Chronic Pain: The Brain to Pain Game
By Dr. Louise Stanger, Ed.D, LCSW, CIP
America’s Drug of Choice: Downers
In Andrew Sullivan’s sprawling New York Magazine take on the voracious nature of the opioid crisis – “The Poison We Pick” – he posits that the “drugs now conquering America are downers: They are not the means to engage in life more vividly but to seek a respite from its ordeals.” Perhaps that explains those who experience chronic pain – a terrible disease that makes everyday tasks like buttering toast and fastening a seat belt – an agonizing experience for which pain pills are the escape. But in the midst of a nation wrestling with a growing epidemic, pain pills may be easy but the addiction it causes for chronic pain sufferers can do more harm than good.
In the United States, chronic pain affects 133 million Americans; and 65% of Americans seek care for persistent pain at some point in their lives reports the American Cancer Society. In total, this issue affects more lives than diabetes and heart disease combined. It’s big business for the healthcare industry – an estimated $100 billion is spent annually to manage pain, including healthcare expenses, lost income, and lost productivity at work and home, per Medline Plus, a publication of the National Institutes of Health.
Types of Pain
In lieu of these growing numbers, one must be able to distinguish between acute and chronic pain.
- Acute pain is short term, typically brought on by a physical ailment such as inflammation or injury, and clears up when the source is treated and heals.
- Chronic pain, however, is long-lasting, generally over three months of persistent pain. Per Medline Plus, chronic pain is believed to be a disease that causes changes in the nerves and persists long after the initial source of the pain heals. Though injury can develop into chronic pain, the most common types Americans experience are headaches, lower back pain, arthritis, cancer and muscle pain.
Pain has been treated via physical therapy, surgery, and nerve blocks. In fact, in the decades before the 1990’s, these were the most common forms of treatment as well as alternative treatment approaches like acupuncture, mindfulness and massage therapy. However, doctors are now overprescribing pain medication, not an inherently bad form of treatment, but research shows close to five million Americans report recently taking prescription pain medication in a potentially unsafe way.
Are There Brain Benefits of Pain?
What if there was a benefit to this growing problem? New research has discovered the pain to brain relationship, a breakthrough in understanding the nature of pain and the body’s response to it. “When we think of chronic pain, we think of an afflicted body part… an aching lower back, a throbbing shoulder,” writes Morgan Ingemanson for eVox Brain Map. “But to effectively treat chronic pain, new research says we should be looking to the brain instead of the body.” As such, this research may lead to complementary and/or alternative forms of treatment that can better treat the disease and save lives from opioids.
Most chronic pain causes changes in the nervous system. When this happens, people who experience chronic pain become more sensitive to pain because the nervous system is on high alert. And because the human brain works in tandem with the nervous system, pain is fully connected to the brain. According to eVox Brain Map, here are the ways pain causes changes in the brain:
Brain chemistry. Neurotransmitters are chemicals in the brain that stimulate activity and inhibition. Normal function of neurotransmitters create a balance in step with a healthy and high functioning body. But when chronic pain disrupts this balance, stimulating the brain to make abnormal levels of neurotransmitters, the chemistry of the brain becomes altered, more sensitive to pain, and reinforces this destructive cycle.
Brain structure. The latest neuroimaging studies have shown that “chronic pain can alter the size of certain brain regions and change the connectivity between these regions.” As such, symptoms can arise that further compound the problem. Fear, anxiety and depression are common in patients who experience chronic pain because the disrupted brain structure triggers these regions of the brain.
Brain activity. Although pain feels the same from acute to chronic, researchers have found an emotional response tied to chronic pain because the brain processes pain differently in these two different stages of pain. “This might explain why treatment that work well for acute pain patients don’t provide any relief for chronic pain patients with the same injury.”
The good news is that the human brain is malleable – it can be molded back into normal functioning states. The key is to using strategies that relax the central nervous system, and allow for brain reprogramming to work. Massage therapy, meditation and mindfulness have proven successful in some chronic pain patients.
The “Goldilocks Syndrome”
The key to these treatment compliments is in understanding the “Goldilocks Syndrome,” in which pain is assessed as being too great or too little, looking for the balance of what is acceptable levels of pain. As in the fairy tale, Goldilocks did not want a bowl of porridge too hot or too cold but just the right temperature. This idea applies to chronic pain patients working through their pain.
For a patient going through physical therapy on an injured leg, for example, they have to relearn how to fully extend and articulate this limb. This requires them to learn that too little work will keep them in their chair and too much will overextend the leg.
As their brain relearns full function and the nervous system stimulates levels of pain, a balance will take place – just the right temperature for the porridge – to give the patient hope and healing. And as emotion is in lock-step with pain, a boost of confidence and the feeling that you are making progress returns the brain chemistry to normal function.
Alternative Therapies Can Help
Patients of chronic pain shouldn’t look to a balance of pain, rather, focus on the alternative treatment methods that work toward a stronger version of yourself. There are a number of therapies for people who experience chronic pain. Physical activity like:
- yoga classes
- rock climbing
and any other number of outdoor activities are a great start. Meditation, mindfulness and breathing exercises are also useful in concentrating the mind on the present, in effect redirecting those neural pathways toward healthy pain levels. Acupuncture, aquatic therapy, Qigong, music, spinal manipulation are all new types of therapies that are paving the way for chronic pain sufferers to find healing.
If you or a loved one you know is experiencing chronic pain, please reach out to me about ways to break through the cycle of addiction from pain pills and find healing in treatment options.