Understanding Chronic Pain: It’s All In Your Head

By: Deanna Camilo, PT, DPT

The first thing we need to know in order to begin our understanding of pain is that pain is a product of the brain’s interpretation of two things:

  1. An unpleasant sensation.
  2. The circumstances surrounding the introduction of the unpleasant sensation.

All sensory information (touch, vision, taste, etc.) must be evaluated by the nervous system, and accurate interpretation of this information depends on the context surrounding the introduction of the sensation.  Pain does not become pain until the brain interprets the sensation as dangerous or threatening. “Dangerous or threatening” is determined by contextual clues provided by the rest of the body: emotions, previous memories, and potential consequences of each response. Thus, the amount of pain you experience is not necessarily related to the amount of tissue damage and is entirely dependent upon everything else happening in your life at the time of the initial injury.

Imagine you just received a big promotion at work and are walking to your car to meet your friends for a celebratory dinner.  You get halfway to your car, step in a pothole, and sprain your ankle.  Now imagine you have just been laid off and are walking to your car thinking about how you are going to inform your spouse of the loss of income.  You get halfway to your car, step in a pothole, and sprain your ankle.

Both of these scenarios result in a sprained ankle, but in the first example you will probably just continue on to your car, meet your friends, and forget all about your ankle by the end of the night.  In the second example, your nervous system was already interpreting danger from the stress associated with losing your job.  Now you’ve thrown in tissue damage (regardless of how minor the sprain is) and your nervous system provides more “threat/danger” cues to the brain.  Your brain then decides that what would be a minor inconvenience under normal circumstances is now a major problem and it cannot allow you to ignore the potential threat. You are now experiencing intense pain.

So how do our bodies go from this relatively normal pain state to a chronic pain state?

Chronic or recurring pain is pain that lasts longer than 3 months.  Generally speaking, the injured tissues have had an opportunity to heal in this time frame, but the brain has continued to produce pain signals. These continued pain signals are a result of a sensitized nervous system.  This means that it doesn’t take as much stimulation to activate pain receptors as it would in an individual who isn’t already experiencing pain.  In fact, the pain generating chemicals in the body are so strong that they can turn normal receptors into pain receptors and eventually sensations and stimuli that are typically non painful are interpreted as painful.

Let’s go back to our ankle sprain example.  It’s been 3 months, it still hurts to walk on your ankle and you’ve noticed that the weight of a sock makes your ankle hurt just as much as if you were to walk on it.  Your nervous system is sensitized and has lost its ability to distinguish between painful stimuli and non-painful stimuli. In order to break the cycle of chronic pain, the brain and nervous system must be retrained.

A great place to start is to reflect on your personal pain experience.  Think about your current thoughts and emotions related to your pain as well as the emotions you were experiencing when your symptoms increased.  Evaluate your diet and lifestyle.  Smoking, alcohol consumption, poor nutrition and low physical activity level can play a big role in your personal pain experience.  Take matters into your own hands and schedule an appointment with your physical therapist. Getting your body moving at comfortable levels without fear is a great way to teach your brain that not all stimuli are painful.


Medical Disclaimer: Motion Stability has created and compiled the content on its website for your information and use. This information is not intended to replace or modify the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. Please remember that the information and content, in the absence of a visit with a health care professional, must be considered as an informational/educational service only and is not designed to replace a physician’s independent judgment about the appropriateness of risks of a procedure or condition for a given patient. 

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