Maybe you hurt your back lifting something two years ago. Or you had surgery on a knee, a shoulder or a foot, and the scans now say it healed well. Yet the pain is still there, some days worse than others, sometimes in places that were never injured.
If that sounds familiar, you are in very large company. Pain that continues for longer than three months is called chronic pain, and it is one of the most common reasons people seek care. It is also one of the most misunderstood, including by the people living with it.
I came to this work partly through my own experience. A serious sports shoulder injury and several surgeries sent me looking well beyond any one approach, and a combination of them brought relief. What follows is the explanation I wish everyone with lasting pain could hear early on.
Pain is an output of the brain, not a reading from the tissue
It feels as though pain comes straight from the place that hurts. In fact, the nerves in your tissues do not send pain. They send danger signals. Specialized nerve endings called nociceptors detect heat, pressure, stretch or chemical changes from inflammation and pass that information up the spinal cord.
Your brain then decides what that information means. It weighs the signal against everything else it knows: your memories, what you expect, what you fear, how tired you are, how safe you feel, what is happening around you. If it concludes that you need protecting, it produces pain.
This is why a soldier can be badly wounded and feel little until the danger has passed, while a paper cut can feel enormous on a bad day. The danger signal is only one input. The brain systems involved in pain overlap with those involved in fear, anxiety, attention, mood and reward, which is why the National Institute of Neurological Disorders and Stroke describes pain as a biopsychosocial experience: biology, psychology and your circumstances all play a part.
None of this means pain is imagined. All pain is real. It means pain is a protective decision made by a very intelligent system, and that system can be influenced.
How the alarm system turns itself up
After an injury, it is normal and helpful for the area to become more sensitive for a while. That sensitivity protects healing tissue. Usually it settles as the tissue repairs.
Sometimes it does not settle. Nerve cells in the spinal cord and brain can become more excitable and more efficient at passing on danger messages. Researchers call this central sensitization. Neuroscientist Clifford Woolf describes it as a prolonged but reversible increase in the excitability of the pain pathways.
When the system is sensitized, you may notice:
- Pain from things that should not hurt, such as light touch, clothing or a gentle stretch
- More pain than expected from things that should only hurt a little
- Pain that spreads beyond the original area
- Pain that lingers after an activity has stopped
- Flares linked to stress, poor sleep or worry, not only to what you did physically
Think of a smoke alarm that started out tuned to detect a real fire. Over time it has been turned so sensitive that it goes off when you make toast. The alarm is working. It is just set too high.
Notice one word in that research description: reversible. The same capacity for change that turned the alarm up, which scientists call neuroplasticity, is what allows it to be turned down.
What keeps the alarm turned up
Several everyday factors tell the brain that the body is still under threat. None of them is your fault, and each one is something you can work with.
Fear and avoidance
When movement has hurt before, it is natural to guard and avoid it. Over time, avoiding movement can make the body stiffer and weaker, and it teaches the brain that the movement is dangerous. The less you do, the more threatening it becomes.
Poor sleep
Short or broken sleep lowers the threshold for pain, and pain disturbs sleep. Each one feeds the other.
Stress and a nervous system on alert
A body in constant fight or flight is primed to protect. Stress hormones and muscle tension add to the danger signals, and a worried brain pays closer attention to every twinge.
Uncertainty
Not understanding why you hurt is itself a threat. Words like “degeneration” or “worn out” on a report can leave the impression that your body is fragile, even when the findings are common in people with no pain at all.
Pain is a protective decision made by a very intelligent system. That system can learn, and it can be taught that you are safe.
Matt DeWild, RN
Ways to turn the volume down
There is no single switch, but there are several well supported ways to help a sensitized system settle. Many people find that combining them works better than any one alone.
- Learn how your pain works. It may sound too simple, but research on pain education suggests that understanding the biology of pain can reduce pain and fear and improve movement. Knowing that hurt does not always mean harm lowers the threat level your brain is responding to. Reading this far counts.
- Find your baseline, then build slowly. Choose an activity that matters to you, such as walking, gardening or reaching overhead. Find how much you can do on a bad day without a big flare, and start there, even if it is small. Then increase by a little, perhaps 10 percent, every few days. This is called graded activity, and it gently teaches your nervous system that movement is safe.
- Pace, do not push through or stop. Many people swing between doing too much on good days and resting completely on bad days. Breaking tasks into shorter pieces with planned breaks keeps the system steadier than the boom and bust cycle.
- Have a flare plan. Flares happen, even when things are going well. Decide in advance what you will do: ease back to a lighter version of your activity, use heat or gentle movement, rest your mind as well as your body, and return to your baseline when it settles. A flare is a sensitive alarm going off, not a sign that you have undone your progress.
- Protect your sleep. Because sleep and pain are so linked, a regular wake time, a dark and cool room and a wind down routine are part of pain care, not separate from it.
- Bring in calming input. Practices such as mindfulness, tai chi, yoga and massage are among the approaches the National Center for Complementary and Integrative Health reports may help some painful conditions. They give the nervous system direct experiences of safety in the body.
When to see your doctor
Persistent pain deserves a proper medical assessment, and a doctor can rule out problems that need specific treatment. Please seek care promptly if you have any of the following:
- New weakness, numbness or tingling in an arm or leg
- Loss of bladder or bowel control, or numbness in the groin or inner thighs
- Fever, unexplained weight loss or night sweats with your pain
- Pain after a fall or accident, or pain that is severe and getting steadily worse
- Pain that is constant and unrelenting at night, regardless of position
These are uncommon, but they matter. If none of them apply and your pain has been checked, the ideas above are a sound place to start.
How IFH approaches lasting pain
At Integrated Functional Health, lasting pain is approached through the nervous system first. That begins with Regulate: helping your nervous system move out of constant alarm, so your body feels safe enough to rest, heal and change. From there, Integrate means helping the different parts of your brain work together, for better function across mind and body.
Integrated Functional Neurology with Matt is designed for exactly this kind of problem, where the nervous system has learned to stay on guard. If sleep, food, stress and activity are part of your picture too, functional health coaching looks at them together. Matt is glad to work alongside your doctor, physical therapist and other care.