As a Registered Massage Therapist (RMT) and instructor practicing and teaching about Pain and Stress, I have come to know a little bit about chronic pain. Chronic pain, and pain studies in general, are a constantly evolving field of research and study in the medical community. Even with the new developments and knowledge, it remains a poorly understood phenomenon. Having said that, I want to share with you a few thoughts around pain, specifically chronic pain, so we can share the knowledge around and open up more conversations.
Before we jump in, let’s talk a bit about the world of pain.
Generally, there are 3 subdivisions of pain acuity: Acute, Subacute, and Chronic. According to different resources, the timing is slightly different for each phase but here are the basics:
Acute: “Acute pain usually comes on suddenly and is caused by something specific. It is sharp in quality. Acute pain usually does not last longer than six months. It goes away when there is no longer an underlying cause for the pain.” (1) It’s usually around 1 month in duration and usually tissue damage related.
Subacute: “This means that the symptom or illness is not yet in a chronic state, but has passed the acute phase. It may also indicate that the condition is not as severe as the acute stage.” (2) Essentially the time passed between acute and chronic. It’s usually around 1-3 months duration and usually tissue damage related.
Chronic: “Chronic pain is pain that is ongoing and usually lasts longer than six months. This type of pain can continue even after the injury or illness that caused it has healed or gone away.” (1) It’s usually longer than 3-6 months duration, not usually tissue damage related.
So as you can see, the chronic pain definition is not very clear.
What’s causing it then, if it’s not always tissue related?
Now, this is where it starts to become fuzzy. It would be nice if we could segregate pain into tidy little boxes, but it doesn’t work like that.
There are a few different causes of chronic pain but I want to highlight two: chronic injury/musculoskeletal pain (muscles, joints, bones, and soft tissue), and neurogenic/neuropathic pain (nerves and nervous systems). (4)
In most cases, chronic pain is a mosaic of those biologic causes above with cognitive, emotional, and social components thrown in, as well.
As knowledge is growing in this area, we have some clearer insights into this mostly invisible, but highly impactful disease. (Yes, research is now saying chronic pain can be classified as a disease.) (3) And while we know some solid facts around chronic pain, it’s still an area that is largely not well understood and where more research needs to be done.
But, let’s give it a go. Let me share with you 3 things we should know about chronic pain:
1. It’s not in your head, it’s in your nervous system.
Like we deciphered before, acute pain is usually the result of signals caused by pressure, temperature, and chemical changes, passing from damaged tissues to the Central Nervous System (CNS). Our CNS, composed of our brain and spinal cord, is what determines the perception of pain. Until that cerebral processing occurs, pain is not perceived by us as humans. Interesting right? Usually, once that tissue has healed, those signals stop firing and our pain goes away.
However, with chronic pain, there’s a crappy loophole. If our CNS is in control of the perception of pain, the pain signals are not always from damaged tissues or tissue generated, even if it feels like it. “Pain signals remain active in the nervous system for weeks, months, or years. Some people suffer chronic pain even when there is no past injury or apparent body damage.” (1)
Meaning that even though the healed tissues aren’t sending those pain signals, our CNS may be self-gnereating them, perceiving them, and/or interpreting them as continued pain. (Crappy loophole, right?) Now we may be tempted to say that it’s “all in our heads”. But it’s not. It’s in our Nervous Systems.
2. Chronic Pain affects all dimensions of a patient’s life. Seriously.
So when you think of that CNS loophole around chronic pain, where it may not be tissue generated, but CNS generated, how would that affect you?
You are still perceiving pain. That pain is real, it’s every day, it’s just as real as if there was tissue damage, even if there may not be anything there. I don’t know about you, but that would affect me tremendously.
It would affect my ability to work, my stamina, my household, my finances, my mood, my activities. The list is endless and exhausting. But do you want to know what the kicker is for most chronic pain patients?
Their pain may be invisible to those around them. There isn’t a glaring, bleeding wound, a cast, or crutches. It’s just them and their pain. It’s hard to be cognizant of something we can not see or fully understand and that adds a whole new lens to the equation of chronic pain. It can be incredibly isolating. It can feel like you’re alone with your pain, unable to do the things you want to do, the way you want to do them, and that this invisible thing, called Chronic Pain, has you in handcuffs.
Chronic pain is insidious and its multifaceted effects affect all dimensions of our lives. Seriously.
So I know we’ve painted a pretty glaring picture, but I want to highlight that there are things that can be done, and new research is proving to be effective around treatment approaches.
The BIOPSYCHOSOCIAL model, where you take a 3D treatment approach incorporating biology, psychology, and sociology, is found to be effective. It involves physical treatments to our bodies and tissues, cognitive interventions for our CNS, emotions, and coping strategies, and a social component where we can incorporate families, cultures, community and support systems.
If your life is being affected by chronic pain in this multifaceted way, that’s frankly poorly understood by medical professionals and laymen alike, you may need a multifaceted approach.
That’s where the BIOPSYCHOSOCIAL model comes in.
We may not know what’s causing chronic pain, but we know what can be done about it, and what the future can look like. By treating in a 3D approach, like the BIOPSYCHOSOCIAL model suggests, it may be more accessible, holistic and effective for chronic pain warriors. Even though that poorly painted symptom picture has the possibility of being true, we can do something to change it and/or manage it, and at the very least, we can let you know you’re not alone. (8, 9, 10, 11, 12)
So if this hasn’t left you more confused than when you started, awesome.
If it has, please join the club.
Chronic pain is a dark area of the medical realm and like we mentioned, more research needs to be done. But, it can’t be done without conversation. So let’s keep this conversation going and feel free to comment below with any research or information you feel is helpful, the more we talk about it, the better. If you’re a chronic pain warrior, know that there are those of us out there rooting for you!
If you’re like to know more about the BIOPSYCHOSOCIAL model, dive more into the topic of chronic pain, and check out the sources cited in this article (and a few more!) to flex your brain muscles, here they are: