there was or is a source of pain, long-lasting pain detaches itself from it. It becomes a problem of its own, and is therefore comparable to other chronic conditions like high blood pressure, diabetes, asthma etc. Like these conditions chronic pain usually cannot be cured but it quite often can be controlled to enable you to go on with your life.

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