Chronic Pain

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?


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!

Chronic Pain, Favorites, Fibromyalgia, Pain Science

Understanding pain as your body’s alarm system

pretty fire

In my experience, the key to learning to work with your pain instead of against it is to learn to view pain as your body’s alarm system.

In the developed world, most of us are privileged enough to have very little experience with pain.  As children, we only feel pain when we’re at the doctor’s office getting a shot, or when we fall down and skin our knees.  We come to the conclusion that our bodies are designed for us to come to: that pain means something is wrong. 

The truth is that pain a bit more complicated than that.  What I learned from pain neurophysiology education is that pain is the body’s alarm system.  It not only warns us when something is wrong, but when the body thinks something might go wrong.  To help you better understand this, I’ve collected the following anecdotes:

Pain can stop you from injuring yourself

In his amazing online lectures that I think everyone should watch, Neil Pearson instructs his audience to extend one index finger straight up in the air, and then use the index finger of the other hand to slowly bend the first finger backwards.  It doesn’t take long for this to hurt; however, your finger hasn’t actually been damaged.  The pain is your body’s way of telling you to stop, because if you keep going, it will be damaged.

The body’s protective mechanisms don’t always work perfectly.  Case in point: thirst.

There are many ways that our body can warn us to do something, or not to do something.  Thirst is another example.

Thirst is largely controlled by a part of the brain called the hypothalamus.  This part of the brain has a “thirst center” which measures the ratio of blood cells to water in your blood.  When the percentage of water dips below a certain point, your brain tells you are thirsty.

In his book Painful Yarns, Lorimer Moseley explains how thirst is not as accurate a measure of hydration as we generally believe.  He tells the story of two individuals whose car broke down in the middle of the Australian Outback.  They nearly died of dehydration.  When they were finally rescued, they drank until their stomachs were full of water and then told their rescuers they weren’t thirsty.  In fact, they were still severely dehydrated: most of the water they had consumed was still in their stomachs, not circulating in their bloodstream where it could do them any good.

What had happened is that the act of drinking up all that water had temporarily overridden the thirst signals their brains were sending.  The thirst mechanism is designed to get us to drink, and they had drunk all the water their bodies could handle at that moment.  They were still severely dehydrated, yet they weren’t thirsty.

The essence of what I’m trying to say here is that pain and thirst are mechanisms the body uses to get us to take action in some way.  Neither one is always an accurate indicator of exactly what is happening in the body.  They are a sign that the body wants us to do something.

Your body can block out pain signals when something else is more important.

One last thing to know about the pain alarm system is that your body can override it if your survival is in jeopardy.  If you are caught in a situation where your life is in danger, your nervous system might decide it is more important for you to focus on what’s going on around you than what’s going on inside your body.

Neil Pearson gives a great example of this.  He tells the story of a patient he once treated who had been hit by a drunk driver on the way to work.  He woke up upside down in his burning car, and realized he had lost an arm in the accident.

The man managed to extricate himself from the car, collect his missing arm, and walk back up to the side of the highway all without feeling any pain. 

As Neil explains, it’s not as if the nerves in his arm weren’t sending his brain any signals; they were sending signals like crazy.  But his brain knew there were more important things to focus on: retrieving the arm, getting away from the fire, and getting help as soon as possible.  Once he was safely in the ambulance, his brain knew his immediate survival was no longer in question and pain signals set in with a vengeance.

In Conclusion

Pain is your body’s alarm system.  It is not there to give you accurate readings, at all times, of what is going in your body. Rather, it has been designed by millions of years of evolution to get you to change your course of action if your body thinks you need to do something differently.

In the case of people with fibromyalgia and chronic pain, this alarm system has begun to malfunction.  When the body goes through a painful, traumatic experience, it can change the way the nervous system works.  The pain alarm system can become overactive, and your nerves start sending you pain signals at odd times, or all the time, even when nothing is physically wrong.

This isn’t an intuitive process.  As I discusses earlier, pain signals are designed to make us think something is wrong.  Our biology leads us to believe that the amount of pain we feel is equal to the amount of physical damage we have incurred.  But when you begin to understand, on a conscious level, that pain doesn’t necessarily mean there is anything wrong, you can begin to break the cycle of chronic pain.  (I’ll be talking about how in subsequent posts).


Beautiful fire picture courtesy of Loving Earth on Flickr.

Chronic Pain

Tip for knee and hip pain: Go down the stairs backwards

When I first developed knee issues, I found it extremely painful to go down the stairs normally.  I would limp down in an awkward way, trying to find a way to move that wouldn’t hurt my knees so much.  Of course these awkward, tense movements ended up placing a great deal of strain on my hip flexor muscles (the muscles in the front of the hips), and I ended up with some pain there too.

When I finally went to aquatic physical therapy, I found that the stairs to get into the pool were designed for patients to walk down backwards.  I was amazed at how much better it felt, and suddenly I couldn’t believe I’d never thought of it before.

When you go down steps forwards, your hip and knee joints have to bend significantly.   But when you go down backwards, your knees and hips remain in a much more neutral position, closer to the position you’d be in if you were simply standing up.

I started experimenting with going down the stairs backwards at home, and now I do it all the time.  Stairs used to be my biggest enemy, but now that I’ve figured out this trick, they’re relatively pain free.   Sometimes, if I’m having a particularly rough day, I even go down the stairs backwards in public (it helps so much that it’s worth the embarrassment!).

I’m not sure I would recommend this trick to anyone who might have balance problems.  It does take some getting used to, and you have to be very deliberate about where you are going to put your feet.

But assuming everything is ok neurologically, give it a try.  Just make sure you have something to hold onto, like a wall or a railing.  And definitely check the staircase first to make sure there’s nothing there for you to trip over!