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Causes of Chronic Pain: A Deep Dive into Pain Science
Chronic pain is a complex and multifaceted condition that can significantly impact an individual's quality of life. Unlike acute pain, which serves as a warning signal of injury or illness, chronic pain persists beyond the usual recovery period and may not have an apparent cause. Understanding the underlying mechanisms of chronic pain is crucial for effective management and treatment. This article delves into the primary causes of chronic pain, including injury, disease, nerve damage, and psychological factors, through the lens of pain science.
Injury
Injury is a common precursor to chronic pain, especially when the initial trauma fails to heal properly. For example, a back injury from a car accident or a sports-related injury can lead to prolonged pain long after the acute phase has resolved. The persistence of pain following an injury is often due to several factors:
Incomplete Healing: When an injury does not heal completely, it can result in ongoing pain. This may be due to improper treatment, inadequate rehabilitation, or the severity of the injury.
Scar Tissue Formation: The body’s natural healing process can result in the formation of scar tissue, which can restrict movement and lead to pain.
Altered Pain Pathways: Injuries can cause changes in the nervous system, leading to heightened sensitivity and chronic pain. This is known as central sensitization, where the central nervous system becomes more responsive to pain signals.
Chronic Inflammation: Persistent inflammation at the site of injury can continue to cause pain. Inflammatory mediators released during the healing process can sensitize nerve endings, making them more responsive to pain stimuli.
Disease
Several diseases are known to cause chronic pain, affecting millions of individuals worldwide. Understanding how these diseases contribute to chronic pain involves examining their specific mechanisms:
Arthritis: Arthritis, particularly osteoarthritis and rheumatoid arthritis, is a leading cause of chronic pain. Osteoarthritis involves the degeneration of joint cartilage, leading to pain and stiffness, while rheumatoid arthritis is an autoimmune condition that causes inflammation of the joints.
Fibromyalgia: Fibromyalgia is characterized by widespread musculoskeletal pain, fatigue, and tenderness in localized areas. The exact cause is unknown, but it is believed to involve abnormal pain processing in the brain.
Multiple Sclerosis: Multiple sclerosis (MS) is an autoimmune disease that affects the central nervous system. Pain in MS can be neuropathic or musculoskeletal in nature, resulting from nerve damage or muscle spasms.
Nerve Damage
Neuropathic pain, a type of chronic pain resulting from nerve damage, presents a unique challenge in pain management. This pain can arise from various conditions, including diabetes, shingles, and traumatic injuries.
Peripheral Neuropathy: This condition involves damage to the peripheral nerves, often seen in diabetic patients. Symptoms include burning, tingling, and sharp pain, usually in the hands and feet.
Postherpetic Neuralgia: Following an outbreak of shingles, some individuals develop postherpetic neuralgia, where nerve damage causes persistent pain even after the rash has healed.
Traumatic Nerve Injuries: Accidents or surgeries can lead to nerve damage, resulting in chronic neuropathic pain. This pain is often described as shooting, stabbing, or burning.
Central Sensitization: This phenomenon involves an increased response to pain signals in the central nervous system, often seen in conditions like fibromyalgia and complex regional pain syndrome (CRPS).
Psychological Factors
The interplay between psychological factors and chronic pain is significant, highlighting the biopsychosocial model of pain. Emotional and psychological states can exacerbate the perception of pain, making it more difficult to manage.
Depression: There is a bidirectional relationship between chronic pain and depression. Chronic pain can lead to depression, and depression can amplify the perception of pain. Neurotransmitter imbalances in the brain, common in depression, can affect pain pathways.
Anxiety: Anxiety can increase muscle tension and exacerbate pain symptoms. Chronic pain patients often experience heightened anxiety, which can lead to a vicious cycle of pain and anxiety.
Stress: Chronic stress can alter the body’s pain perception by affecting the hypothalamic-pituitary-adrenal (HPA) axis, leading to increased sensitivity to pain. Stress also contributes to muscle tension, which can aggravate pain.
Catastrophizing: This cognitive distortion involves anticipating the worst possible outcomes and magnifying the threat of pain. Catastrophizing can intensify the experience of pain and hinder effective coping strategies.
Conclusion
Chronic pain is a complex condition with multiple underlying causes, including injury, disease, nerve damage, and psychological factors. Each cause involves distinct mechanisms that contribute to the persistence and intensity of pain. Effective management of chronic pain requires a comprehensive approach that addresses the physical, emotional, and psychological aspects of the condition. By understanding the science behind chronic pain, healthcare providers can develop targeted treatments that improve the quality of life for individuals suffering from this debilitating condition.
Douglas Kropp, RMT, at Sensory Wellness, employs a comprehensive approach to managing chronic pain, focusing on its various causes and symptoms. Through registered massage therapy, Douglas Kropp promotes relaxation, improves circulation, and reduces muscle tension, addressing pain from incomplete healing, scar tissue formation, and altered pain pathways. This holistic approach also targets chronic inflammation and provides relief for conditions like arthritis, fibromyalgia, and neuropathic pain. By integrating massage therapy into a pain management plan, Sensory Wellness enhances both physical and emotional well-being, ultimately improving the quality of life for chronic pain sufferers.
