By Anja van den Berg
We’ve all woken up with an uncomfortable neck spasm or needed some medical attention after spraining an ankle. But what would you do if the pain you’ve experienced for a certain period just never really subsided?
The Centers for Disease Control and Prevention (CDC) says that chronic pain is one of the most common reasons adults seek medical care. Chronic pain is emerging as a health concern on its own, with negative consequences to individual persons, their families, and society as a whole.
Chronic pain refers to pain that continues after an acute injury has healed or after a period that should allow for healing has passed, says Dr Mel Pohl, Clinical Assistant Professor in the Department of Psychiatry and Behavioural Sciences at the University of Nevada School of Medicine.
“Often, for unknown reasons, the injury or tissue damage doesn’t heal as expected,” Pohl continues. “Because of this, the nerve fibres continue to fire as if there is damage that needs attention.”
With this unrelenting signal travelling up the spinal column to the brain, eventually, the transmission circuits become more efficient at transmitting these signals – like a one-lane road becoming a four-lane highway.
The continuous input into these circuits causes more transmission, with the net result being more pain. At the same time the number and array of pain-causing neurotransmitters in the nervous system increase.
“Over time, the threshold for the pain receptors to fire is lowered, and a less intense stimulus is needed to cause the nerve to discharge and send its signal,” Pohl explains.
“What started out as a message from the site of an injury to the brain has become a self-contained feedback loop within the nervous system – a disease of the brain.”
A study by the Institute of Medicine discovered that pain can endure long after the illness or injury that caused its initial onset has been treated or healed, until it eventually evolves into its own disease. That is, pain is no longer indicative of another prognosis ─ it is the prognosis, and a disabling one at that.
Under the strain of prolonged pain, nerves not only become supersensitised to pain signals, but begin amplifying them. Once these changes occur, they can be extremely difficult to undo.
Chronic pain also leads to negative emotions: anxiety, anger, depression, helplessness, loss of purpose, frustration, guilt and shame.
Pohl explains why: as pain becomes chronic, the sensory components become less important and the emotional and behavioural components tend to take on more importance.
“Having pain is a strong emotional experience. It will reshape your behaviour. It will reshape how you interact with the world. And that in itself means your brain is going to respond differently over time.”
International studies have shown that most doctors are not adequately trained in chronic pain management. Surveys have found that most primary care physicians feel inadequately prepared to counsel patients on pain.
Unfortunately, without an adequate understanding of pain and its mechanisms, many medical practitioners are quick to downplay the experience of their patients as faking or exaggerating. What this translates into is denying a debility because it is invisible to the naked eye.
The Journal of Pain study concludes that a transformation is needed in the curriculum of medical schools to rectify the “lacklustre state of pain education.”
Psychology Today: https://www.psychologytoday.com/us/blog/day-without-pain/201301/chronic-pain-it-is-all-in-your-head-and-it-s-real
Harvard Medical School: https://www.health.harvard.edu/blog/chronic-pain-the-invisible-disability-2017042811360
National Pain Report: http://nationalpainreport.com/future-doctors-unprepared-manage-pain-8822008.html
National Pain Report: http://nationalpainreport.com/medical-schools-failing-at-pain-education-8813868.html
Centres for Disease Control and Prevention: https://www.cdc.gov/mmwr/volumes/67/wr/mm6736a2.htm