“Chronic Pain and Holistic Treatment Approach “
Acute or sudden onset, usually short-lived pain, is a symptom, while chronic pain is a disease or disorder, complete with brain changes that can be seen on special imaging such as functional MRIs. The nature, course and treatment of chronic pain are therefore very different from acute pain. The sad part is that many patients do not have a good understanding of their condition.
One develops chronic pain through a process called neuroplasticity, which is the brain’s ability to change itself, mainly in terms of structure, under certain conditions. This is a vitally important process, as it is the way we learn and acquire new skills. Ongoing or chronic pain usually starts with and is triggered by an unusually intense pain focus that leads to a change in behavior patterns and ways of thinking, causing the pain nerve circuits, or nerve networks expand in the brain, eventually infiltrating brain centers associated with memory, fear, and the emotions. With time, this results in a capacity for these areas to also trigger and drive the chronic pain experience. In essence, we ‘learn’ chronic pain, even though that was clearly not at all anyone’s intention.
We see that the onset of chronic pain causes anxiety in the patient who fears that the pain signals indicate ongoing tissue damage, which it usually doesn’t they. This in turn causes an increased pain focus, which involves unhelpful behaviors and the termination of everyday adaptive behaviors that lead to further neuroplastic brain changes and more severe and frequent pain signals, the result of which is more anxiety and less activity, and so on it goes.
The good news about this though, is that neuroplasticity works both ways. You can learn a language which results in learning- based brain changes, but after many years these changes can be reversed through disuse, causing you to lose a large part of those language skills. Therefore, the key to chronic pain treatment is to get the person to change their behaviors, progressively replace the unhelpful thinking patterns that they have developed, and to try to change their focus from pain, to increased functionality and improved quality of life. These non-medical sounding treatments are what remove the major drivers of the pain response. Medications and injection therapies can provide much needed temporary relief and respites from pain, but they don’t address the cause.
This approach is not only based on extensive, multi-centre clinical experience, but also on scientific evidence. The big challenge in treatment is that chronic pain intrudes into every aspect of an individual’s life, their physical and mental health, emotions, work, relationships, social activity, self-esteem and even their very identity. Also, they most often have other co-morbid conditions like anxiety states, mood disorders, sleep dysregulation and de-conditioning, among other factors. For a simple explanation as to the explanation of chronic pain and the steps that need to be taken, the podcast on “Chronic Pain and Treatment Approach” is a helpful reference.