Acute pain is normal. Chronic pain is not. But all pain is REAL.

Understanding how the brain works gives power to pain sufferers

Happy New Year friends of Chronic Pain Chats! I hope the start to 2024 is treating you well. With the new year I am off to the races with my manuscript and have some hefty timing goals for my first draft. I’ve been spending a lot of time thinking about the book outline and how all the pieces will fit together. My editor suggested that the chapters toggle between narrative and prescriptive. My first chapter is focused on a narrative titled “The Beginning is the End” accounting early 2023 when I changed my view on my pain and started to take a different course of action. The second chapter is prescriptive, unpacking how the brain’s role in pain can impact us. This relates to the first Chronic Pain Truth I talked about in my September post “My Chronic Pain Truths” which is: Acute pain is normal. Chronic pain is not. But all pain is REAL. “All pain is real” is a new addition to the truth’s framing, more on that below.

As a person living in pain, the first nine years of my experience emphasized treatments solely focused on the body. It made sense (so I thought), because I, like millions of others in chronic pain, have a diagnosis that could drive a pain condition. But for most people in chronic pain, the biological drivers of pain are not the only drivers. The reality is, when someone lives in pain for a lengthy period, pain is not acute pain, and the brain can be (and most likely is) a factor.

No doctor ever spoke to me about my brain’s role in pain but through research, reading books by experts, and most importantly, the stories of others living in pain, I began to put the puzzle pieces together. It should not be this hard to get the full story, right? But with time and persistence I began to unlock pain’s mysteries for myself, gaining new power and more control over pain’s role in my life.

Let me be honest. The brain’s role in chronic pain is NOT straightforward by any means.  But it’s function cannot be ignored. For the book I went hunting for the best possible explainer for how the brain functions in chronic pain and I’ll be honest, most descriptions are extremely oversimplified or far too detailed. Either will leave you scratching your head thinking, “Is that really it?” or “Wow, that's a lot, I need a bunch of letters behind my name and a medical dictionary to even start to understand this”. So, the goal of chapter two in the book is to strike the right balance, so that you can say “Yes! I get it now. My brain is a powerful and amazing system that is doing amazing (yet destructive) things.” My hope is in knowing this, pain sufferers will feel empowered (I know I did).

So, here is my high-level summary of what I’ve come to know. Please understand that I am NOT a clinician or psychologist. I’m a person living in chronic pain who also happens to be a health policy expert, skilled at analyzing complex health information and writing about it in a digestible way. I use these skills to give you my not so detailed/not so simplistic summary of your brain and chronic pain:

-       Acute Pain. When pain happens suddenly, it is commonly a warning sign of disease or other physical threat. This is called acute pain, and generally dissipates when the underlying cause is addressed or healed.  Such pain is short-term, lasting no more than six months. Note that pain is a natural and essential aspect of the human experience, protecting us from dangers. Acute pain is sending warning signals like when you stub your toe or burn your hand on a stove, and your brain is responsible for those signals.

-       Chronic Pain. When we experience chronic pain (pain lasting more than 3 months), one’s “hand” is left on the stove and stuck there. When this occurs, nerve connections are not turning off or disconnecting the way they should, and the “alarm” continues to siren. This is a breakdown in the brain’s systems and is associated with neuroplasticity which is responsible for brain’s capacity to adapt, change, and rewire itself.  With ongoing pain, neuroplasticity is essentially teaching your brain to be “hard wired” to the pain. As pain continues, the pain connections get stronger and stronger, and the vicious cycle continues. Not all chronic pain is neuroplastic, but it is commonly to blame.

-       Fight or Flight. Neuroplasticity is aided by our physical responses to threats or “fight or flight” which can be associated with that alarm going off. When you feel threatened, your body releases adrenaline and other hormones in the sympathetic nervous system as your body prepares to protect you. This can include physical reactions such as elevated heartbeat and blood pressure or tension in muscles. There are many chronic pain triggers that can cause a fight or flight (alarm) reaction. Beyond physical triggers such as tissue damage and chronic disease, other activators include stress, isolation, inactivity, childhood trauma, and even beliefs about pain. Check out this cool infographic about chronic pain threats and related alarms in the body to learn more.

Put it all together!

If you experience pain that becomes chronic, consider evaluating the threats or triggers that may be driving signs or symptoms of pain. Combine this with your brain’s sophisticated capabilities to connect, learn, and modify itself (neuroplasticity), sprinkle in fight or flight and voila! The cycle of chronic pain has done its job and now pain is your regular companion.

Okay, now what?

You will note in the info graphic a lot of different types of threats are in play. Some are biological, some are psychological, and others are social (or a product of your environment). Do most peoples’ triggers fit cleanly into one type of threat category? You know the answer already (no). For most people, a complex web of bio-psycho-social factors are in play when someone suffers chronic pain. This is important for health care treatment and how we manage in our daily lives. More on this in a later post but for now let’s get back to where we started:

Acute pain is normal. Chronic pain is not. But all pain is REAL.

“All pain is real” was a MUST add to this chronic pain truth because, irrespective of what type of pain you have, whether it is purely physical or due to a breakdown in the brain’s function, it does exist, it can and will impact daily life, and it needs a biopsychosocial approach to be addressed.

Thanks for reading and supporting Chronic Pain Chats! If you know someone who may have an interest in this newsletter, please share the link below.  - Mara