Why does chronic pain not always tell the truth?

May 13, 2023

Why does chronic pain not always tell the truth? by Joe Kantyka

Chronic pain does not always tell us the truth, and we see this a lot here at Oakfield. Many of our patients come to us with chronic pain that has been with them for weeks, months or even years(sic!). And if you are one of these patients you will have been told at your first appointment that the longer you have had pain for, the longer it takes to get satisfying results (there are exemptions of course). But why is that?

What is pain?

Pain is an unpleasant sensory and emotional experience that is felt in the body and motivates us to do something to escape it.

The most accurate concept of pain is that pain is not a measure of tissue damage, but an indicator of the brain’s conviction about the need to protect certain tissue. If the brain concludes that there is something more important than protecting a body part then it decides to not produce pain.

Pain pathway summarised:

Damaging stimuli is detected by primary nociceptors which are high threshold pain/damage receptors and send a signal to the spinal cord (secondary nociceptors) and then to the brain.

A pain signal from primary nociceptors is open to modulation at the spinal “relay station” which means that other pain signals can decrease the first one. Already at this point limited signals can be sent further to the brain. At the end of this pathway is the brain that decides, based on the entire package of evidence, if the danger is different from that suggested by spinal nociceptors. Then it will correct the signals by facilitating or inhibiting spinal nociceptors.

Sensitisation of Spinal Nociceptors:

When spinal nociceptors are active for an extended period of time they become sensitized, which means they are way more sensitive and can be irritated even by a small, non-threatening stimulation.

How does all this information answer the question from the beginning of this blog? As you know from my previous texts about shoulders and the diaphragm, an injury of just one muscle, joint, bone or ligament always affects other tissues by compensation mechanism. If we connect what we know about pain and compensation mechanisms, we have the answer.

Let’s take an example of a whiplash injury from years back, if never fully healed, can cause first peripheral sensitization and then spinal sensitization according to the nerve supply of the injured tissues.  As sensitivity of that region has been increased, the body will try to protect it by inhibiting muscles and ligament activity from this level by increasing activity of surrounding structures. That increased activity is a compensation mechanism, so now other tissues will receive an increased number of signals, which if happens in an extended period of time can cause… peripheral and then spinal sensitisation. And now we are in a vicious cycle of new compensation and sensitization. Do you remember that the brain decides about the final pain location? Great! So that is how we can end up with chronic lower back pain (because that is what the brain decides) after a whiplash injury 20 years ago. And the more time that has passed from the primary injury, the more compensations our body can create. So then we, the practitioners at Oakfield, have a difficult task of uncovering the next layers of compensations created over that time. And then you and your body have an even harder job to “reset” your nervous system and make space for new, nice and clear signals going from the tip of your toes to the brain!

If you want to male a start on uncovering the layers of compensation in your body and find the root cause of your chronic pain get in touch or book in today!