As most of us have been taught to associate pain with physical damage, it's common to get caught up in anxious thoughts when the pain is present. We often quickly assume that excessive pain indicates worsening injury. Unfortunately, these thoughts don't help; they only exacerbate the situation. This is particularly true for patients with chronic pain, where eliminating triggers that put our nervous system into a panic state becomes crucial. By desensitizing our central nervous system, we can transform our pain blueprint and alleviate suffering. But before delving into how Pain-Changer achieves this, let me take you through the realm of chronic pain and its connection to sensitization.
Introduction to Chronic Pain
Did you know that some individuals can't feel pain? While this might sound appealing, it comes with a drawback of lacking a proper warning system in the absence of pain. Imagine touching a hot stove. Pain receptors in your hand send a pain signal to your brain. This signal gets processed, and your brain promptly decides to generate pain. Why? To prompt you to remove your hand from the hot stove.
Pain is essentially an alarm system that protects our bodies. It warns us to stay away from a hot burner or stepping on broken glass. Pain also informs us to take it easy when our bodies are injured and need time to heal. All in all, pain is a crucial factor for survival. It's no surprise that the absence of pain is associated with a very short lifespan. But here's the catch – we're talking about acute pain, which follows a clear cause-and-effect trajectory. Chronic pain, on the other hand, is far less straightforward.
Chronic pain typically persists for over six months. This type of pain can linger even after the injury or illness that triggered it has healed or vanished. Pain signals remain active within the nervous system for weeks, months, or even years. Some individuals suffer from chronic pain even when there's no past injury or visible physical damage.
To explain chronic pain, researchers have discovered an intricate network of new pain triggers that provide a better explanation than mere physical damage. The brain plays a pivotal role in this new pain network. However, as we know, our brains also juggle other matters – emotions, thoughts, stress levels, hormones, and more. Research reveals that such factors, especially for patients with chronic pain, wield greater influence over the control center than the pain signals originating from the injured site.
In other blog posts, we discuss the concept of neuroplasticity to explain chronic pain. There, we describe how our brains learn to produce pain. In essence, each instance of pain leaves a pain blueprint in the brain, and the more this blueprint is activated, the stronger it becomes. Furthermore, whenever pain is present, your brain searches for triggers that caused the pain, so you can avoid them in the future – all in the interest of keeping your body safe. After sufficient repetitions, these triggers become linked to your pain blueprint. This allows these triggers to activate the pain blueprint in the absence of any pain signals. An extreme example occurs in patients suffering from phantom limb pain. However, it can also happen even when the body is technically "healed." Neuroplasticity is one reason why pain persists even after the body has technically healed. Sensitization is another biological process that explains how pain can become chronic.
Chronic Pain and Sensitization
Sensitization renders the nervous system more sensitive, leading to quicker and/or more intense pain perception. Our nervous system is a complex network comprising nerve receptors, transmission fibers, gateways, and, of course, the brain. There are two distinct divisions in the human nervous system: the central nervous system, encompassing the brain and spinal cord, and the peripheral nervous system, which consists of the network of nerves transmitting nerve impulses. Both systems play a role in experiencing (severe) pain.
Peripheral sensitization literally means heightened sensitivity in the edges of our bodies. To elucidate peripheral sensitization, let's revisit the example of touching a hot stove. To safeguard our bodies, numerous pain receptors are distributed. These are primarily present in our skin, as it's often the first point of contact with potential threats. However, our muscles, bones, and organs also house these receptors. These pain receptors fire when we cross a certain threshold, indicating that heat, pressure, or chemicals pose a threat to our bodies. Upon firing, an electric pain signal is sent to your brain to trigger appropriate action, such as moving your hand away from the stove.
However, much like any machinery, these pain receptors can malfunction, a phenomenon known as peripheral sensitization. This can occur in two ways. The threshold for activation can be lowered, or the pain receptors can fire as if on steroids. A lowered threshold is common in patients with Allodynia. These chronic pain patients experience excruciating pain from the gentlest touch, such as brushing against a feather. Clearly, the touch itself doesn't cause damage. The issue lies in an overstimulated pain system. The activation threshold is so low that even gentle touches produce pain signals.
It used to be thought that peripheral sensitization caused chronic pain. This aligned with older pain models, where the cause and solution for pain were sought directly at the site of injury. However, insights have evolved. Newer theories suggest that central sensitization plays a more dominant role. Here's why.
