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How I can figure out chronic pain and my brain

So apparently, having anxiety can be linked to having chronic pain. I have never heard this before. But I think that may explain more about what's been happening to me.

 

I'm still deep in this rabbit hole of trying to study and understand how pain works. This is mainly because I'm going through some chronic pain right now. The pain has been about a year, and it comes and goes. Some days are good. Some are not so good. Having pain sucks. But at least, I am learning a lot of new things about how pain, our bodies, and our brains work. That's pretty cool.


This week, I came across this podcast With Dr. Melissa Farmer on Pain and Emotional Learning. It's a deep dive into pain and brain science. It's very nerdy, but it's full of gems.


Out of everything, I want to highlight this idea that struck me.


According to recent research, acute pain and chronic pain are actually processed in different parts of the brain. With acute pain being processed in the sensory parts, and chronic pain being processed in the emotional parts.


That's the big idea I'm taking away from this.


But what does it mean?


What is Acute Pain?


Acute pain is short term pain.


If I stub my toe on the leg of a table, I'll feel a lot of pain really quickly and it will tell me to "pay attention to my toe." It's a neat evolutionary trait that lets us detect danger quickly and respond right away.


More seriously, if I overexert my at my Sunday pickup game, and pull a hamstring, that pulled muscle will feel sore and tender. It will hurt a lot. My instinct will be to rest.


Then after a few days, the pain subside and go away.


That's acute pain. It goes away after a while.


What about Chronic pain?


On the other hand chronic pain doesn't go away. It lasts. I've seen several definitions, but on average, it's pain that's been around for at least six months.


Lower back pain is good example of this. Many people today deal with it, and it's not something that just goes away with rest. It seems to keep coming back. And it always seems to hit after a long and stressful day at work.


In my case, I'm still dealing with some nerve issues, which may have started out as acute pain, but by this point, it's been around for about a year, and I would count this as chronic pain.


It's not structural (anymore)


I've talked about this before, but it's important for me to understand that it's not a physiological problem anymore. I don't have a bad back, or some misalignment in my spine, since I've done the tests to check. X-rays, and MRIs have come back showing no major issues.


New studies show that there is actually a low correlation between structural imaging and pain. A person can have really poor spine position but feel no pain at all. Another person can have no physical problems, but feel unreasonable amounts of pain.


Bonus:

If you have time, check out this TED talk on how pain works.

It gives a good example of what we're talking about


Back to the podcast I was listening to


I'm quoting now Dr. Melissa Farmer.

She says,

"For the people whose pain continued, they saw a slow shift from those sensory regions to emotional regions, the amygdala, certain parts of the prefrontal cortex."

Here's the context of the quote if you'd like to see.

(It's very scientific in its language)


Here's how I understand what she's saying.


I think it means that over time, pain that was once processed in the sensory part of the brain is now being handled by the emotional parts of the brain.


This makes sense since the sensory part of the brain always has new stuff coming in, so it has to pass on the responsibility of dealing with the pain to other areas.


This means that when navigating chronic pain, it I have to consider my emotional relationship to pain.


Does the pain make me feel scared? Worried? Anxious? Am I always fighting it? Does it frustrate me to no end?


It sounds like attaching negative emotions to pain can actually make my chronic pain persist.


I paper I saw recently titled, "Predicting transition to chronic pain" sums it up:

There is now a small but emerging literature regarding the interaction between negative moods and acute and chronic pain.

Here's a full link to the paper if you're interested



Some of my takeaways from this


Whew so that was a lot of science. But what are my takeaways from all that?


1. When it comes to long term pain, I have to understand how the brain works.


At this point my brain is handling my chronic nerve pain in the emotional part of my brain. That means what triggering my nerve pain is no longer a physical injury, but the fear and emotions that surround the hurt from the past.


Maybe I'm afraid that I'll get hurt again. Or I get anxious thinking about the progress that I've lost, and how I won't be able to get back to my old fitness habits.


Either way, there are negative emotions that are attached to my pain.


2. I know I'm an anxious person, and that's something I have to work with


Following up on that, I also understand that I tend to have a lot of anxious thoughts. Especially when real life seems to be going out of control, I'm quick to catastrophize things. Injuries are a part of that.


I remember last year, when my acute pain wasn't improving, I was having thoughts like "Oh I'll never get better," or "Oh, I guess this is my life from now on."


It's easy for me to worry about pain again and again and it can just spiral out of control.


3. There's nothing to be afraid of, and I have to teach that to my brain


The final thing I want to explore is how to teach my brain that things are okay.


For the negative emotions, things like mindfullness, awareness can probably help. Maybe I can look into stoicism? No concrete plans here yet, but at least I understand that it's a part of how I can manage my chronic pain.


And from a physical perspective, I can slowly re-train my brain to not be so afraid of movement. I wrote before how moving safely can help expose and adapt the body and help it bounce back from pain.


I want to keep exploring movements that don't flare up my symptoms and allow me to show my body that there is nothing to be afraid of, and that I won't hurt myself if I do safe and controlled movements.