What is Chronic Pain?

Chronic pain is really difficult for you to live with. It is different and treated differently from acute pain. Moreover, it can affect almost every part of your life. However, counselling and other chronic pain resources can help you deal with your chronic pain. Additionally, it can reduce pain, lower the level of suffering, and impact your daily life.

What is Chronic Pain?

Chronic Pain is essentially pain that continues after an injury is healed or should be healed. However, it can also occur for people who have experienced nerve damage or other injuries that never fully heal. Normally, it is not considered chronic pain unless the pain has been persistent for 3 months or more.

Chronic Pain is different from acute pain and needs to be treated differently. The nervous system is much more involved in chronic pain. Additionally, it is often increased or caused by an overactive nervous system. The body uses pain to alert you to danger, but for many with chronic pain, the alert system is extra sensitive and either overreacting to stimuli or reacting to stimuli that are not dangerous. Moreover, the level of pain that someone experiences with chronic pain is often representative of the amount of danger versus safety that their brain interprets.

Chronic pain is a holistic condition that can be impacted by many things, such as physical activity, problems within muscles and joints, nutrition, sleep, stress, temperature, past trauma, emotions, and thought patterns. Essentially, anything that the brain can interpret as dangerous can be a trigger for chronic pain. With Chronic Pain, a person may have to pace themselves and plan ahead to avoid pain increases.

Types of Pain

Nociceptive Pain

Nociceptive pain is pain from injury to nociceptors. Nociceptors are receptors found throughout your body that react to chemical, mechanical, and thermal stimuli that might put you in harm’s way. When nociceptors are stimulated enough to reach the pain threshold, signals are sent to the brain to be interpreted so you experience pain. Nociceptors are not pain receptors but receptors that provide information to the brain that can result in pain sensations. An example of nociceptive pain is the pain you feel when you get a paper cut.

Neuropathic Pain

Neuropathic pain can be caused by nerve damage or impairment, such as a pinched nerve, or by injury or a disorder of the peripheral or central nervous system, such as diabetes.

Nociplastic Pain

Nociplastic pain is also known as neuroplastic pain and primary pain. It is pain that is not caused by another condition, such as pain caused by misinterpretations in your pain system. Some conditions of nociplastic pain include fibromyalgia and migraines.

Mixed Pain

You can be experiencing more than one type of pain at once. Often, long-term nociceptive pain or neuropathic pain can be amplified by nociplastic pain. This is referred to as mixed pain. It can mean that you are experiencing much more intense pain than the damage to your body warrants. You can feel much more in control of your pain when you can remove the nociplastic element of your pain. This allows you to make your pain more manageable and predictable, as well as helping you plan for the future and return to activities that you had to give up. The residual pain is also easier to treat after the nociplastic pain has lifted.

Pain As An Alarm System

Nociceptive Pain Means the Alarm System is Working Properly

Your pain system is operating properly and reacting to the damage to your nociceptors. When you heal the damage, the pain should go away. This is like the fire alarm going off when there is a fire.

Neuropathic Pain Means the Hardware of the Alarm System is Damaged

Your pain system is damaged and reacting to the damage. This is like something going wrong with the wiring of an electronic device.

Nociplastic Pain Means the Software of the Alarm System is Malfunctioning

When you have nociplastic pain, you need to fix the alarm system. Firefighters won’t be able to solve a malfunctioning fire alarm. You need to fix the pain system. You may also suffer from poor concentration, poor sleep, sensitivity to light, noise and smells, low mood, anxiety, irritability, itchiness, and numbness. These symptoms are signs of nociplastic pain and brain reorganization.

Mixed Pain Means that There is An Overreaction of the Alarm System

There is damage to the nociceptors or the nerves, but your pain system is overreacting, causing more pain than the damage requires.

How Trauma Can Influence Chronic Pain

Trauma and Chronic Pain can influence each other. Chronic pain is reported in 20 to 80% of individuals with a history of trauma. Additionally, 10 to 50% of individuals with PTSD report chronic pain.

