(This is the first in a series on chronic pain, its causes and treatment.)
It sounds ridiculous, but this is something that both patients and doctors forget: Chronic pain never starts as chronic pain. You don’t get up from bed one morning, rub your right shoulder and suddenly realize it has been hurting for three months.
Chronic pain always starts as acute pain. But many things change while on the road to becoming chronic pain. Nonetheless, doctors and patients alike tend to treat chronic pain as if it is just acute pain that’s hung around too long.
It isn’t. Chronic pain is an entirely different beast. And if we are to manage it successfully we have to recognize that we’re no longer treating the same pain.
What happens is this: As pain (inflammation) continues over weeks, months, or years, it causes mechanical changes, physiological changes and neurological changes; changes that did not exist when it first started.
Without tackling all three, we will not succeed in treating chronic pain.
Let’s take a simple neck sprain, for example. Somebody pulls their neck out throwing a baseball, getting into a minor fender bender, or even catching themselves when they trip. After a few days, the pain starts to ease up; they never get treatment, because eventually it turns into an ignorable dull ache, or goes away entirely.
Then a few weeks or months later, there’s a flare-up; they either repeat the motion that caused the injury, or in some other way aggravate those muscles. This time it doesn’t go away, instead causing high levels of pain day after day after day. Then they call the doctor.
The answer, unfortunately, is all too often round after round of increasingly powerful painkillers while getting physical therapy for a neck sprain. And nothing really gets better.
That’s because the problem is no longer the sprained muscles. They’ve healed. But over time, there have been changes.
Because the person has been trying to ease up on their neck, their range of motion decreases and the muscles actually shorten. They don’t have to extend as far anymore, even though they should. Same with the vertebral joints. They start to lock up, because they really don’t have to move so much these days.
The inflammation, a physiological process, has turned into a positive feedback loop, with inflammatory chemicals and other changes causing the production of even more inflammatory chemicals.
The nerves themselves become overly-excitable, as they try to protect the neck from further damage, sending pain signals back to the brain at ever-decreasing levels of stimulation.
Eventually it reaches the point where almost any movement, or even rest, causes one of more of these systems to flare up, and the pain becomes constant.
Other symptoms may appear as well, such as headache, or even fatigue, as so much of your energy is spent trying to avoid/stop inflammation and pain.
As you can see, we’ve gone far beyond a simple sprained neck. And with the chronic pain, a number of other dysfunctions begin to appear:
Depression. Depression is the number-one coexisting disorder with chronic pain. We cannot ignore this issue, because it limits what we can do with all of the others.
Stomach/Intestinal problems. Chronic pain can change the environment of your gut, forcing out good bacteria, and creating the conditions for impaired digestion, creating nausea, bloating, constipation and other problems, as well as the malnutrition that always accompanies impaired digestion.
Pain in other places. As your body tries to compensate and placate the original painful area, it puts increased stress on the joints, muscle and ligaments elsewhere. They’re trying to pick up the slack, and getting overtaxed and overused.
Unless we address all those factors, we will fail in eliminating and controlling chronic pain.
In the next installment of this series, I will discuss in more detail how I help my patients with chronic pain in an all-encompassing treatment plan.
Or, if you are unwilling to wait, click here to make an appointment online. Or call me at 860-567-5727 to discuss your problem with me.
I look forward to speaking with you.