Redefining Chronic Pain
Re-defining chronic pain.
Somewhere around 7.5 million Canadians suffer from chronic pain. For something that almost 20% of us suffer from, it’s surprising how poorly we understand pain. There are lots of diagnostic labels out there - but many of them are what are called diagnoses of exclusion. A diagnosis of exclusion is what you are left with when you’ve ruled out all other causes. Fibromyalgia is a well known example of a diagnosis of exclusion.
Ideally, a diagnosis would help you understand what is wrong so that you can fix it. For example - if you are diagnosed with atrial fibrillation, that is linked to a specific problem in the body that can then be (hopefully) corrected and the problem resolved.
Real pain can happen without a structural problem.
Unfortunately, we know that many pain diagnoses don’t seem to work this way - even when there is a structural problem that’s fixed or healed, the pain can continue. Or, the pain moves somewhere else. Or, you have a diagnosis of exclusion - a painful condition but without a clear structural problem to fix.
The idea of neuroplastic pain is the key that unlocks this problem. Understanding that our brain can present pain to us regardless of structural problems opens us up to understanding that we don’t need to have something structurally wrong with us to feel real pain. Sometimes, our brain has learned to present pain based on other stimuli. Things like normal body sensations, emotions, or other experiences can cause the brain to present pain signals when there isn’t any actual danger to our body.
I believe pain is chronic as soon as it has neuroplastic elements.
The international association for the study of pain (IASP) defines chronic pain as anything that lasts over three months or persists beyond the healing of an injury. To me, that works well enough as a label, but from the point of view of understanding what’s going on in your body - it isn’t particularly helpful. I think pain becomes chronic when it begins to display neuroplasticity - this may be months later, or it may be at the moment that pain shows up (when it shows up out of the blue.)
How do we know if there is neuroplastic pain?
Unfortunately neuroplastic pain can’t be tested for directly. On the other hand, there are a number of hallmark experiences that strongly suggest neuroplastic pain. Below is a list of the most common symptoms suggestive of neuroplastic pain:
Pain originated during a time of stress.
Pain originated without injury
Pain is inconsistent - sometimes it is present, sometimes not
Large number of non-specific symptoms
Pain spreads, or moves around the body
Pain is triggered or worsened by stress
Pain is triggered by things that have nothing to do with your body (e.g. smells, sights, times of day, weather)
Symmetrical symptoms in peripheral locations - it’s unusual to develop pain from structural issues on both sides of the body at the same time.
Delayed Pain - pain which develops after activity (that you didn’t notice during the activity)
Childhood adversity
Common personality traits:
Self criticism
Putting pressure on yourself
Worrying
Lack of physical diagnosis
You may have many of these symptoms, or you may have just 1 or 2 - if you do, this strongly suggests that you have neuroplastic pain. Make an appointment today and we can begin treating it.
Be well.
