As you may relate from your own experience, or have been told a story about a dear friend, it is not uncommon to hear about people who suffer from chronic pain. One may live with minimal pain until one day it becomes debilitating leaving one with unclear answers. Common questions arise like:

How does chronic pain develop?

Why does it get worse over time?

How can one break the cycle?

Answers to the above questions will be explored in this article, but before we get into it, we want to let you know that we have a Specialized Chronic Pain Physiotherapist - Vanessa Peacock on our team to help with any chronic pain conditions you may have. If you live in British Columbia, Canada - we can help! Click the link at the end of this article to book your first session.

Now on to the education!

 Chronic Pain Defined

Firstly, chronic pain is defined as “pain that persists for 3 months or longer that leads to physical decline, limited functional ability and emotional distress (with interference with activities of daily living and social participation in society) and cannot be better accounted for by another chronic pain condition.”

Hence, chronic secondary pain syndromes are linked to other diseases as the underlying source of pain. Chronic pain is increasing in society with 10-20% of the population reporting chronic or recurrent pain. It is classified as a leading source of human suffering and disability and has been linked to increased mortality and dementia. 

The factors that predict the evolution of chronic pain after an acute episode of pain are not related to any ‘biological’ factors such as findings from a physical examination or changes on an x-ray. Interestingly enough, the predictive factors stem from ‘psychological variables’ which include mood, stress, social situations in which one’s pain is present. The biopsychosocial model reveals that one’s experience of pain is determined by the interaction between the biological, psychological, and social influences in one’s life. It is important to note that there are multiple models out there, but the point is that no one model is correct, but that different models have their own strengths and weaknesses and suit people on an individual basis.  

Currently, there is quite a costly impact on the healthcare systems in which efficient strategies are required. For example, it costs the U.S.A 60 billion dollars annually to treat chronic and subsequent related pains. Further research is highly crucial for best treatment and management as there are currently millions of lost workdays throughout the world secondary to chronic pain.

What Causes Chronic Pain? 

There is not a comprehensive list of all of the factors that contribute to chronic pain as every individual has their own experience. ANYTHING that’s happened in your life, body or brain could contribute to the experience. It is important to know- and to keep telling yourself- that your pain is real and your experience is valid.  Chronic pain is a natural human response- which means that you did not do anything wrong! It is important to provide compassionate care to yourself as we tend to be quite hard on ourselves. That being said, one’s chronic pain development is not anyone’s fault. Optimistically, that downward spiral can be stopped and the cycle can be broken.

Chronic pain is unique and individualized- meaning that it looks and feels different to everyone. Some may find that their journey stems from childhood, whereas for others, it begins at the onset of their symptoms. Whichever the case may be, it’s an equally valid and real experience.

That being said, research has identified a few things that have been found to cause chronic pain. The following will outline a guideline of how chronic pain can develop. Remember - you may find that you experience all of the points, just a few, or none at all. And that’s okay!

• Experiencing a challenging childhood can elicit the brain’s protective mode more easily- making the ‘danger alarm’ more sensitive

• Individualized coping strategies like being a perfectionist or people-pleaser. This can create vigilance and tension in the nervous system

• Health-related scares like an incorrect diagnosis or surgery can lead to catastrophizing pain, which increases the brain’s emotional response (amygdala) activity.

• Everyday stress combined with a heightened nervous system can lead to physical symptoms such as headaches or stomachaches.

• A major life event can be traumatic or emotional like a loss can run parallel to worsening of symptoms.

• New learned neural pathways develop in the body as the pain becomes chronic. The more the nervous system “practices”, it becomes easier for the system to activate it again.

• The brain changes causing the sympathetic nervous system to become heightened. This leads to the brain acting protectively, thinking there’s danger and triggering a pain response even when there’s no danger present.

• Pain-related stress impedes daily activities, social interactions, and mental health.

• The pain gains momentum and becomes worse. Activities that once relieved pain and produced endorphins have now become inhibited as fear grows.

• Education is the first step to breaking the cycle. Simply learning how pain works in our bodies can help reduce the fears around pain in itself.

• Understanding the nervous system’s pathway will help provide clarity.

• Building new neural pathways that enable physical activity and gratitude can boost motivation.

• Knowledge is power! Learning about pain will often lead to symptom reduction and lead to enhanced participation.

 How Can We Heal Chronic Pain?

The management approach is very much related to problem-solving and returning control to the sufferer as the sufferer may feel a loss of hope. Many patients state that the pain rules their lives and cannot see how this can change without a medical cure. However, with appropriate instruction in a range of pacing techniques, cognitive therapy to help identify negative thinking patterns and the development of effective challenges, stretching and exercising to improve physical function, careful planning of tasks and daily activities, and the judicious use of relaxation training, many people find the treatment enables them to take back control of their lives, to do more and feel better.

In the literature, the focus tends to lead towards psychological management strategies as pain is unique and dependent to the individual’s personal beliefs and coping strategies.

Educational strategies, such as Explaining Pain and Pain Neuroscience Education (PNE) have also been used to treat chronic pain. The aim of educational strategies is to provide patients with an understanding of the biological processes behind pain in order to reduce pain. The Explaining Pain approach highlights to a patient that pain is not a marker of tissue disease, but rather a sign of the perceived need to protect the body. Pain Neuroscience Education (PNE) focuses on teaching people in pain about the neurobiology and neurophysiology of pain. While the current evidence for Explaining Pain is low-level, the evidence base is growing and, clinically, it appears to offer improvements in pain and disability.

What Should I Do If I Have Chronic Pain?

First things first, talk about it! Let your healthcare providers know, and find a community of people who you can talk to. Invisible illnesses like chronic pain can often lead to seclusion and a feeling of isolation. Your friends, family and healthcare team should be a source of support for you - not stress.

As we mentioned above, there are many modalities that can help with chronic pain. At Chipperfield Mobile Physiotherapy, we approach chronic pain in a holistic manner - with our Physiotherapists, Massage practitioners, Acupuncturists and Occupational therapists all working together to get you the best care. Be sure to find a healthcare team who validates your experience and is trained to help with chronic pain conditions.

If you or a family member is dealing with Chronic Pain, we can help!

Our team currently sees clients in: Vancouver, Burnaby, New Westminster, Richmond, Surrey & Langley.

We can also see clients virtually all throughout the Lower Mainland! Click the link below to learn more.