- 1. Chronic pain which is due a specific and identifiable process or cause. (EX: herniated disc, degenerative disc disease, or another structural chronic injury).
- 2. Chronic pain that is non-specific and there is no clearly identifiable pain generator that explains the pain. (EX: Fibromyalgia).
Our bodies experience pain through a combination of chemical messengers, emotions and the thoughts that communicate through pain pathways.
Pain signals can change depending on how quickly or slowly the messages are being sent. There is also a possibility for pain signals to be fired after an individuals injury has been treated or removed. This means that the magnitude of the tissue damage may not be compatible with the experienced sense of pain. Some of the reasons healed tissue can remain sensitive (thus leading to chronic pain) may be due to: post surgical scar tissue, inflammation, nerve irritation and muscle spasms. There are also certain individuals who experience pain even if there is no tissue damage left due to a misfiring of a pain signal in the nervous system; this is due to the nervous system having been “conditioned” to continue sending pain signals (ex: phantom limb pain).
Gate Control Theory:
Pain is processed separately by the central nervous system (consisting of the brain and spinal cord), and the peripheral nervous system (outside the brain and spinal cord). Our peripheral nerves detect pain, touch, vibration, and temperature. These detections are then send down a pathway through our spinal cord and then to our brain. The brain then tries to make sense of the messages in order to decide how to respond to the pain. However, before the messages get to the brain, the pass down the spinal cord which has “nerve gates”. These gates can either open which would allow the messages to move freely to the brain, or the gates can close, which would inhibit the impulse going to the brain. As you can imagine, if the impulse is inhibited and the gates close, the result would be a decrease in pain sensation. Just the same, if the gates are open and the messages flow to the brain, then a person will experience more pain.
Additionally, the emotions and thoughts that the brain attaches to the experience of a sensation will determine how the pain is processed and even experienced. If the brain chooses to pay a lot of attention to the pain, then it will send signals to the spinal cord to open the gates which will amplify the pain. If the brain decides to ignore the pain, then it will send signals to the spinal cord to close the gates which will result in the decrease of pain.
Which Factors Cause the Pain Gates to Open?
Sensory Factors: extent of injury and/or degenerative changes, extent of scarring and other physical reactions to the original injury even after healing (ex: inflammation), muscle tension, re-injury, inactivity/de-conditioning, long-term narcotic use, poor body mechanics, poor pacing of activities.
Cognitive Factors: degree of focus on the pain, boredom, beliefs and attitude about the meaning of pain (ex: heart attack vs indigestion), perceived lack of control over the pain, focusing on the pain, having no outside interests, worrying about the pain, thinking about all the bad things associated with the pain, negative beliefs about your future.
Emotional factors: depression, anger, anxiety, stress, frustration, sadness, hopelessness and helplessness.
*At times of anxiety or stress, the descending messages from the brain may actually amplify the pain signal and the nerve gates as it moves up the spinal cord.
Sensory Factors: increasing your activity, short-term use of pain medication relaxation training and meditation, and aerobic exercise.
Cognitive Factors: outside interests, thoughts that help you cope with pain, and distracting yourself from the pain.
Emotional Factors: having a positive attitude, decreasing depression, being reassured that the pain is not harmful, taking control of your pain and your life, and stress management.
Understanding the biology of pain as well as the mind-body connection, gives us an opportunity to gain perspective on the mechanisms that are happening inside of our body. Understanding the mechanisms that produce sensations such as pain, as well as the ones which help decrease it, can help us make mindful decisions about how we can respond to our bodies.