Chronic pain has many different looks depending on who is experiencing it. For some people, the pain is unbearable and must be dealt with on a daily basis. For others, it can settle in during fatigue or stressful periods of life.
It can be hard to remember when pain is knocking on your body with very real physical sensations that the underlying causes of pain can include mental-emotional factors as well. Very often, low energy and fatigue, depression, and pain can cluster together. What came first? Is it important to know?
Looking at what circumstances make the pain better or worse can offer clues into what's underlying the pain and how best to take care of it. Here is a quick way to remember the main factors that contribute to chronic pain:
By looking at the whole health picture and taking care of each piece of the puzzle, you'll often find that both the physical and mental-emotional pains experience improvement. Just like with other chronic health issues, putting together the mind and body aspects of the illness often produces the best results in recovery.
Let's take a closer look at the ins and outs of chronic pain in the next section. Health practitioners usually ask a lot of W questions--what, when, where?--when investigating chronic pain symptoms. We'll use a 5W approach to explore chronic pain in the upcoming tabbed section, along with 1H (How).
Chronic Pain on the Brain
Chronic pain doesn't only occur in older populations. As issues like chronic fatigue, fibromyalgia, and obesity rise, so do instances of chronic pain in younger people. It may not seem like it when the pain hits, but the conditions giving rise to the pain may have been setting in for months or years before symptoms actually show up due to prolonged fatigue, insomnia, digestive issues, stress, illness, and other lifestyle factors.
These days, work conditions can readily contribute to chronic pain as well. Desk jobs typically keep the body locked into one gargoyle-like position for hours on end. As joints become stagnant, so does the fluid inside the joints that normally keeps them lubricated. Stiffness can set in and when the joints don't move as easily, the muscles fibers surrounding the joints get more strained during use. On top of that, stress in the workplace and in life can tense up neck and back muscles, a very common complaint among people of all ages. Those who lift a lot for their jobs often experience low back pain too.
Who can experience chronic pain? These days, a lot of people can. That's why it's important to explore:
- The underlying factors of chronic pain
- The ways in which lifestyle adjustments can help reduce chronic pain
- How to keep your stress manageable so that it doesn't spread to the musculoskeletal system
Let's keep going with our W questions on chronic pain. Click on the next tab to read about what chronic pain is.
What is chronic pain? Chronic pain comes in as many varieties as there are massage therapists and chiropractors out there. Chronic pain is basically pain that doesn't go away on its own. Typically if a muscle gets overused or a bone sprained, the pain will go away on its own after some icing and rest. But we're not talking about that. Many times with chronic pain, it can seem to spring suddenly--from out of nowhere.
Chronic pain is mild to severe pain lasting longer than six months. The signals of the pain keep firing in the nervous system for a long time after any initial injury or trauma takes place. In fact, a lot of chronic pain starts without any injury at all which can make it feel like a big mystery as to what's going on.
As chronic pain drags on it can often be taxing on mental-emotional health and bring about fatigue as well as other physical symptoms. The most common kinds of chronic pain include headaches, backaches, joint pain, and pain from injury. The quality of the pain is different for each person and can feel anywhere from a dull ache to sharp and shooting pain. It's not uncommon for there to be disturbances in other organ systems along with chronic pain, such as sleep or digestive issues.
Doctors and other health practitioners use something called the 7 Attributes when it comes to asking questions about symptoms. The seven attributes include questions about:
- The onset of the symptom
- The location
- Duration and frequency
- What makes the symptom(s) better or worse
- How bad it feels from 1 to 10
- Other locations that are affected in the body
These questions are standard and important to a medical visit. But often with chronic pain, the answers to these questions may sound a lot like "I think.....um...." or "I don't remember.." or "I don't really know." Chronic pain often affects the body daily, but it can still feel vague and uncertain to describe where and how it's happening. And with chronic pain, x-rays don't always solve the underlying mystery.
That is why beyond the 7 attributes, it can be most helpful to look at the health issues that are clustering around the chronic pain and forming an individual's unique constellation of symptoms. The other symptoms can help point to more clues on how to help the body heal. Click the next tab to read about the "When?" of chronic pain.
Chronic pain can set in after an injury or infection. Some people will heal from these events without having any lingering symptoms. But everyone's different, and for some people the body just doesn't feel the same afterward. It can feel frustrating to wait for the symptoms to go away while the body seems to have a different plan in place. After a while, simple treatments like icing and rest may not work as well as they did after the initial injury and it's now time to brainstorm on new approaches.
