A 7-part Series on Chronic Pain
by Josh Meyers, PT, DPT, OCS
Pain is good. It helps one to avoid danger, survive an injury, and protect oneself when confronted by physical or emotional threats. The problem arises, however, when pain persists after a danger is removed, an injury heals, or a threat is no longer present. Medical providers call this persistent type of pain chronic pain, and it is the leading cause of disability in America.
Hope, however, lies in the fact that chronic pain is treatable. Through this series, readers will learn how chronic pain develops, recognize common symptoms, and understand how chronic pain is treated. Our goal is to empower readers to take action and regain control of their pain. Comments at the end of each post are welcome. Be sure to ask questions and share experience to help others with similar symptoms.
Part 3: Tissues Heal
The last post explained how the brain produces a pain experience when a perceived threat exists. This post explains the relationship between tissue damage and chronic pain.
When an injury causes tissue damage (muscle, tendon, skin, bone, etc.), it triggers the inflammatory response. Damaged tissue releases chemicals that enhance blood flow at the site of injury. This additional blood flow causes the area to become warm, red, and swollen. An inflammatory response is fairly normal, and it is not uncommon for one to experience pain during this process due to the presence of chemical byproducts from injury, byproducts from healing, or pressure from extra fluid in the area.
A typical inflammatory response will remain active for about 72 hours before chemical irritation and pressure subside. As this process winds down, pain follows suit. Injured tissue completes the formal healing process within 6-12 weeks, and the majority of injury-related pain disappears. This is the point where people return to normal levels of activity.
Chronic pain, however, develops when pain persists beyond this normal process of injury, inflammation, and healing. Since most tissue (and any associated chemical irritation) heals within 6-12 weeks, one must question the source when pain remains after this amount of time. When chronic pain is present, tissue damage is not likely the cause.
Pain Does Not Indicate Tissue Damage
Furthermore, pain does not indicate tissue damage. Paper cuts can hurt a great deal, but tissue damage is minimal. We hear stories about a farmer who loses an arm in the field and drives himself to the hospital; tissue damage is significant, but pain is not. And then there are instances where one finds blood from a scrape or cut on the body, but cannot recall an injury or any associated pain. These examples support the fact that pain (or lack of it) does not indicate the presence of tissue damage.
At the same time, pain persists in people that have never had an injury. People with fibromyalgia experience pain on a daily basis even though many have not had a significant injury. Phantom limb pain in those with an amputation feel pain from a limb that is not even present. In these cases, it is not tissue, but stress and other emotional triggers that drive an extra-sensitive nervous system to produce pain.
Research supports the disconnect between pain levels and tissue damage too. Lumbar pain complaints peak in middle age despite the fact that research shows that a person’s spine continues to deteriorate with age.1 Rotator cuff injuries found with MRI reveal similar findings. People with small rotator cuff tears have considerable amounts of pain while up to 30% of others with more significant tears are not aware that damage exists.2 Herniated discs in the low back behave in the same manner. While some with a minor disc bulge have debilitating pain, up to 40% of people with a herniated disc don’t even know it.
If Not Tissue, Then What?
When people mistakenly associate pain with the amount of tissue damage, it perpetuates chronic pain. Furthermore, this link between pain and the presence of a structural problem promotes the belief that pain will not resolve until the structural problem does. The problem with this assumption is that there are countless people with arthritic joints, degenerative spines, or torn rotator cuffs that do not have pain. Aging is a normal part of life, but experiencing persistent pain is not.
To accept the fact that tissue heals, one accept the fact that something other than tissue contributes to persistent pain. This “something” is hyper-sensitization of the nervous system. People with chronic pain do not have a tissue problem; they have a nervous system problem. When the body’s alarm system remains extra-sensitive in individuals with chronic pain, even small changes in pressure, movement, temperature, or stress can cause a pain experience.3 In the next post, readers will learn how these neurological changes develop and how treatment changes them.
Let’s Hear From You
What are your experiences with pain? Have you had pain persist long after the time it takes tissue to heal? Share your experience in the comments below.
If you suffer from chronic pain, there is hope. Call us today to find out how physical therapy can help treat your chronic pain.
- Taylor JR, Twomey LT. Age changes in lumbar zygapophyseal joints. Observations on structure and function. Spine (Phila Pa 1976). Sep 1986;11(7):739-745. Twomey L. Clinical Anatomy of the Lumbar Spine and Sacrum. Third ed. New York: Churchill Livingstone; 1997.
- Sher JS, Uribe JW, Posada A, Murphy BJ, Zlatkin MB. Abnormal findings on magnetic resonance images of asymptomatic shoulders. The Journal of bone and joint surgery. American volume. Jan 1995;77(1):10-15.
- Devor M. Sodium channels and mechanisms of neuropathic pain. J Pain. Jan 2006;7(1 Suppl 1):S3-S12.