Chronic Pain
Chronic pain is considered to be pain lasting more than six to eight weeks. However according to the lieterature this is not relevant, useful or true. It is much more relevant to consider Chronic Pain as pain lasting beyond the time it would take for an injury to heal.
As discussed in the 'Acute Pain' page of this site pain is not a sensation; rather it is a response from the brain to information after an initial warning message of tissue damage (nociception). Nociception detected by distant sensors in damaged tissue and is transmitted via the spinal cord to the lower brain centres (the parts of the brain that work without thinking).
The initial response of the lower brain will usually suppress the pain while the thinking part of the brain, the higher part, will work out where the pain is and what is the likely cause. The middle part of the brain is responsible for your emotional response to the pain and will be looking for reassurance from the higher part that everything will be OK!
If you tread on a tack, you will know where to look, the explanation is obvious, the injury is clearly minor, although painful, and the emotional response is limited as there is no future likelihood of continuing pain. The damage report will continue to be suppressed by the lower brain and all you need to do is have a good shout and you will be fine.
The same cannot be said for Back Pain that comes for apparently no reason, which feels very severe and there is no way of assessing the damage because you cannot see it, a pain that you cannot control and that you seriously believe may affect your life in a negative way. Here the pain will be initially suppressed but after the threat cannot be allayed this will reverse and the lower brain will amplify the damage report to collect more information.
The result will be an ‘Acute Pain’ (short term) event that can spiral out of control. Effectively this is the standard Back Pain event, very painful but not serious. However it is this response of the nervous system that can make the transition into Chronic Pain. Once the damage report is amplified the brain and body will begin to process the information in a different way, a process called ‘Sensitisation’.
‘Peripheral Sensitisation’ due to Back Pain can occur if a damage report from a particular area is amplified for long enough, and that may only be a few days, the sensors and nerves will continue transmit more signal even though there is no more damage, and thus a normal load can be interpreted as damage.
‘Central Sensitisation’ due to Back Pain can occur when the emotional response to the lack of understanding of the pain is increased due to previously held beliefs and expectations by the sufferer and the constant search for more information from the damage sensors maintains the state of amplification and this can increase to cover other similar sensors giving a Sensitisation of the whole body.
So you can see that the pain can be increased and perpetuated beyond the time the injury takes to heal and indeed can be indefinite. This is not a question of psychological weakness but simply a need for the person to have a feeling that they can control their situation.
If you are in a situation where your pain is lasting beyond your expectation then the Spine Team can help you. The 'Patient Centred Model' is designed to have this as a central concern and teaching the body to respond appropriately to normal load is part of the standard, but very individual, Rehabilitation strategy of The Spine Team.
The Spine Team specialise in treating and managing Back Pain that has not responded to other treatments.