Chronic Pain Series (Part 1)
Chronic pain is a complex condition that affects millions of people around the world. It is defined as pain that persists for more than three months and can be caused by a variety of underlying conditions, such as injury, disease, or nerve damage. Chronic pain can be debilitating, affecting a person’s physical, emotional, and psychological well-being. In this blog post, we will explore chronic pain, its causes, symptoms, and available treatments.
Causes of Chronic Pain
Chronic pain can be caused by a variety of underlying conditions. Some of the most common causes of chronic pain include:
Injury: Chronic pain can be caused by an injury that fails to heal properly. For example, a back injury or sports injury can cause chronic pain that persists long after the initial injury has healed.
Disease: Chronic pain can be caused by a variety of diseases, such as arthritis, cancer, fibromyalgia, or multiple sclerosis.
Nerve damage: Chronic pain can be caused by damage to the nerves that transmit pain signals to the brain. This type of pain is known as neuropathic pain.
Psychological factors: Chronic pain can be exacerbated by psychological factors, such as depression, anxiety, or stress.
Symptoms of Chronic Pain
The symptoms of chronic pain can vary depending on the underlying condition. However, some common symptoms of chronic pain include:
Persistent pain that lasts for more than three months
Pain that is described as dull, aching, or burning
Pain that is localized or widespread
Fatigue and lack of energy
Sleep disturbances
Depression and anxiety
Difficulty concentrating or completing daily activities
Diagnosis of Chronic Pain
Diagnosing chronic pain can be challenging, as there is often no clear cause for the pain. A doctor will typically conduct a physical exam and review the patient’s medical history to determine the underlying condition. They may also perform imaging tests, such as X-rays, MRIs, or CT scans, to help identify any physical abnormalities or injuries that may be causing the pain. In some cases, nerve tests, such as electromyography (EMG), may be used to evaluate nerve function and detect any nerve damage.
Treatments for Chronic Pain
There are several treatments available for chronic pain, depending on the underlying condition and severity of the pain. Some common treatments for chronic pain include:
Medications: Over-the-counter pain relievers, such as acetaminophen or ibuprofen, may be effective in managing mild to moderate chronic pain. For more severe pain, prescription medications, such as opioids or antidepressants, may be prescribed.
Massage therapy: Massage therapy may help by decreasing muscle tension, increasing circulation, reduce stress and anxiety as well as trigger the release of endorphins which are our body’s natural pain killers.
Physical therapy: Physical therapy can help improve mobility and reduce pain by strengthening the muscles and increasing flexibility.
Nerve blocks: Nerve blocks involve injecting a local anesthetic into a specific nerve or group of nerves to block pain signals from reaching the brain.
Acupuncture: Acupuncture involves inserting thin needles into specific points on the body to stimulate the body’s natural pain-relieving mechanisms.
Cognitive-behavioral therapy: Cognitive-behavioral therapy (CBT) can be effective in managing chronic pain by helping patients develop coping skills and strategies for managing pain.
Surgery: In some cases, surgery may be necessary to address the underlying condition causing chronic pain. For example, surgery may be used to repair a herniated disc or remove a tumor.
Prevention of Chronic Pain
Preventing chronic pain can be challenging, as it is often caused by underlying conditions or injuries that are beyond our control. However, there are some steps that can be taken to reduce the risk of developing chronic pain, such as:
Maintaining a healthy weight: Excess weight can put additional strain on the joints and increase the risk of developing chronic pain.
Staying active: Regular exercise can help strengthen the muscles and improve flexibility.
In conclusion, chronic pain is a complex and multifaceted condition that can be caused by a wide range of underlying factors. Understanding the various concepts and terms related to chronic pain can help individuals better manage their symptoms and improve their quality of life. If you are experiencing chronic pain, it is important to seek medical advice to determine the underlying cause and develop an appropriate treatment plan.
Stay tuned as we go deeper into each aspect of chronic pain, its causes, how it works and treatments options that are available.
What Is A Migraine?
How Can Registered Massage Therapy Help?
Introduction
Migraines are on the lower side of what I consider a good time, as someone who suffers from episodic migraines after a few years of chronic migraines I am all too familiar with the impact they can have on our lives socially, physically and psychologically. Migraine sufferers tend to miss a lot of work, have to cancel last minute with family and friends and may find it harder to stick to an exercise routine if you’re constantly being interrupted by this unwelcoming frequent visitor. Some people may worry about what the boss, family and friends think as a lot of people don’t fully understand what a migraine is. This article will hopefully help you understand a little bit more of what we believe is actually happening and maybe give you a few pointers on how to navigate a life while living with migraines.
What is a migraine?