To add another layer of complexity to chronic pain, some people will develop it in the absence of any noticeable injury or infection. One of the hardest things for these people to recall is when exactly symptoms started. They easily remember how the pain started affecting daily living, but recalling any triggering events can be difficult. Why is this?
Well, in some cases there aren't any obvious triggering events or something that "happened" to bring on the chronic pain. For other people, however, the point when the pain started may have been a very stressful time with a lot going on at once. It's not uncommon that stressful times become the seat of new symptoms in health, especially in the area of chronic pain. Stress gives people very little room to breathe let alone think and often makes the body suffer as a result.
If someone thinks about it for a while, they may remember, "Oh yeah--that was when all that stuff was going on. It was kind of stressful actually." If not, then maybe the "when" will surface during the process of trying to get better, developing a healthy and supportive lifestyle, and reducing any stress. Often, the process of getting better teaches someone a lot about his or her health and lifestyle. Next, we'll talk about the "Where?" of chronic pain.
Chronic pain can be a whole body experience or it may set in at one or more commonly used joints or muscles. Some types of chronic pain are made worse by exercise and others can actually feel better from a healthy level of exercise or stretching. The anchoring joints often get a lot of usage and more of the brunt of problems that come from chronic pain.
The shoulder capsule anchors the arm to the body and has a wide range of motion, as in it can move up, down, across your body, and away from your body. These movements are made possible by the unique design of the shoulder joint but when there is too much looseness or tightness in the joint, it can become painful from either unrestricted or too restricted motion. The hips, which anchor the legs to the trunk of the body, can be affected in a similar way.
The knees are another frequent joint traumatized by chronic pain. It has a lot of strength and stability in it, making possible activities like walking, running, kicking, and jumping. But because it becomes locked at a certain point during the motion, pain can set in from overuse, unsupportive shoes, poor posture, and other factors.Wrist, ankle, and vertebral joints are also commonly susceptible to pain and repetitive injury.
Muscles can also become sore so frequently it may seem like they'll never relax or feel normal again. Shoulder, neck, back, and upper leg muscles are commonly affected. No matter where the area of chronic pain is located, it can be helpful to see whether you feel "in your body" and can notice excessive tightness or looseness in joints and muscles.
Television, computers, phones, and just general distractions and stresses of life can often take our attention away from living inside our real bodies. Getting back in touch with your physical frame can make a difference in how you feel. Here are a few common chronic pain conditions along with their typical locations of pain.
- Fibromyalgia--Whole body pain/tenderness in joints, muscles, tendons, and other soft tissues
- Rheumatoid arthritis--Inflammation and stiffness of joints such as wrists, fingers, knees, feet, and ankles on both sides of body
- Chronic fatigue syndrome--Muscular pain made worse with exercise and fatigue
- Frozen shoulder--Painful stiff shoulder that restricts most shoulder movements, especially raising the shoulder up and out
- Sciatica--Often accompanied by sharp low back pain, with pain traveling down the leg
Whole body chronic pain also accompanies many types of autoimmune conditions, digestive disorders, stress-related conditions, sleep problems, and mental-emotional health issues. Supporting the health of the interconnected organ systems can help all types of chronic pain conditions.
Sometimes only your body knows all the factors that went into creating the chronic pain that you deal with on a daily basis. But the body will still give you clues into what is making matters worse and these clues may be part of other body systems. Sources of chronic pain can be from:
- How the body is used
- Excess weight gain
- A past injury
- Family history of similar complaints
- Autoimmune conditions
- Inflammation in the body
- Mental-emotional factors
- Lifestyle habits
Let's take a closer look at a few of these common sources of chronic pain.
The body likes to be respected...don't we all? When the body feels disrespected by its user, it can react to the mistreatment in different ways that can contribute to chronic pain. Mechanics involved in exercise, posture, sleep, and working can all kink the muscles and joints in ways that they don't like. People also may skip stretching before and after strenuous physical exertion, neglect warm-ups and cool-downs, and forget to rehydrate. What started out as simple exercise can turn into a physical nightmare eventually. Once in a while, it's helpful to ask the body, "Hey, how are you doing?" even if you've got what seems like a good exercise routine in place.
