Chronic Pain Neuroscience Austin. In my last year of graduate school, I was completing my final clinical rotation at an outpatient clinic in the Central Valley of California in a town called Fresno (the best produce I have ever had is from that region). It was my second day at this site and I headed in an hour early to get a jump on my patient load for the day to make sure I knew the background history of each patient. I was the first one there that morning and did not know it. I headed to the clinic’s back door like I did the previous day and opened it. Nothing out of the ordinary there.
But along with that came the blaring of the security alarm which resonated like an old firehouse bell. It was 6:00 a.m. I didn’t have the code to shut off the alarm, and now I was responsible for disturbing the surrounding neighborhood for about a good half hour before my clinical instructor arrived and turned it off. Luckily the owner was more amused than upset about the whole ordeal!
The memory reminds me how our world can change and be abruptly disrupted, much like an event that causes pain. One moment we are okay, then the next our bodies are firing an alarm bell when something isn’t right like twisting our ankles or banging our toe on a doorframe. Most of the time, it doesn’t take long for that internal body alarm bell of pain to stop and we go back to normal.
But sometimes after a serious injury event that limits how we live our lives, that internal body alarm that signals pain, changes, and can go off for no reason, even when there is nothing wrong with our already healed tissues. Maybe you are currently experiencing this. So, what the heck is happening and why won’t your pain go away after many weeks, months, or years?
The Physiology of Chronic Pain
Chronic Pain Neuroscience Austin. Our nervous system is imposing when we think about just sheer volume. The number of nerves we hold in each of our bodies is about 45 MILES LONG and is a neural highway that governs every single function that keeps us upright. When something appears off or is seen as a threat, it sets off electrical impulses that help us to avoid or stop continued harm to ourselves. Take for example stepping on a nail with our foot.
Many of us think that the nerve pain receptors in the tissues that we just punctured tell our bodies that we are experiencing pain. In actuality the nerve pain receptors send an electrochemical impulse to our spinal cord and eventually up to our brain where it is distributed to multiple areas where the location of the pain, the intensity of the pain, the psychological impact on the event, and the level of importance of the pain (is it serious or can we ignore it) is determined in 50 -200 milliseconds; so fast that we remove our foot from the nail before we feel the pain sensation come on.
Chronic Pain Neuroscience Austin. So our body’s pain alarm system goes off and helps us to stay out of harm’s way and for most injuries and accidents that alarm shuts off and goes back to normal. Our minor injury heals and we are back to ourselves, baby! However, pain is so individualized for each of us, harm that has been inflicted secondary to the severity of pain, (seriousness of injury, or the level of involvement of the surgery), limitations in function (not doing things with the same speed, intensity or volume), or disability (not able to do an activity at all), can cause your pain alarm system to stay elevated.
This sustained elevation can lead to instances where even slight movements, physical touch, or temperature change can trigger a pain response, even though your tissues are fully healed. Anecdotally and observed by research, patients who tend to attain chronic pain are those who may have underlying anxiety, depression, or neuroticism. So if you’re wondering why your pain continues to linger long after your tissues should theoretically be healed, this may explain why. So what’s the remedy you ask? We need to start moving both literally and figuratively!
So What Can Be Done?
Chronic Pain Neuroscience Austin. First, if you’re reading this article, you have already provided yourself with therapeutic help. Research has shown that education on the root cause of an elevated body pain alarm system helps decrease the sensitivity response and get you back to previous baseline levels as seen in the above chart. This is why getting clarification to lower our uncertainty and anxiety levels is effective.
Chronic Pain Neuroscience Austin. The second thing you can do is start to get aerobic activity in your daily routine. Just 10 to 20 minutes a day, 3-5 days a week of moderate (heart rate 50-70% of your max heart rate) aerobic activity (walking, swimming, bike riding) is enough to improve your nervous system alarm thresholds over 2-12 weeks. This is helpful for several reasons: improving your mood which helps decrease anxiety and avoidance of movement and initiating endorphin release to support the parasympathetic nervous system which stops the fight or flight response. Constant activation of your sympathetic nervous system (what produces your flight or flight response) sustains a heightened body alarm system that ultimately promotes chronic pain.
Chronic Pain Neuroscience Austin. The third thing to do is to ensure you get more restful sufficient sleep. Stay tuned for more about sleep in future blog posts. It has been found that even one night of sleep deprivation can lead to hyperalgesia (elevated pain), lowering the body’s natural pain-inhibiting pathways even in pain-free individuals, and promoting pain-inducing inflammation of your nervous system. Insomnia (being awake 30 minutes after turning off the lights or after falling asleep, 3x/week, for 3 months) is highly prevalent among people with chronic pain, with 53% to 90% showing clinically significant degrees.
It makes sense that our brain needs sufficient time to renew through sleep as it is essentially the CEO of how our body interprets and responds to pain. Our sleep needs to be a priority. If taking recommended sleep hygiene actions (see in our future blog) does not work, cognitive behavioral therapy for insomnia may be needed to formulate coping strategies for stress which is a key factor in preventing us from attaining quality sleep.
Chronic Pain Neuroscience Austin. Lastly, make sure you are taking incremental steps to get back to the activities that you did before getting injured. Make a list of all the things you want to perform and get with your physical therapist to plan out the frequency, volume, schedule, and proper body mechanics to complete those tasks. A good rule of thumb is to make sure your pain levels do not exceed 4/10 on a 0-10/10 pain scale (0 = no pain, 10 = unbearable). If it does, that is a strong indication to take a break and return to the task later. With gradual progression, you can return to your pre-injury self.
Chronic Pain Neuroscience Austin. Know that tissues heal from injury or surgery but that pain can come from your nervous system being rewired from its normal pre-injury self. This unfortunately maintains the feeling of pain past the healing timelines of previously injured tissues that are now healed. Finding out if your pain is due to a skewed nervous system that is secondary to injury or can be resolved quickly and conservatively is what we can help you to determine.
The faster you find this out, the quicker you will be on the road to recovery. If you think this matches your situation or somebody you know, don’t waste any more time and come seek us out. Let’s quiet those body pain alarm bells and get you back to living life on your terms!
Reference List
Kourbanova, K., Alexandre, C., Latremoliere, A., 2022. Effect of sleep loss on pain—New conceptual and mechanistic avenues. Front. Neurosci. 16, 1009902.
Louw, A., 2013. Why Do I Hurt? 1st ed. Oxford University Press.
Nijs, J., Mairesse, O., Neu, D., Leysen, L., Danneels, L., Cagnie, B., Meeus, M., Moens, M., Ickmans, K., Goubert, D., 2018. Sleep Disturbances in Chronic Pain: Neurobiology, Assessment, and Treatment in Physical Therapist Practice. Physical Therapy 98, 325–335.
Nijs, J., Malfliet, A., Roose, E., Lahousse, A., Van Bogaert, W., Johansson, E., Runge, N., Goossens, Z., Labie, C., Bilterys, T., Van Campenhout, J., Polli, A., Wyns, A., Hendrix, J., Xiong, H.-Y., Ahmed, I., De Baets, L., Huysmans, E., 2024. Personalized Multimodal Lifestyle Intervention as the Best-Evidenced Treatment for Chronic Pain: State-of-the-Art Clinical Perspective. JCM 13, 644
Tan, L., Cicuttini, F.M., Fairley, J., Romero, L., Estee, M., Hussain, S.M., Urquhart, D.M., 2022. Does aerobic exercise effect pain sensitisation in individuals with musculoskeletal pain? A systematic review. BMC Musculoskelet Disord 23, 113