The first thing to note is that migraines are more than just a bad headache. At this point there is no known “cure” for migraines as research is still limited and educating healthcare professionals and the public on the matter is still growing. Originally the thought was that migraines were caused by the constriction and dilation of blood vessels in the head causing the source of severe pain. With more current research the belief now is that migraines are a neurological disorder involving nerve pathways and brain chemicals.(3) There is now evidence to support a familial factor to migraines (“90% of migraine sufferers have a family history of migraines”)(4), but studies now show that environmental factors also play an important role.(3)
A migraine is an intense pulsing or throbbing pain, usually focused in one area of the head but both sides are affected in about 1/3 of attacks. This must happen at least 5 times and last for 4-72 hours when untreated to be diagnosed as a migraine. Other symptoms that commonly occur include sensitivity to light (photophobia), sound (Phonophobia), touch (Allodynia), smell (Hyperosmia), nausea/vomiting, dizziness (Vertigo), visual disturbances “aura” (zig-zag lines, flashing lights or temporary loss of vision, which occur in 25% of people, lasting usually less than an hour) and tingling in the extremities or face. In 15-20% of attacks symptoms start to show before the actual head pain begins.(3,4)
Common Triggers
Triggers will vary from person to person and can change throughout someone’s lifetime. Some common triggers include, stress, food sensitivities/additives, caffeine, artificial sweeteners, delayed or missed meals, physical exertion, anxiety, depression, sensory stimuli, sleep changes, weather changes, alcohol and drug use and hormonal changes in women. It usually takes a lot of trial and error to pinpoint someone’s specific triggers, but with the help and guidance from you Family Doctor, Naturopath or Dietitian they can help narrow them down and find something that works for you. It can be very
Social/Economic
It is important to note that you are not alone in this, migraines are the 3rd most prevalent and 6th most disabling illness in the world effecting over 1 billion people worldwide.(4) Statistics in Canada are limited but, in the USA, an estimated 39 million people are affected, 18% of which are women, 6% are men and 10% are children.(4)
In a quantitative opinion survey by Eli Lilly and Company (February 20, 2018)2, they found that those who suffer from migraines have an increased impact on their day-to-day life. Out of the 1018 adults who took part in this survey 518 people had been diagnosed with migraines. Out of these people 91% that “those who do not suffer from migraines don’t understand the severity of the illness”, 62% try to hide the true impact from those at work or school, 82% expressed the stress of having an unpredictable illness like migraines, 70% agreed with the statement “I’ve avoided making plans because of migraine.” And on average missed 7.4 gathering such as birthdays, holiday gatherings and graduations within the last year. Among parents 72% agree that migraines affect their ability to take care of their family and 77% of which have children under the age of 13 agree they aren’t able to interact the way they would like with their children. Also found in the study is the impact on careers of those suffering from migraines. 68% agreed they are less productive at work, 55% believe migraines have had a negative effect on their career goals while 32% have admitted to turning down opportunities including promotions causing a loss in additional earnings due to migraines. They also found that migraines effect the people in our lives as well, 90% of those who have a family member suffering from a migraine attack agreed they feel “helpless” and 74% would like this person to seek better care or treatment to help.
So, it is easy to see that migraines can directly affect our lives in more than just physical pain but on are much broader scope from our careers to our relationship and everything in between. For those who suffer from migraines, remember you are not alone.
How Massage Therapy Can Help
Massage therapy can help by decreasing stress, reducing muscle tension around the neck, shoulders and upper back, and desensitizing your nervous system. Our goal is to create a safe space to help you on your path to wellness, as mentioned earlier “there is no cure” for migraines but by decreasing stress and tension, prescribing you individualized home care stretching, exercises or mindfulness practices, we can hope to decrease the frequency and even the intensity of migraine attacks.
As I’m sure most of you know that most people tend to hold their tension in their shoulders/neck and can be the source of Tension Type Headaches (TTH) in quite a few of us. These TTH’s can sometimes trigger migraines if the affected areas have become increasingly sensitive, especially when additional stress either physically or mentally is piled on. This increased sensitivity is a protective response from our body to warn us of potential danger or damage, this is possible even when there is no actual physical damage. When an area that is already sensitive receives additional muscle tension a TTH may be triggered, once a TTH is occurring in an area that has an increased sensitivity it is possible for a migraine to be triggered as well.
By receiving semi-regular massage, acupuncture, chiropractic’s, physiotherapy and staying proactive with your self-care plans (that we can help you make) you can start managing the stress in your life more efficiently, decrease the muscle tension before it becomes a contribution to headaches and best of all you will start to replace those potential “damage” signals with good feeling, a “safe” signal that will over time decrease that sensitivity to a point that will be easier to manage.
References
1. Golden L. Peters, PharmD, BCPSSupplements and Featured Publications, Current, New, and Emerging Therapies for the Prevention and Management of Migraine, Volume 25, Issue 2
2. Survey reveals many people with migraine live with pain nearly half of every month [news release]. Eli Lilly and Company: Indianapolis, IN; February 20, 2018.
3. Migraine Research Foundation https://migraineresearchfoundation.org/about-migraine/what-is-migraine/
4. Migraine Research Foundation https://migraineresearchfoundation.org/about-migraine/migraine-facts/
5. Noseda R, Burstein R. Migraine pathophysiology: anatomy of the trigeminovascular pathway and associated neurological symptoms, cortical spreading depression, sensitization, and modulation of pain. Pain. 2013;154(suppl 1):S44-S53. doi: 10.1016/j.pain.2013.
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