The Chronic Pain Connection

Those of you who suffer from maladies such as migraines, fibromyalgia, or irritable bowel syndrome (along with neuropathic and inflammatory pain), know the meaning of chronic pain. Modern medicine and its diagnostic testing often give us no conclusion as to what is causing the pain. In fact, numerous visits to varying pain doctors often reveal nothing physically wrong with their patients. Mayo Clinic’s Health Letter, September, 2015 informs us “Without a rational explanation for the ongoing, often debilitating pain, attempted therapy is at best an educated guess. At worst, it’s more like a stab in the dark.”  My elder son, at the age of 44 years old, understands this statement more than anyone I know, having suffered with fibromyalgia on a daily basis for the past 15 years of his life.

Thanks to decades of research, this “hit or miss” diagnosis may be finally changing. Recently, several forms of chronic pain have been discovered to have a common link – the excessive sensitization of nerves and nerve connections in the spinal cord and brain (central sensitization syndrome/css). 

Mayo’s newsletter tells us “With it (css), nerves are rewired so that ordinary sensations are misinterpreted as being harmful or painful.” The discovery of this syndrome is helping doctors and therapists to break down barriers of past misunderstanding in having thought that the pain wasn’t real or having hoped for cures or causes that didn’t really exist. While central sensitization may be only a part of what is causing certain chronic types of pain, this new rational explanation of what’s happening will hopefully help medical professionals to understand the pain’s scope and source. It is hoped that the syndrome’s discovery will also help the patient receive successful rehabilitation therapies in the future.

Normally, pain, after being caused by some harmful stimulus to the body, travels from the nerve endings to the central spinal cord and on through various parts of the brain.  

“However,” according to Mayo Clinic, “there are multiple types of nerve cells involved in this transmission, junctions along the way with chemically activated and deactivated receptors – and a certain amount of room for misinterpretation of those pain signals by parts of the brain.”  Ordinary pain usually follows an arc with the initial sharp pain received activating a response from the body. Next comes a longer less sharp pain motivating care for the injury. Eventually, the pain may become dull as healing begins to take place.

Central sensitization happens when the pain process does not follow the normal downward part of the arc. Here spinal cord nerves reconfigure themselves to be in more constant sensitivity and excitement. Even sensations that should not be perceived as painful may be felt as such. Stresses in life that should be manageable can set off a huge amount of pain. Ordinary aches and pains, noises, smells, and even bright lights can become grossly over-exaggerated in situations of extreme sensitivity. Medscape’s Multispecialty webpage article mentions that inflammatory pain (such as arthritis), in areas surrounding the actual injury of tissue, can respond to non-threatening stimuli “such as a touch, clothing, light pressure, or a hairbrush, as if they are painful.”  MRI research shows there are changes in the way that the brain routes and processes pain in central sensitization messages. These diagnostic tests show that nothing can be wrong physically, or if there is a problem, the pain is far out of proportion to the physical problem. In these cases without a justification for pain, therapy just won’t work. A downward spiral of chronic pain can result in increased stress, isolation, a loss of fitness and sleep, depression, and even more pain occurring.

Mayo’s newsletter instructs us “The causes of central sensitization appear to involve a mix of factors.”  First, a genetic component may increase the possibility. Second, extremely poor childhood experiences may lead to the rewiring of nerves. Third, higher levels of stress hormones in youth or later may become a factor. Fourth, the newsletter adds “There’s often a cause or event that seems to get the sensitization started. Many who have chronic pain recall a physically or emotionally stressful event such as a car accident, abuse….”  My son can point to one incident that he strongly believes began the onset of his fibromyalgia development. In 2000, attempting to do a good deed, our elder son stressfully tried to remove his grandfather’s auto out of a deep ditch. As a result, he developed back pain difficulties. Medscape, in its “Expanding Our Understanding of Central Sensitization,” gives us still another factor. The site says “Evidence suggests that chronic pain results from a combination of mechanisms, including neural ‘memories’ of previous pain.” 

Research continues to attempt to identify the sensitization processes. Until better treatments are identified, however, Mayo Clinic recommends a comprehensive plan for rehabilitation to gain better control over the pain:  “…a specialized pain rehabilitation center may be worth considering if you and your doctor have struggled to manage your pain.”  The treatment options at these centers will include medication management, managing health and stress levels (management of lifestyle), counseling, yoga (tai-chi), acupuncture, hypnosis, and massage.  

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