Central Sensitization
The central nervous system can also become oversensitive. Central sensitization usually refers to heightened sensitivity in the spinal cord and brain. Both structures play a significant role in the pain response. Imagine accidentally touching a hot stove once more. We now understand that pain receptors fire a pain signal destined for the brain when the heat crosses a certain threshold. However, before the signal reaches the brain, it must navigate several challenges. One such challenge is passing through numerous pain gates.
Gate Control Theory
The gate control theory posits that pain signals don't always reach the brain as soon as they are generated in damaged tissues. Instead, they must traverse various "neurological gates" in the spinal cord, which determine whether the pain signals should be allowed through to the brain. In other words, before pain signals reach the control center, they must pass through a series of security gates that can be open or closed. The outcome is simple: pain is perceived when the gates are open, and it's not perceived or is less intense when the gates are closed. With central sensitization, these gates allow stimuli to pass more easily, resulting in more pain signals reaching the brain.
So, what affects the status of these gates? They're never fully closed. It's more accurate to say that the gates have a limited size, and the guards can process only one signal at a time. And they follow a single rule: the most severe message takes priority, a logic that's quite understandable. However, the entire process has more nuances. Which signal do you think takes priority at the gates? A pain signal originating from your stomach that you believe is due to spicy food, or a pain signal from the abdomen that you think is caused by colon cancer? The pain signal that's potentially more harmful takes precedence. If you chose the second option, you're on the right track.
Wrongly adjusted Pain Switch
This example illustrates how our thoughts and emotions can amplify pain signals and grant them priority when passing through the gates. This brings us to the second component of central sensitization: the brain.
Imagine the pain signal from the hot stove, making its way from your hand to your brain. The signal follows your spinal cord, passes all the pain gates, and moves steadily upward toward the brain. Upon arriving at the brain, it's utter chaos. Visualize alarms, sirens, people in white coats rushing about. Remember, this is where important decisions are made to estimate the appropriate level of pain. However, the panicked individuals can't rationally assess the pain signal. Consequently, they decide to classify the pain signal as a significant threat and produce intense pain as a response.
While the story is a simplified interpretation of complex brain processes, it closely resembles the reality for many chronic pain patients. It's as if the volume of these pain systems has been cranked up and is stuck in a state of high alertness, with the pain alarm going off at the slightest hint of danger. It might sound odd, but this decision aids our survival. Yes, you'll experience pain, but it'll likely motivate you to cease whatever is causing the pain. This alarm system is useful for acute pain. It alerts you when your body is under threat. However, when pain becomes chronic, this alarm system isn't always accurate. Sometimes, it sends pain signals even when there's no longer a threat. In short, your body works too well to protect itself with the pain mechanism. In simple terms, the pain control center prioritizes safety over regret.
Hyperalgesia is an instance of a wrongly adjusted pain switch. It occurs when a stimulus that's normally painful is perceived as more painful than it should be. An example could be a simple bump that would normally cause slight discomfort, but for a chronic pain patient, it feels excruciating. Again, when the nervous system is perpetually on high alert, it produces highly amplified pain.
Can we turn down the pain volume?
Modern pain science clearly indicates that central sensitization plays a crucial role in maintaining chronic pain. While pain initially seems to be a purely biological process, the solution to chronic pain lies in our brains (which, we sometimes forget, are also a part of our biology).
At Pain-Changer, we've focused on training the brain to reduce pain. By calming pain responses, we work against central sensitization. Should we succeed, the pain signal may still reach the brain, but the pain output will be drastically different. With each decrease in pain output, the pain blueprint also shifts. To reduce pain response sensitivity, we've developed educational materials and guided brain training exercises. In these training sessions, we address knowledge, thoughts, emotions, attention, behavior, and biological processes.
It's crucial to realize that the recovery from chronic pain isn't solely about physical treatment or exclusively about the brain. It's the interplay between both elements that yields optimal outcomes. Therefore, it's valuable to continue physical therapies targeting physical damage. However, when these efforts don't provide the desired relief, our brain-focused approach might be the missing puzzle piece. If this concept resonates with you, don't hesitate to get in touch. Through a personal conversation, we can explore whether we can make a difference, without any obligation.
For healthcare professionals interested in addressing chronic pain through brain-focused interventions, we're more than willing to share more information about our approach.
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Important: This article is intended solely for educational purposes and does not offer personalized medical advice.
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