Rethinking
Chronic Pain

You don’t become aware of pain until your brain processes it. This involves many different types of nerve cells, different parts of your brain, and your context — your environment, your emotions, and other things going on in your body and in your life.

People can have major injuries and not experience pain — for example, this has happened to soldiers on the battlefield. It is not that the mind is playing tricks. Instead, it is basic to how our body and brain work: the brain may process some signals and not others depending on what else is going on and what parts of the brain are being used. What is happening around us matters.

Your pain system is smarter than we ever realized. It can take into account many different factors, including your past experiences of pain and your need to avoid future harm.

 New ideas have revolutionized how we think about and manage pain. The focus now is on understanding and treating the whole person.

It is a very logical and common belief that any experience of pain is telling you that harm is occurring in your body and that you need to protect yourself from further harm. However, new research has found that pain can continue long after any active harm is occurring.

One example of this is pain from a "phantom limb." People with a limb that has been removed (amputated) are no longer at risk of harm to that limb. Even so, their nerves and brain continue to react as if harm is still occurring – by feeling pain.

Chronic pain is pain that lasts more than 3 months.

Chronic pain may be caused by many issues such as inflammation, muscle guarding/tension, neuropathic pain caused by nerve injury, changes to your nervous system created by past injury.

Many things can turn up the volume on chronic pain such as poor sleep, nutrition, mood, stress, and physical deconditioning.

With chronic pain, your body is often responding to past harm.

Nerves can continue to send pain signals even after the harm is gone.

Some nerves, when damaged, grow new nerve cells that are specifically for sending pain signals. When this happens, these nerves often send more pain signals, even when nothing is stimulating them

Pain can act like an alarm system that never gets turned off, continuing to sound an alarm even though the danger has come and gone.

Physical pain and suffering are often used as if they are the same word, but they are actually different.  Physical pain is the product of a complicated warning system in your body.  Suffering happens when your sense of who you are is threatened.

It is very common to experience pain without suffering. For example, many people view the pain of running long distances or lifting heavy weights as a positive — even exhilarating — experience.

It may not be possible to totally get rid of physical pain. A lot may be done to reduce the suffering caused by the pain. Over time, a reduction in suffering may lead to a reduction in physical pain.

Most people taking opioids long-term are doing so because at some point their pain has caused them to suffer—has interfered with their ability to do the things that make them who they are. However, opioids may also cause suffering.  This is why it is more important to focus on addressing suffering than pain.