Until recently Western medicine has placed emphasis on identifying and treating structural problems in the body in an attempt to alleviate chronic pain. These efforts have come with mixed results, and chronic pain remains widely prevalent as a severe detriment to quality of life.
Fortunately, advances in neuroscience research, coupled with the observations of astute clinicians, have led to a successful new paradigm for understanding and treating chronic pain. The facts are apparent: most physical injuries heal, and most degenerative age-related structural abnormalities are not associated with pain. What is going on then? Pain is a multifaceted experience, highly dependent on the brain's interpretation of nerve signals from the body. In fact, all of our senses work this way: we are not experiencing reality directly, but rather the brain's interpretation of reality via patterns of signaling activity between groups of neurons. The ultimate purpose of pain is to help us avoid tissue damage, but sometimes real pain can persist after the injury has healed, or even at times in the absence of any significant tissue damage.
Chronic primary pain has been recognized by the International Classification of Diseases, 11th Revision (ICD-11) as an official diagnosis. This has also been called neuroplastic pain by certain authors on the subject. This diagnosis refers to when the pain is not better accounted for by a diagnosable abnormality in the body. Indeed, these syndromes are due to functional changes in the state of the nervous system and body rather than structural pathology in the body itself. Examples of such conditions include fibromyalgia, complex regional pain syndrome, chronic migraine, irritable bowel syndrome and non-specific low-back pain. These conditions result from sensitization of the brain and nervous system, which can occur due to the pain itself and/or other reasons. "Nerves that fire together wire together" and the pain is essentially a learned response, a habitual behavior of the brain and nervous system. This process of neural learning is referred to as neuroplasticity. Related concepts include hyperalgesia (painful stimuli are felt more intensely) and allodynia (pain is perceived due to stimuli which would typically be non-painful).
This more commonly occurs when the threat value of the pain is greater. When pain preoccupies one's thoughts, especially in a negative context, the brain is essentially learning that the pain is more threatening. How does it then respond to this increased threat? By producing more pain in an attempted warning signal! This is essentially the primitive brain's misdirected attempt at protecting the body. This leads to what is called the fear/pain cycle, in which the symptoms perpetuate themselves and can even become worse over time. Heightened generalized activity of the brain's threat response system due to certain personality traits, past/present stressors, and unprocessed emotions also contributes to this process. Fortunately, these misfiring neural circuits can be "unlearned" or retrained. Chronic primary pain is often highly treatable and even sometimes fully curable. Schedule a consultation with me to see how!
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