Why does it (continue to) hurt?

We are all familiar with and usually accept short-term pain - after, say, an injury or operation. We assume that pain serves a purpose (a warning sign) and that it will disappear soon with the healing process.

Unfortunately, this doesn't always happen. It is not so rare for pain to persist for much longer than the causing problem. An example is post-herpetic neuralgia after shingles, when intense pain is felt for long after the skin has healed. Another is ongoing wound or scar pain and sensitivity after an operation.

Also, not all problems causing pain can be healed or settle fully over time, like back pain or arthritis.

Central sensitisation

Independent of the original cause, other factors contribute to chronic pain.

If the body and mind have to constantly pass on and deal with pain signals for longer periods of time several structural and functional changes take place: The pain pathway in our central nervous system (the spinal cord and brain) gets sensitised. Research has found a number of mechanisms at spinal cord level (e.g. wind-up) and in the brain (neuronal reorganisation) that influence the pain experience independent of the original pain source. As results the “pain system” gets sensitised, the physical pain threshold is lowered and painful feelings can be generated randomly by the pain pathway.

Other consequences

Our mind is also often struggling to cope with pain and it's consequences. Results can be anxiety, anger, frustration, sadness, low self-esteem, changes in daily routine, behaviour and personality. These are often first spotted by partners and friends. Typically, sufferers have to reduce physical and social engagements, which in turn results in isolation and makes life rotate around the pain problem more and more. The changes of emotions and life-situation tend to further worsen the pain experience and so a self-reinforcing spiral is set in motion.

As a result of these factors the persisting pain becomes a disease of it's own; pain doesn't serve a useful purpose any more. So controlling the pain and it’s consequences becomes the focus of pain specialist treatment.

Ways out of the spiral

Successful treatment needs to address the various contributing factors and deal with them in a coordinated way. Often, the physical pain source cannot be healed, but pain and central sensitisation can be relieved and better controlled. Emotional, behavioural and resulting social problems shouldn't be ignored. Assessing and addressing them appropriately is an essential part of getting better and returning to a better life. This is why physical therapies and sometime Psychotherapy are an important part of a comprehensive treatment plan.

Ultimately, all treatment are targeted to facilitate and enable active self-management to regain control of your day to day life. This is comparable to a person with diabetes needing to learn how to manage personal sugar levels. While it may sound daunting at an early stage, it can be done and many patients achieve this successfully. There is an excellent online leaflet  written by a pain sufferer which will tell you more about this. The NHS Pain Clinic runs Pain Management and Functional Restoration Programme for those who struggle with self-management of chronic pain.

Acute and chronic pain

The information given on this website is meant to support a medical pain specialist appointment. It should not be taken as stand-alone universal advice and may be incomplete or unsuitable for your specific circumstances. It cannot replace medical assessment and advice, and should not be used as such. The website is operated from the UK and meant for UK residents.

Copyright © 2017 by Dr Michael Luckmann

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