Treating Chronic Pain as a Two-Way Street

The nervous system has a system of checks and balances that ultimately determine how strong a pain signal is experienced by the individual. Different parts of the spinal cord and brain can play a role in either magnifying or weakening the pain signals traveling through them.

How a pain signal is amplified or dampened depends on a lot of factors (the person’s chemical makeup; genetics; personal history with accident and injury; emotions; context; whether or something else is happening at the moment that’s more important– aka why soldiers in battle can be shot and feel no pain).

One theory posits that chronic pain patients no longer have the same signal-weakening mechanisms that healthy individuals have. This is why they feel things, much more strongly, that might not really register to another person.

This is why, in many cases, I feel as though it’s misleading to talk about chronic pain as though it’s “in” the nervous system; that it’s something the nervous system is just coming up with on its own.

Instead, I think a lot of what chronic pain sufferers feel is pain signals which would be present in anyone– it’s just that in chronic pain sufferers, the pain signals are magnified, while other people might never register them consciously.

Now, this is not definitely not true all of the time.  Research has proven that physical injury/pathology is not necessary for pain.  After all, someone suffering from phantom limb pain where his leg used to be does not still have a leg to have a physical problem in!  But I do think it is possible that it’s the case, in chronic pain patients, more often than some authors realize.

So why don’t we try to stop those pain signals, which helping to perpetuate the chronic pain cycle, from starting in the first place?

Think about what it took to trigger the process of central sensitization in the first place. It’s usually caused by some kind of traumatic physical event. I think it’s a little idealistic to assume that people are always going to bounce back into mint condition three to six months after an injury/illness/surgery and not have any structural reasons at all for pain.

Yes, a tight muscle here or there might not be “painful” enough to consciously register to patients in the general population. But when we’re talking about central sensitization, the criteria for what is “significant” enough to become painful is pretty low.

And if the point is to get the person’s nervous system to calm down, wouldn’t it make sense to try to calm down the thing that’s happening at the very start of the whole signaling cascade? Why not approach the problem by dealing with both the end and the beginning of the cycle?

Now, I get why some treating professionals have downplayed the idea of approaching treatment from this angle. When you’re trying to convince a person that a muscle spasm or a trigger point isn’t “dangerous,” you don’t want to turn around and make it sound like you’re worried about it. If you alarm the person, you’re going to cause his or her nervous system to leap back into action, cranking his or her level of pain back up.

But what if it was possible to educate the patient on pain, and what is and isn’t dangerous, and explain that a muscle spasm isn’t really dangerous at all… while still acknowledging that he or she might be in less pain without the muscle spasm starting the cycle off in the first place?

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I’ve got a lot more thoughts on this subject, but I want to hear your thoughts.  Did you ever feel like you had a doctor, physical therapist or other medical professional who had great advice to give you about living with chronic pain, but didn’t seem to have much interest in looking for any potential physical reasons for your pain? I’m curious… let me know!


4 thoughts on “Treating Chronic Pain as a Two-Way Street

  1. The theory in this post about how chronic pain patients experience pain more strongly than healthy individuals because they don’t have the same signal weakening mechanisms is really interesting. That would explain why they feel pain more strongly than other people. My sister has endometriosis, so I can imagine that the pain that she feels during her menstrual cycles would be much more severe compared to what other women have to go through.

  2. Most of my doctors have told me to just get used to the chronic pain and deal with it. The first time I had a doctor who wanted to find the cause of one of my bigger pains, it was like a breath of fresh air. She compared my MRI to a nerve conduction test she did and was able to explain where and why my legs were in pain. It was truly exhilarating to have a doctor want to know. Most doctors simply sit back and say it is just the fibromyalgia acting up again. Why don’t you try water therapy?

    1. Yes, that’s exactly the overly-simplistic approach to treatment I’m talking about: people telling you to learn to deal with “pain” as though it’s separate from everything else taking place in your body. The doctor who did the nerve conduction tests does sound like a breath of fresh air!

      And yes– I’ve been doing aquatic therapy for a while, actually– it’s one of the only reasons I’ve stayed at all sane this winter! I’m thinking of branching out and maybe getting a second opinion, however, to see if maybe there are any additional exercises I should be doing.

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