There is no single cause for Persistent Pain. Often it follows an injury, illness, or surgery and simply persists even after the body appears to have healed. In some cases, there is no identifiable cause. However, modern Pain Science has shed some light on why we might not be able to see the cause of Persistent Pain. Normally, when a part of our body gets hurt, our nervous system sends a message to our brain to warn us about possible danger. Our brain then decides whether or not this message should result in pain. This is an important thing to note – although we may feel pain in our foot (for example), it is actually our brain which generates this sensation for us. Pain is actually a very helpful feature of the human body. For example, it’s good to know when we are resting our hand on a hot frying pan, or standing on a drawing pin!
Contemporary advances in Pain Science suggest that Persistent Pain is a result of a brain and nervous system that have become hypersensitive to danger. So hypersensitive, in fact, that they keep trying to warn us about some danger by creating pain, even when we are safe. This is the main mechanism that underlies Persistent Pain – even if problems do exist in your joints, ligaments, muscles, nerves or immune system, your brain will not create pain for you unless it believes that you are in danger. This new understanding of how pain really works forms the basis of modern, effective, evidence-based psychological treatments for Persistent Pain, such as Acceptance and Commitment Therapy (ACT) and Cognitive Behavioural Therapy (CBT).
According to modern theories of pain (specifically, the Gate Control and Neuromatrix Theories of Pain) our brain chooses to create pain only when it believes we are in danger. It also weighs up whether or not pain is going to be useful for us. Consider the following examples that demonstrate this:
- People who have been bitten by a shark often report experiencing no pain until they reach the beach. This is surprising given that their body would be sending lots of danger messages from the injured area to the brain. This delay in pain occurs because the brain understands that creating pain would not be useful in the water, as this may disable the person’s ability to swim to safety! So, it waits until this person can actually do something about their pain (e.g. ask someone on the beach for help) before choosing to make pain.
- A construction worker is rushed to the emergency department in great pain after a nail from a nail gun goes through the toe of their boot. Upon closer inspection, doctors discover that the nail did not seriously injure this person’s toes at all, it went between them! In this example, the toes were uninjured, and thus, they were not sending danger messages to the brain. However, the brain had other evidence to suggest the construction worker was in danger (a nail through their boot!) and it was this evidence from their eyes that the brain used to decide that it should make pain in response to this situation.
- Have you ever gone to the doctor or dentist because you are experiencing pain, only to have the pain disappear as soon as you sit down in the waiting room? Our brain makes pain to tell us to take action, and turns pain down when it believes the appropriate action has been taken. This explains why when we take action (e.g. make an appointment with a doctor and enter the waiting room) our experience of pain may reduce, or sometimes even go away entirely!
According to a modern understanding of pain, our brain uses information from all around us to decide whether or not to make pain. Thus, there is now good scientific evidence for why our experience of pain is increased when we are sad, angry, anxious, under financial stress, in a strained relationship, having a bad day, feeling too hot or too cold, and feeling hungry or thirsty – To our brain, this is all evidence that we might be in danger, and it increases our experience of pain in an attempt to keep us safe. Unfortunately though, pain does not help us escape non-physical dangers.
Now that we know that our brain turns-up pain when it feels we are in danger (and turns it down when it believes we are safe), evidence-based treatments such as Acceptance and Commitment Therapy (ACT) and Cognitive Behavioural Therapy (CBT) for Chronic Pain take advantage of this new understanding to increase your brain’s feeling of safety. These treatments involve:
- Education on modern pain science
- Strategies to calm negative thoughts (e.g. Mindfulness-based attention training)
- Graded exposure to physical activity to teach the brain that movement is safe, reducing its threshold for creating pain
- Using imagery exercises to practice virtual movements to reduce the brain’s pain threshold
- Pacing skills to prevent you from “overdoing it” and experiencing a flare-up of pain
- Learning skills to manage stress, depression or anxiety
- Skills to manage related conditions, such as Post-traumatic Stress Disorder
- Getting in touch with your values to get more out of life and feel happier