Chronic Pain... is it All in Your Head?



Note: This is the second of a three part series addressing the source of chronic pain. The first part addressed the inflammatory component of pain and the last part will address childhood environment and factors that increase the risk of chronic pain. Click here to read Part 1.

Chronic pain is an all too familiar foe to those who suffer from it. As we saw in Part 1, chronic pain is linked to inflammation which can be greatly reduced with the right diet and the care of a naturopathic physician.

But what about those of us who have chronic pain and very little inflammation? Our diets are clean and our lab tests are within normal ranges, but we still suffer from debilitating pain. Is there anything that can be done for chronic pain with little inflammation?

While inflammation does play a huge and important role in the cause of chronic pain, there seems to be another factor to consider: the central nervous system or CNS.


The CNS is composed of the brain and the spinal cord. This is the hub of our senses and movement. Our brains and spinal cords do a delicate dance with our muscles and sense organs helping us to navigate and experience the world around us. Without our CNS, we wouldn't be able to process or enjoy the simplest pleasures in life like a cool breeze blowing across our faces or a sip of warm tea.

While the CNS helps us to enjoy and experience life, it also helps us to understand and process pain. For example, you touch a hot stove and immediately pull away without a thought. This is called a withdrawal reflex and it's initiated by your spinal cord to prevent further injury and pain.

The very same CNS that helps to prevent pain under the right circumstances can create pain in the worst ones. CNS dysfunction has long been considered to be an important piece of the puzzle when understanding the origins of chronic pain. New research is starting to agree.

It has been shown that people suffering from fibromyalgia have a decreased amount of GABA (gamma amino-butyric acid) in a specific portion of their brains[1]. GABA is an inhibitory neurotransmitter that reduces neuron excitability. In other words, GABA is a chemical made by our brains that helps to calm the brain down when it is released.


People with fibromyalgia have fewer amounts of this necessary neurotransmitter in their brains which contributes to increased brain activity and higher amounts of perceived pain. Studies done on people with fibromyalgia using functional MRI to image the brain have found that certain portions of the brain were more active when the patients thought about their pain[2].

Many clinicians believe that people with chronic pain engage in something call pain catastrophizing which is when a person has an exaggerated negative orientation to actual or anticipated pain experiences[3]. This catastrophizing, a negative way in which a person sees and reacts to his pain, leads to an exacerbation of his pain. Further more, pain catastrophizing increases the chances of chronic pain development.

Research is showing that the brains of chronic pain sufferers are stuck in loops that are "sensitized and maintained by 'sustained attention and arousal'"[4]. Basically this means that the person is acutely aware of and extremely preoccupied by the pain. When the unpleasant sensation is noticed or increased, an emotional response occurs which serves to increase the amount of pain and continue the debilitating cycle.


I know what you're thinking. "How can I not think about my pain all day? I can't function because of it. How can anyone tell me not to think of how much pain I'm in? I'm the one suffering, right?" I understand that and am in no way trying to invalidate your experience but what if you could decrease your amount of pain just by changing your view on life?

A study done with patients suffering from osteoarthritis found that positive psychological programs improved not only the patients' negative moods and life satisfaction, but also greatly reduced their pain[5]. Perhaps thinking away your pain doesn't sound so strange now?

If thinking away your pain doesn't sound like something you would enjoy, there are other options. Research has shown reduction in chronic pain with therapies like biofeedback, Qi Gong, and acupuncture. Relaxation techniques were also found to be beneficial.


Your mind is an extremely powerful tool that can either hinder your progress or give you the break through you need to defeat chronic pain. With guidance from your naturopathic physician, you can decrease the pain you are in and start living a more fulfilling life. What would you do to alleviate chronic pain in your life? Let me know in the comments below!

References

1.Foerster B, Petrou M, Edden R et al. Reduced insular γ-aminobutyric acid in fibromyalgia. Arthritis & Rheumatism. 2012;64(2):579-583. doi:10.1002/art.33339.

2.Lee J, Protsenko E, Lazaridou A et al. Encoding of self-referential pain catastrophizing in posterior cingulate cortex in fibromyalgia. Arthritis & Rheumatology. 2018. doi:10.1002/art.40507.

3.https://www.practicalpainmanagement.com/pain/other/co-morbidities/pain-catastrophizing-what-clinicians-need-know

4.Hausmann L, Youk A, Kwoh C et al. Testing a Positive Psychological Intervention for Osteoarthritis. Pain Medicine. 2017;18(10):1908-1920. doi:10.1093/pm/pnx141.

5.Lee C, Crawford C, Hickey A. Mind–Body Therapies for the Self-Management of Chronic Pain Symptoms. Pain Medicine. 2014;15(S1):S21-S39. doi:10.1111/pme.12383.


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