What is Chronic Pain?

John Miller Physiotherapist

Article by John Miller

Chronic Pain

Recent research has helped to shed more light on the changes in your body with chronic pain.

What is Normal ‘Protective’ Pain?

Normally pain is good. It informs you about potential or actual damage to your body’s tissues. Nociceptor nerve cells in the tissues of your body react to strong stimuli such as pressure, heat, cold or chemicals.

These nociceptors send a message to the spinal cord, which then forwards another message to the brain. Your brain then processes these messages and produces a coordinated response to escape whatever is causing the tissue damage.

What is ‘Pathological’ Pain?

Research has shown that changes occur in your body at all levels of pain processing. These changes include:

Changes at the Injury Site

At the injury site, your peripheral nerve becomes much more easily excitable. This means that it takes far less of a stimulus to cause it to fire off. Sometimes, a gentle brush against the skin is enough to fire off the pain pathway.

Unfortunately, it is not just the damaged nerves that become more excitable but also the neighbouring nerves, which further amplifies the nerve messages. Some nerves can also start firing off spontaneously, meaning they do not need a stimulus to fire off.

Changes in your Spinal Cord

In the dorsal horn of the spinal cord, changes occur in some of the cells that receive the nociceptor messages. These changes lead to greater sensitivity to the spontaneous nociceptor messages mentioned previously. Changes can also occur in some cells, leading to a ‘memory’ developing between two cells, leading to an amplified response in the neighbouring cell.

Changes in your Brain

Usually, your brain can decrease the level of pain you experience by releasing natural opioid hormones. When you suffer chronic pain, changes occur in the midbrain, which increases the nociceptive messages. This means you’ll perceive even more pain.

Chronic pain messages stimulate brain parts involved in emotion, fear and feelings. This may help explain why conditions such as depression, sleep disorders and pain catastrophising are linked with chronic pain.

We also know that chronic pain leads to atrophy or ‘shrinking’ of parts of the cortex and midbrain. Brain-stimulating activities may help to limit this ageing.

Do You Need More Information about Chronic Pain?

If you need more information about your pain or how to manage your chronic pain best, please consult the advice of your physiotherapist. Your physiotherapist is highly trained to help you to understand and reverse the changes that occur with chronic pain.

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