In our last blog we discussed chronic pain. This issue will focus on physiology.

The term chronic pain is loosely defined as a body that is still hurting after the normal 100 days of healing has come and gone and the body is still painful. In the lumbar spine for example, in the absence of disease, your body should be feeling better 4 months after the onset of symptoms. This is particularly true if you did physical therapy for your injury or pain.

Let’s take a look at how pain works. Let’s start with your brain. Did you know that the only way you can feel pain is because your brain tells you to? In other words, if your brain does not think something hurts then it does not hurt even if real injury occurred . For example, there are many stories of soldiers who were shot or seriously injured and able to continue fighting and felt no pain. Obviously, their bodies were seriously injured , but they felt no pain? How could this be? Likewise, there is a condition called phantom pain where a body part is amputated but pain is still felt in the place where the body part used to be. I once worked with a young man after he lost his right leg in an auto accident. He complained persistently about how chronic pain in his right foot hurt. He no longer had a right foot. How could this be?

The brain orchestrates pain. It is the head honcho, the master decision-maker about whether something is painful or not. Pain is only felt because the brain says so. And the pain is typically a call to action to tell you to take action. Take action because there is a danger. For example, you place your hand on a hot burner, the brain senses the change in temperature and knowing this will damage your hand, it sends you a massive pain signal….a call to action…”remove hand from burner!” If we had no pain, we would constantly hurt our bodies. Pain is a way to protect us.

Let’s see how this works with chronic pain. Let’s say you have no diseases that cause pain or inflammation in the body. You’ve have chronic lower back pain. It hurts all the time. It seems to have no pattern. And, the injury or event that started your chronic back pain was 2 years ago. The body should have healed by now. If I were your physical therapist, my question would be, “why hasn’t this body healed in this healthy person in the last 2 years?” From an anatomy and physiology perspective, the body should have healed. The physical therapist must figure out what portion of the chronic lower back pain is from the lower back itself and what portion may be coming from a brain and nervous system that is hyperactive and sensitized. Typically, with any chronic pain, there are components of both.

With a hyperactive and sensitized nervous system, not only is the brain vigilant to pain triggers but the pain sensors in the body feel more pain with less intense stimulation. The more often the lower back pain is present, the better the brain becomes at producing pain in the lower back. The sensors in the body are also hyperactive and send more signals to the brain about pain. The brain produces pain with more speed, more intensity and with less stimulus. It is very similar to playing a musical instrument. The more you practice the piano, the faster and better you get at it and the longer you play, the easier it is to play without thinking. Your body just plays. The brain is so well trained, that it can tell your fingers where to go quickly and without you thinking about it. When you have chronic pain, your brain is very good at playing the pain tune. The brain and body have practiced and practiced and the longer you’ve had chronic pain the easier it is to feel pain. The trick is to figure out why, and give the brain and body a new tune to play.

Just like playing the piano, when you stop practicing, you can’t play as well. The longer you go without playing, the harder it is to just sit down and play a difficult piece of music. With chronic pain, it’s the same way. If your physical therapy treatment addresses the brain and nervous system, it is possible to get your brain out of practice of feeling chronic pain. You can retrain your brain and thereby, get your body out of chronic pain. This coupled with the physical causes of pain is a very powerful method for overcoming chronic pain in the lower back or any part of the body.

Many patients who come to Life’s Work Physical Therapy have tried many treatments to overcome chronic pain without success. Treatment is only successful when you team with your physical therapist to address all the causes of the chronic pain. Identification of physical and neurophysiological causes of chronic pain is integral to your success. The Life’s Work Physical Therapy approach is designed to get you back to your life doing the things you want to do with the least amount of pain as possible. Chronic pain is not a necessary part of injury, healing or life.