“Acute pain is a symptom, chronic pain is a disease.”
This concept is a conversation is that I have daily with my patients in pain clinic and within the hospital.
If I had to pick out the most important things that someone with chronic pain needs to hear, this idea would go at the top of the list. (Second would be that this: yes, your pain is real. Yes, I believe you have it even if you look “normal” on the outside. Third on the list is the follow: no, your pain isn’t “in your head” but your mind and brain ARE involved.)
The Difference Between Acute and Chronic Pain
Acute pain is a signal from the body to the brain that something needs to be done differently. Examples include getting the message to withdraw your hand from that curling iron that’s burning you or moving the coffee table because you’ve stubbed your toe on it 5 times in the last 2 weeks.
The whole idea behind acute pain is to let the brain and mind know that there is a problem so that all of the executive functions that are decided upon afterwards can keep you safe and, most importantly, alive.
Once the acute pain signal lasts for a while (ex: from that back pain following your car accident), the signal behinds to turn “pathologic”. That means that changes occur within the central nervous system that reinforce that message, even though that actual physical area of injury may have healed.
That’s why so many people are told that there is “nothing wrong” with them based on labs, imaging, and physical exam…but they are miserable with pain day in and day out.
Chronic Pain as a Disease Process
Chronic pain is a “scrambling” and continually reinforcing disease process within the brain and spinal cord (and down to the nerves in the extremities).
The neurons within the portion of the brain involved in the disease state and down to the body-part impacted by pain all exhibit abnormal signaling.
When you take the 30,000 foot view of chronic pain, that’s pretty much it! Messages within the central nervous system are not being initiated properly and get misinterpreted along the way.
Here’s the example I use in pain clinic all the time: the initial injury is like someone breaking into the car and the acute pain is the car alarm going off. Chronic pain is like no one ever turning that alarm off even though no one is trying to break in anymore.
Because of this, chronic pain is a disease that needs to be managed over time just like we do with diabetes, hypothyroidism, or autoimmune conditions. The logic that “I’ll just fix the area that hurts and I won’t be in pain anymore” is flawed once this disease process starts. Sure, it works with acute pain because the pain is only reflecting a localized problem. But once the central nervous system begins to get dysregulated, chronic pain is the disease that needs to be diagnosed and managed properly.
Treating the Chronic Pain Disease
This new look at the pathophysiology–aka: what’s the actual issue–of chronic pain explains why chronic pain is managed with drugs that are normally marketed for depression, such as SSRIs and SNRIs (Cymbalta is one I take for my chronic pain). I also like to use CBD oil and other medicinal herbs as more natural options for this purpose.
The role of these drugs in chronic pain is to “turn down” that car alarm in the hope that the central nervous system will get the message that you’re safe and that the pain process no longer needs to be invested in. Like all things in modern medicine, interventions only help guide the body to a better place until it can heal from the inside.
(A good example of this is antibiotics: antibiotics don’t kill every bacteria that is causing a problem. Antibiotics only help kill off some of the bacteria until it’s at a level that the body can handle via the immune system. The same is true of these drugs.)
In addition to addressing the central nervous system piece, the brain and spinal cord dysfunction does go on to affect the peripheral nerves (all the nerves that come out of the spinal cord and go on to work further downstream) and muscles. This is why pain specialists will also add medications (or supplements, in my case) that address each of those systems as well.
This is how you arrive at the management of chronic pain as a disease process! Just like you can be a well-controlled diabetic that basically lives as a “normal” person with management, you can be a well-controlled chronic pain patient…but that doesn’t necessarily mean that you don’t have the underlying physiology that will always predispose you to the chronic pain disease.
Chronic Pain Flares
I’m a good example of this. After 13 years of living with pain (which started from severe endometriosis but became a generalize central pain syndrome), I’ve learned to manage my pain pretty darn well. But I was recently hit by an uninsured driver and my neck–which is one of my chronic pain sources–got whiplashed pretty bad.
My central nervous system went into “chronic pain” mode once again; in other words, the car alarm went off again! It’s taken me several weeks now to get the signaling under better control and I still have some work to do.
This ongoing “management” of a disease can seem disheartening to the pain patient that wants to heal and never think of pain again. Unfortunately, this is not how this particular disease works. The good news is that it CAN be successfully managed so that you can live out your life comfortably.
Chronic Pain and Hormones
For women with chronic pain states, such as is seen with endometriosis or lupus or fibromyalgia, the hormonal system can also be impacted by alterations in the signaling of the central nervous system.
The brain and spinal cord system “run the show”, so to speak, in many ways and dysfunction there can absolutely change how cortisol, the sex hormones, and baby-making capabilities are maintained.
This is why many women notice that their pain gets exponentially worse at certain times of the cycle and why the presence of pain can go on to cause changes in hormone balance.
There will be lots more blog posts on this important subject in the future so stay tuned! For now, please help us get the word out on how chronic pain works by sharing this article with the people you know who live in pain every day and need to hear this information.