RODALE NEWS, LENOX, MA—Do you experience chronic pain? If so, there are several strategies that may help you experience less pain and greater quality of life. Over the last decade, researchers have used neuroimaging techniques to actually peer inside the brains of chronic pain sufferers. And their discoveries have led to a clearer understanding of the physiological mechanisms involved, as well as more effective strategies for chronic pain relief.
THE DETAILS: Chronic pain is especially difficult to diagnose and treat because, often, there is little or no evidence of underlying tissue damage or inflammation in the place where the individual feels pain. For instance, in cases of fibromyalgia, irritable bowel syndrome, temporomandibular disease, and recurrent headaches there may be no evidence of tissue damage or change in the affected area. In other conditions, such as chronic back pain, osteoarthritis, rheumatoid arthritis, and lupus, the degree of inflammation or structural damage may not necessarily correlate with the degree of pain. These inconsistencies have made it a real challenge for doctors and therapists to bring relief of chronic pain to those who need it.
For example, among chronic back pain patients, the extent of spinal abnormalities that are visible on examination with conventional imaging techniques does not always correlate with the subjective pain reported by the patient. Someone in excruciating agony and in desperate need of pain relief may have an MRI that shows no detectable problem. Yet, another patient, whose spine looks like a train wreck, can remain pain free. In fact, two thirds of people who have never suffered serious back pain have “abnormal” back structures, such as herniated disks, that are often blamed for chronic back pain. Incredibly, studies have found that some back pain sufferers improve dramatically after receiving sham surgery. And sadly, many back patients don’t improve at all after receiving real, supposedly “successful,” surgery.
WHAT IT MEANS: So, does this mean that if you experience chronic pain, it’s all in your head?
Well, yes…and no.
Yes, because we now know that there are chemical processes in the brain that give rise to chronic pain.
But no, in the sense that chronic pain is not imagined or false pain. It’s real, physical pain, even if we can't see a physical cause for it.
To gain a deeper understanding of chronic pain and how to treat it, I spoke with Afton Hassett, PsyD, a research psychologist in the Chronic Pain and Fatigue Research Center at the University of Michigan Medical School. She explained that the experience of pain is quite complex. "It begins with pain receptors in tissues of the body that send signals via nerves to the spinal cord," she says. "Those signals are transmitted up the spinal cord to the brain, where they give rise to the subjective experience of pain."
So, Dr. Hassett explains, there are components of the pain process, involving 1) the tissues of the body, 2) the nerves that run from those tissues to the brain, and 3) the brain itself. And experts in pain recognize three primary types of pain that correspond to these three components:
Peripheral pain, which originates from damage to tissues of the body, such as a broken arm or an infected tooth.
Neuropathic pain, which stems from damage to or impingement of a nerve, such as a diabetic neuropathy or a pinched nerve.
Central pain, which arises from imbalances in the brain that affect pain perception.