What does unchecked inflammation in the body from a poor diet, excess stress, lack of sleep, and a weak immune system look like? It's like a flame in the body that can't put itself out. The inflammation causes swelling, infiltration of immune factors, heat, and irritation of the body's tissues. Aka--a playground for chronic pain. Inflammation puts the body in a state where it's in the mood to react, creating a trigger reaction for pain and sensitivity in the body. It also places a burden on the immune system and makes it harder for the body to concentrate effectively on healing chronic pain issues.
The body reacts to strong thoughts and emotions not just through changes in mood, but also through physical changes. For example, when someone's sad or scared, they may hunch forward more with their shoulders or maintain a protective posture. Stress can also create tension in the muscles, particularly of the neck, back, and shoulders.
Over time, these changes in the body can build on themselves and lead to chronic pain felt not only during stressful times but rather every day. Stress can also make the body feel more tired, making it even harder to recover from chronic pain.
How do lifestyle factors play into chronic pain? Lots of ways. Neglecting supportive lifestyle habits introduces more wear and tear on the body, which becomes an even worse problem when there's already chronic pain. A careless diet weakens the gut's lining and immune system, doesn't provide useful nutrition for muscles and bones, and makes the body sluggish. Poor sleep and stress both increase cortisol levels in the body, a stress-relief hormone that can break down muscle tissue at high levels. Lack of activity can lead to weight gain, which places an additional burden on a body experiencing chronic pain.
Click on the next tab to read about the How of Chronic Pain.
How is it possible to experience pain in the first place? Here, in a nutshell, is what's involved:
- Pain input from the injured site
- Signals relaying the pain to the central nervous system (CNS)
- Processing of the pain in the CNS
- Output from the CNS to the site of pain
All of this is achieved using the intricate nerve highways of the body, its electrical signaling, and its chemical messengers. The body has to first register pain from its pain receptors. Pain receptors are abundant in the body, each of them specializing in detecting different types of pain. For example, some receptors detect pain from mechanical pressure while others can detect pain from chemical signals.
Muscles and joints contain many nerve endings that can detect chemicals released from damaged tissue. Once the signal or signals are sensed at the receptor, the message gets sent like e-mail through the nerve system over to the the spinal cord and brain. The brain processes this input and now the ball is in its court to respond.
Once the brain decides what to do, it sends output signals to release natural pain-relieving opiate molecules such as endorphins. Signals are also sent to other areas of the body causing an increase in heart rate, blood pressure, breathing, and the sweating response. More blood needs to be pumped to the area that is hurt so that immune cells can enter and do their job.
- Of course, chronic pain is different than getting a cut on your finger. Chronic pain is tricky because it can linger for a long time after any initial trauma has healed and can even occur without an injury. It doesn't warn the brain that it's coming on and doesn't produce all the same pain-relief responses in the body. Chronic pain involves a more repetitive pain pathway that's still under research because little is known as to the how's and why's of what is involved.
The brain can influence pain perception. That's why distraction can sometimes help reduce pain and placebos work in some people. Thoughts and emotions can also affect pain signaling, especially in chronic pain cases. Someone can feel worsening pain when his or her thoughts become fixated on it. Has this ever happened to you?
Other factors can affect pain perception too, such as age. The nervous system in the elderly has experienced more wear and tear, so pain thresholds can decrease and lead to more severely felt pain. Stored memories of past pains can likewise affect how we perceive pain today. Fatigue also tends to worsen pain.
Chronic pain involves a lot of communication between different parts of the body and not just the site that feels hurt. Hormones, nerves, neurotransmitters, physiology, thoughts, and emotions all become involved. So do lifestyle factors such as sleep and diet quality, physical activity, and stress levels. Though we can't put an instant band-aid on this one, recognizing how chronic pain is connected to whole body health can help create strides in improvement.
Click the next tab to learn more about chronic pain symptoms.
Chronic pain symptoms are very diverse depending on who's experiencing them and what type of condition exists. For that reason, we'll focus on each condition separately in the Chronic Pain Stars section. Here are just a few of the challenging chronic pain issues out there:
- Pain of Chronic Fatigue Syndrome
- Arthritic Pain
- Depression and Chronic Pain
As you read through each one, try and think of how the mind and body are connected and in what ways stress, thoughts, and emotions can affect the experience of pain.