People with chronic pain and a history of trauma tend to have worse functional status, report more significant distress, and demonstrate worse responses to medical intervention. Similarly, worse PTSD symptoms in people with chronic pain are associated with higher levels of pain, disability, and psychological distress, raising the possibility that the conditions may negatively influence each other. The presence of chronic pain and PTSD increases symptom severity in both conditions.

Consequences of Chronic Pain

Fatigue

Fatigue and chronic pain often accompany each other. Sometimes, fatigue can be harder to live with than pain. Fatigue is an overwhelming sense of tiredness, lack of energy, and exhaustion. It is beyond the feeling of being a bit tired. Chronic pain and fatigue share the same pathways in the body. Fatigue is worsened by pain, which can be further exacerbated by fatigue.

Grief

Unfortunately, grief usually ends up being a part of the chronic pain experience. It’s the grief of things you lost to the pain and the process of moving through life within your new circumstance. As you move through the grief process and gain acceptance of your pain, it can get easier, and you can start to find purpose and identity within your new circumstances.

Sleep Issues

Chronic pain can cause sleep issues, and sleep issues can worsen chronic pain.

Toll on Your Mental Health

Chronic pain is linked to depression and anxiety. It is also connected to trauma. When it is severe and you are stuck in a state of helplessness, it can be traumatizing.

Ableism and Stigma

People who have chronic pain often deal with ableism and the stigma of having an invisible disability, which can bring additional suffering and distress to your chronic pain experience.

Medical Gaslighting and Systemic Discrimination

Medical gaslighting is when a medical professional dismisses a person’s health concerns as being the product of their imagination or downplays their legitimate medical concerns. This can refer to situations in which a medical provider may not have meant to mislead or manipulate the patient. Instead, they failed to take their concerns seriously or to pursue them in an attempt to reach a diagnosis. In addition, some physicians use gaslighting to dismiss people’s (specifically women’s) medical concerns. This is unfortunately common with people suffering from chronic pain and other chronic conditions. This may cause you to feel irrational about specific medical fears or concerns.

Chronic Pain Management

Counselling can help you learn how to better manage your chronic pain. It can bring down the distress associated with your chronic pain and reduce your suffering. Some of the ways a chronic pain management approach in therapy can help you:

• Figure out how to cope with the pain
• Plan strategies to minimize pain increases
• Figure out priorities
• Change thought patterns
• Identification of the cause behind pain increases
• Manage emotions
• Create boundaries to better manage pain.
• Learn skills to help them communicate their needs.
• Find validation for the struggles with chronic pain.
• Reduce the level of pain you feel.
• Improve other co-occurring conditions that may be affecting your pain, like depression, anxiety, trauma, grief, substance use disorders, and suicidality.

Chronic Pain Treatment

Treatments that target the nervous system and the brain’s interpretations can treat and sometimes eliminate nociplastic pain. Other types of pain can have the intensity and distress level reduced through the following treatments.

Pain Reprocessing Therapy

Pain Reprocessing Therapy is a system of psychological techniques for use with neuroplastic pain. It is focused on breaking the fear-pain cycle by retraining the brain away from faulty misinterpretations fueled by fear and threat toward a more accurate view that is based on safety. In the Boulder Back Pain study, it was found that Pain Reprocessing Therapy improved the pain for 98% of patients and 66% of patients were pain-free or nearly pain-free at the end of treatment (2 sessions per week for 4 weeks) and that these outcomes were maintained one year later. You can read more about the study here: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2784694

Emotional Awareness and Expression Therapy

Emotional Awareness and Expression Therapy is a form of psychological therapy that is designed to help patients attribute their pain and other symptoms to emotionally activated central nervous system mechanisms and become aware of, experience, and adaptively express their emotions stemming from adversity, trauma, or conflict. In various studies, Emotional Awareness and Expression Therapy was found to be effective for Fibromyalgia, Somatic Symptom Disorder, Irritable Bowel Syndrome, Chronic Pelvic Pain, Medically Unexplained Symptoms, and Chronic Pain.

EMDR Pain Protocol

EMDR Pain Protocol is ideal for chronic pain associated with trauma, as EMDR was developed and proven effective as a trauma treatment. However, the EMDR Pain Protocol has also been effective on chronic pain not associated with trauma. EMDR works by activating adaptive informational processing through bilateral stimulation. EMDR can work on the maladaptive aspects of your chronic pain to reduce your suffering.

