Ending the Chronic Pain Cycle


Understanding your pain

When after years of working as a flight attendant I started to feel regular neck pain and headaches, I didn’t pay too much attention to them. They’ll go away again, I thought. Until they didn’t. And became worse.

I never realised before that there are different kinds of pain. Pain just told me there was something temporarily wrong in my body. Just like when I broke my back in 2006. I received treatment, took rest and worked with a physiotherapist afterward. Problem solved.

But this time I went to the physiotherapist, got the usual diagnoses and subsequent treatments and got different results. That’s to say tissues did heal and inflammation subsided. Still the pain remained. And worse; the pain started to spread to other parts of my body.

That’s when my physiotherapist eventually started to mention Chronic Pain Syndrome. It was only when I started to hear the term Medically Unexplained Symptoms (or SOLK in Dutch) that I started to question what this actually means.

I started to wonder, how can they not solve my pain? Does that mean they think I’m making this pain up?

Luckily I had a pain science trained physiotherapist who explained to me what happens in your brain and nervous system when you’re experiencing chronic pain.

Why we feel pain

Now let’s start with the function of pain. Pain protects us against harm. It signals there is something wrong or a threat to our wellbeing. Since this mechanism is crucial for survival, human nature made sure this is a clear enough sign that’s difficult to ignore.

In a nutshell there are three common types of pain:

  1. Nociceptive pain. This kind of pain occurs when there is tissue injury or damage and even potential damage. An example of nociceptive pain is acute low back pain or a pulled hamstring.
  2. Neuropathic pain. This kind of pain occurs when nerve tissue is injured or when there is disease of nerve tissue. Sciatic pain is an example of neuropathic pain.
  3. Neuroplastic pain. This kind of pain tells us there is something wrong in the way our nervous system processes pain. This pain can occur after you’ve experienced an injury or sickness and your nervous system has become oversensitised.

Most structural damage heals within three to six months. So pain without a structural cause that lasts longer than this period of time is labelled as chronic pain. Chronic pain doesn’t actually mean forever though. It just means that the average recovery time for a particular injury has passed.

This Ted Talk explains the workings of pain in a very good (and funny) way.

Know your pain

This blog is about chronic pain, or neuroplastic pain. Now before you jump to conclusions, it’s important that you have ruled out disease, damage or inflammation to your body by a medical expert.

One of the reasons why it usually takes a longer period of time before people with chronic pain get treated by the right specialists trained in pain science, is that it takes a while before specialists can rule out structural damage to your body.

The other reason is that chronic pain patients go ‘shopping’. They go from one specialist to the other in the hope of finding the actual cause of their problem.

And since every specialist usually looks at the problem from their specific field of expertise, it’s not uncommon to get several diagnoses too. If their chosen treatments turn out to be ineffective, you may even be referred to yet another specialist.

Ending the cycle

Once serious damage or disease is ruled out by a trained medical, you can start with a new approach to your pain.

The first and absolute crucial step here is this: You have to understand your pain.

Understanding your pain proves time and time again to be absolutely fundamental to breaking the chronic pain cycle because it changes the way you respond to pain.

What happens when you’re in chronic pain?

When you learn a new skill, your nervous system becomes more responsive in order to learn that skill. The same thing can happen to pain signalling. Your nervous system can become a pro in producing pain signals.

Our pain system basically becomes overprotective of us.

There are too many factors that can determine whether pain can become chronic or not. But some of them include our upbringing, natural resistance to stress, social health, cultural background, ruminating tendencies, early or recent trauma and mayor life events to name a view.

Having an overprotective system does not mean you’re weak, imagining your pain or haven’t been trying hard enough to overcome it. The pain is real. And it is in your head. In your brain to be precise.

How can we train our system to become less protective?

So the bad news was that our nervous system is so plastic fantastic that it can become really good at producing pain signals. And the good news is that our nervous system is so plastic fantastic that we can actually train it into safety mode.

Now our nervous system only learns things well if we do them repeatedly. And usually slowly. Especially when your working with a sensitised nervous system it’s important to take congruent little steps.

Physiotherapists trained in pain science use therapeutic interventions to gradually build up your level of activity. Tiny consistent steps are key. The aim of these programs is not in the first place to end your pain. The goal is reactivation and retraining your nervous system.

While you’re increasing your physical, social and work activities your nervous system gradually adjusts to this new level of activity and the pain signalling very often eases after a certain period of time.

Your level of energy will also gradually improve. Especially if you learn to integrate mind- body tools into your daily routine.

I can’t stress enough how important it is to work with well trained specialists. When I first started to workout with my chronic pain, I didn’t have any knowledge about how to gradually build up a training program suited for chronic pain syndrome. So…. I just started to work out! Which wasn’t a very good idea since I went way too fast which resulted in being severely overtrained within six weeks.

If you want to know whether a physiotherapist is familiar with these kind of interventions, you could ask if your specialist has had training in pain science. In the Netherlands this program is known by the name ‘Graded Activity’.

Mind Body tools for chronic pain

Yoga, ACT and Mindfulness have become a big part of many rehabilitation programs. This is what you’ll learn during sessions:

  • releasing chronic muscle tension
  • reconnecting with bodily signals
  • energy management tools
  • stress management tools
  • becoming more present
  • learning to take value driven actions
  • finding out what truly matters to you

Please leave a comment or let me know your story or question.

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