Chronic Pain Stars
Click through the symptoms below to find out more about the stars that make up the chronic pain cluster. You'll notice how one star can easily affect other stars. For example, chronic pain can cause insomnia which can bring on fatigue and worse chronic pain. See how many connections you can spot among the chronic pain stars. For more information and help on how to resolve chronic pain that may be affecting your health, click on the button below to take the Chronic Pain Survey and visit our Services page.
Fibromyalgia is a pain syndrome involving a very sensitized body. A person often experiences tenderness anywhere in the musculoskeletal system and can even be intolerant to what may seem like the softest touch. Painful areas are called tender points. People with fibromyalgia often experience a lot of trouble sleeping from all the muscle soreness. They can wake up from the aches and often feel stiffness upon waking. It also becomes difficult to exercise and people with fibromyalgia can become very overprotective of their bodies.
To some extent, the overprotectiveness makes sense until you think about fibromyalgia from a mind-body perspective. It is sometimes overprotectiveness and guarding in both the body and mind that contributes to fibromyalgia in the first place. Ultimately, the fibromyalgia body develops tender points and doesn't want to be touched. In some cases, the hypersensitivity may have been there to begin with before the physical symptoms even set in.
As the body seeks to guard itself in its hypersensitive state, it ironically feels even more susceptible to pain from small stimuli. A hypersensitive mindset has now lead to a hypersensitive body. Extreme muscle guarding can eventually make the muscles stiff and unusable. Fibromyalgia has in some cases been linked to past emotional turmoil and may have a mental-emotional root to it. Depression often accompanies fibromyalgia along with sleep problems. Other symptoms that can ride along with fibromyalgia include irritable bowel syndrome, anxiety, stress, difficulty concentrating, and headaches.
Pain of Chronic Fatigue Syndrome
You may wonder why chronic fatigue syndrome isn't just about chronic fatigue. Why are we talking about pain too? Chronic fatigue syndrome is for many people actually a pain syndrome as well. The body becomes so fatigued that the musculoskeletal system's functioning is affected as a result. Muscles and joints will feel like they're not getting enough energy for action or even simple day-to-day life.
Chronic fatigue syndrome can feel at times like a lingering cold. In fact, one of the possible symptoms is a sore throat. When you have a cold, you often feel achy and sore muscles. This is the quality of the muscular pain felt during chronic fatigue syndrome. It can feel like an infection has set in when there may not be any viral or bacterial infection at all.
The key to helping relieve chronic fatigue-related pain is to bring more energy back to the body. For more in-depth information on chronic fatigue, visit the Chronic Fatigue Cluster.
The word arthritis is made up of two parts--'arthro' meaning joint and 'itis' meaning inflammation. Arthritis in general is a joint disorder involving inflammation of one or more joints. Because we use our joints everyday in both subtle ways and very physical ways, joint disorders can greatly impact daily living. There are actually over 100 forms of arthritis out there, but let's stick to the most common ones here.
There are two main types of arthritis: Osteoarthritis and Rheumatoid Arthritis.
- Osteoarthritis (OA) is the most common joint disorder. It comes about as a result of wear and tear in the joint cartilage (cushioning). The hard surfaces of the bones start to rub against each other more as a result, causing bone spurs. Bone spurs are like bony scars in the joints. The joints become raw, weak, and stiff as a result.
OA typically appears in middle age and most people have symptoms by around age 70. Being overweight increases the risk of OA symptoms in the lower body due to the extra work the joints have to perform to carry weight around. Joint injuries, strenuous jobs, high impact sports, and poor nutrition also lead to more OA symptoms later in life.
The main symptom of OA is usually sharp pain in the affected joints along with burning in the surrounding structures (muscles and tendons). There may also be more cracking and popping of joints and a worsening of symptoms during cold weather or humidity. Common joints affected are large weight bearing joints such as the hips and knees along with joints in the hands, feet, and spine. Overuse of these joints can make the pain worse once symptoms set in.
- Rheumatoid arthritis (RA) is not a wear and tear joint disorder, and rather is autoimmune in origin. Auto-antibodies (antibodies that target self) attack the joints and cause redness, swelling, and stiffness in joints such as the wrists, fingers, knees, and ankles.
Both sides of the body can be affected, making daily functioning difficult. A distinguishing feature of RA that sets it apart from OA is the redness and heat of the attacked joints which OA doesn't exhibit. RA can affect other organs systems in the body as well. For more information about RA and autoimmunity in general, visit the Autoimmune Cluster.