Polyvagal Theory

Polyvagal Theory can help to identify triggers that may be causing pain and create strategies to bring in safety that can reduce the pain. There are strategies used to try to bring the nervous system into a more regulated state, so it is less likely to cause or maintain pain.

Mindfulness

Mindfulness has been shown through brain imaging to reduce activation in areas of the brain that manage pain messages. It can also reduce a person’s need for pain medications (Zeidan et al., 2015). Mindfulness can help chronic pain sufferers focus their minds and body in the moment without judgment. It can move you away from negative or worrisome thoughts that can affect your mood and increase your pain.

Conclusion

Chronic pain is hard to deal with, but there are things that can make it better. Often, finding improvements in your life involves understanding the pain system and how it applies to your pain and focusing on strategies that fit the type of pain you are dealing with.

Chronic Pain Resources

Internet Resources

PainBC https://painbc.ca

Pain BC is a non-profit based in BC. It has a huge number of resources for self-management of pain, education opportunities for health professionals, and support for those with chronic pain. It is a truly amazing website to support those with chronic pain.

Tame the Beast https://www.tamethebeast.org

Tame the Beast is a website that is a collaboration between a pain scientist (LM), a pain physiotherapist (DM) and a professional communicator (SC). It shares a number of pain stories as well as providing pain education.

Pain Revolution https://www.painrevolution.org

Pain Revolution is an Australian website with a lot of information for pain education and handouts explaining pain. It has a good number of resources on it.

Pain Canada https://www.paincanada.ca

Pain Canada is a resource for Canadians, both those with pain and those professionals treating people with chronic pain.

Chronic Pain Centre of Excellence for Canadian Veterans https://www.veteranschronicpain.ca

The Chronic Pain Centre of Excellence for Canadian Veterans has monthly webinars about chronic pain, resources for those with chronic pain and those supporting those with chronic pain.

Chronic Pain Resources: Reading

Rethink Chronic Pain – Dr Gaetan Brouillard

Rethink Chronic Pain is a book by Dr Gaetan Brouillard, a Pain Specialist based in Montreal. This book takes on a multifaceted approach to pain, including an explanation of pain, the biological and environmental causes of pain, nutritional influences of pain, natural supplements for pain, ways to treat pain through complementary health approaches (reflexology, acupuncture, etc.), and psychology. It is great to offer some ideas of what next to try and educate on what could be going on with your pain situation.

Change Your Brain, Change Your Pain – Mark Grant

Mark Grant is a Psychotherapist who has specialized in EMDR treatment of chronic pain. This book is great for educating the reader on the connection between chronic pain and trauma. It also offers 15 audio downloads that readers can use to help heal their pain. Headphones are required to get the most out of the audio tracks as they are set up for bilateral stimulation (different sounds to each ear). A number of tracks are set up for use with a trusted partner; for those tracks, you may not get as much out of the experience if you don’t have a trusted partner.

Explain Pain – David S. Butler & G. Lorimer Moseley

Explain Pain is an excellent book by one of the top researchers in chronic pain. It does a good job of explaining the mechanisms behind chronic pain and what adjustments a person with chronic pain can make to reduce their level of pain.

The Way Out – Alan Gordon & Alon Ziv

The Way Out is an excellent book by the person who helped develop Pain Reprocessing Therapy. It has humour, techniques, and understanding for chronic pain patients.

8 Steps to Conquer Chronic Pain – Dr Andrea Furlan

An excellent book that covers all the basics of chronic pain. It contains a process to tackle your chronic pain but can also be read for information. Dr Andrea Furlan is a respected pain specialist in Toronto, Ontario, Canada.

Recommended YouTube Channels

Dr Andrea Furlan https://www.youtube.com/c/DrAndreaFurlan

Dr Andrea Furlan is a pain specialist in Toronto and has many educational videos about pain on her YouTube channel.

Madeleine Eames https://www.youtube.com/channel/UCoNQEC-w_DlFPTiypnhcARQ

Madeleine Eames is a psychotherapist and mindfulness teacher in Kelowna, BC and has many videos about chronic pain and psychological and mindfulness resources.

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