When pain receptors around the head are triggered by tight head or neck muscles, irritated nerves, throbbing blood vessels, or eye strain it will cause the pain characteristic of chronic headaches. Chronic headaches often indicate that the head is being bombarded by some kind of pressure.
Stress is a leading cause of chronic headaches as it tends to produce tension in the head and neck muscles. When these muscles get repeatedly pulled and strained, they put pressure on the nerves and blood vessels surrounding the head, leading to chronic headaches. Poor sleep, overuse of alcohol and drugs, excessive caffeine, dehydration, and a poor diet can all contribute to headaches as well.
The sense organs around the head can contribute to chronic headaches in the process of picking up stimuli from the environment. You may have experienced the eye strain that can come from staring at a T.V. or computer screen for too long or reading a book for hours. The part of the brain that processes visual information is actually located at the back of the head near where the neck muscles start. When this area is tense from eye strain, the tension can easily spread throughout the head and neck and contribute to chronic headaches. Allergies can often block nasal passages and sinuses, building up pressure in the head and leading to headaches as well.
The most common types of chronic headaches include tension and migraine.
Tension headaches have the following characteristics:
- Dull and achy pain
- A band-like tightness anywhere around the forehead and head
- Tender muscles on scalp, neck, and shoulders
- Sometimes nausea and a lack of appetite
Most people with chronic headaches experience the tension-type due to stress, overworking, neglect in dietary habits, and overuse of stimulants such as caffeine. At first, they may only last for between half an hour to a few hours. If they occur 15 or more days out of the month for three months, they are considered chronic. Often, paying attention to lifestyle habits and one's health can make a huge difference in the occurrence of tension headaches.
Migraine headaches look like this:
- Throbbing or pulsing in one area of the head
- Nausea or vomiting
- Sensitivity to light or sound
- More rarely "auras," or visual sensations like light flashes
Rather than the dull pain of tension headaches, migraine headaches are usually more intense and they over-sensitize the sense organs around the head leading to even more symptoms. Migraine headaches can be debilitating and most people want a quiet environment without loud sounds or bright lights during the pain. Women can sometimes experience a cluster of migraines during the week or two before menstruating or even during their periods. Heat can make everything feel worse and can lead to increased dizziness and nausea.
It's important to watch out for, and seek medical attention in the case of very sudden (thunderclap-like) headaches, neck stiffness, a headache that's worse with coughing or sneezing, and new headache pain at age 50 or older.
Depression and Chronic Pain
What is depression? If asked, most people who have experienced depression would describe it as having elements of pain in it. Just like physical pain can be dull, sharp, and exhibit different qualities, so can the mental-emotional pain of depression. In fact, pain and depression share certain chemical messengers in the brain and are commonly connected in chronic pain conditions.
For some people, this connection may cause them to sigh. If depression can make chronic pain worse, and conversely the pain can make the depression worse--where do you start for effective reduction of overall symptoms? Instead of focusing too much on a "chicken or egg" type question, we can look at methods to help reduce chronic pain, look at methods to alleviate depression, and put those methods together to help the whole package of symptoms.
A small shift in mindset helps with this.
- Many times depression is thought of as a mental-emotional symptom.
But it is actually a physical one too. People who have insomnia and depression frequently report that when they get more sleep, they experience better moods. Chronic fatigue in the body can lead to depression and when the body becomes energized again, the severity of the depression can actually change. A depressed body can lead to a depressed mind too.
- Now let's take a look at chronic pain. Chronic pain is mainly thought of as a physical symptom, right?
Well that definition is also too pigeon-holed. Mental and emotional suffering is not something that the body ignores. It would take a bionic being to withstand that kind of suffering without any effect on the body. And besides, it would be a detriment because we need the mind and body to communicate for optimal health. When stress and intense emotions or thoughts build up, the chemical messengers they release from the brain are released everywhere in the body. Chronic pain is one manifestation of these messengers along with other possible symptoms such as digestive issues, sleep problems, fatigue, and hormonal imbalance.
The main point of the story is that methods that are effective in healing chronic pain will be complementary to healing methods for depression too, and vice versa. Sometimes in order to fully understand your unique symptoms, it's helpful to look outside the box and then add what you find there into the box.