Monday, October 15, 2012


I would like to explore the phenomena of chronic pain.

Usually pain is considered acute if it lasts no more than 30 days.
  Pain is generally considered chronic if it lasts 3-6 months after it's onset.

Unfortunately, more often than not, many of us have experienced this all too common malady.  Chronic pain can be literally debilitating.  Sometimes it can lead to cognitive discord and even depression.  It is the harsh somatic white noise in the back ground that never ceases.

I have clients that experience both.  With acute pain, there is usually apparent tissue damage and compensatory patterns throughout the body.  This, however, is thankfully fairly short lived.

With chronic pain, things get a bit trickier.  Now, before I go on, let me just say that there has been quite the paradigm shift in pain science.  Stay with me here for some new insights may seem absurd at first glance.

The New Pain Science. 

With sudden and acute pain we have a pretty straight forward idea of what is going on.  Let's say you stub your toe.  Well, in the general vicinity of your toe you have what are called "nociceptors."  These little guys are sensory neurons that can be found throughout the body.  Their primary job is to let your spinal cord and various parts of your brain know if there has been any damage done to your body.  In essence, their job is to ensure your body's survival.

So, back to your poor toe.  Immediately after stubbing your toe, nociceptors send a very loud, "HEY, WE GOT A PROBLEM DOWN HERE AT THE BIG TOE!" signal to your spinal cord, brain stem.  From there it goes to multiple sites in the brain. 

First it goes to the cerebellum (motor control) and  the thalamus (regulates alertness).  Now, here's an interesting twist.  There is then a dialogue with the frontal lobes of your brain, which are responsible for higher brain functions (executive decisions/long term memories/choosing between good and bad actions.) and the Posterior Parietal Cortex (planning and executing movements.)  Everyone huddles together and figures out what to do.

This "dialogue" between the Frontal Lobes and the Posterior Parietal Cortex eventually leads to a decision/action.

It will hurt or it won't.

This would be the paradigm shift I mentioned before.

It used to be thought that nociceptors sent pain signals to your spinal cord, brain stem and brain.  Now, however, it is believed that they send signals to your brain, and your brain decides whether or not it should be painful.  The brain makes the executive decision if pain will be needed for your survival.

So, with the stubbed toe, your buddy the brain does the right thing, it makes your toe hurt so you protect it and do what is necessary, hopefully, to repair any damage done.  (I am not entirely sure what part of the brain is responsible for the soliloquy of profanity that may follow immediately after stubbing the toe. . .) 

This scenario would be considered "acute pain."

Yet, how does acute pain trans-mutate into chronic pain?  More importantly, what can be done about it?


Sometimes these signals from nocioceptor to brain and from brain to nocioceptors might get confused. 

In an ideal world, some time after stubbing your toe, any tissue damage slowly but surely begins to heal.  Then, the brain makes yet another decision.  It decides that healing has taken place and pain as a mechanism for survival is no longer needed, thus pain begins to subside.

Yet, what happens if there is no more tissue damage, yet pain persists?  There are a number of things that could be going on...

1.  The brain may begin to experience seemingly benign sensation and interpret it as pain.  The brain still considers a certain area to be under threat, even if there is no damage done.  Such as the stubbed toe.  Even though the bruising has abated, simple pressure on the toe might trigger a painful response.  The nervous system is still stuck in a loop of protection/survival.

2.  Long term pain begets even more pain.  This is called long term potentiation.  It's like a well worn neurological pathway that your brain uses over and over again.  The more this pathway is used, the easier it is to follow. 

3.  Old Injuries.  This is key.  Old injuries are very susceptible to awakening over used neurological pain pathways.  Let's say at one point, that toe you stubbed was once broken.  Your brain already has pathways established from your previous accident, and it doesn't take much to awaken them once more. 

Remember the various parts of the brain which light up after receiving signals from the nocioceptors?  These parts of the brain, frontal lobes and posterior parietal cortex, rely heavily on past events and memories before making an executive decision.

If you had never hurt your big toe in any substantial way before, you would curse the gods, ice it and life goes on.  If, on the other hand, you broke such said toe once before, your brain/body is already primed and ready to respond in a perhaps overly protective and zealous manner.  Where pain would once linger for a few days, it instead stays put for far too long.  Your mind and body are hell bent on your survival, so pain persists...

4.  History and Environment.  We all have different family histories...some healthier than others.  Unfortunately, if there was any physical abuse, our bodies may already be hyper tuned to any potential danger as adults.  Old habits for survival die hard.  Also, even if there was no physical harm, but emotional abuse, your body again might be hard wired to to sense any undue sensation as dangerous, and react accordingly. 

Also, how did our parents relate to pain?  We mirror our parents.  Did they ignore pain or hyper inflate it?

Regardless of our respective histories, our bodies respond to our environment.  If we don't feel safe, or we feel in some way in danger, our brain and our bodies may in fact create pain where there is no physical damage done.  Now, to be very clear, you are not "making anything up."  This is happening not even on a subconscious level, but on a very deep level within our Central Nervous System.  If your job is stressful, take note if you begin to feel various aches and pains after even just thinking about your respective jobs.

5.  Visceral in Origin.  This is a slight tangent but should be mentioned.  Sometimes we get pain where there is no damage done.  This called referred pain.  Remember those nocioceptors I was describing earlier?  Well, for whatever reason, there aren't that many in your viscera.  There are a lot more towards the periphery of your body.  So, you may have an adhesion in your guts, yet your brain hasn't received any distress calls from that area.  Unfortunately, over time, you may begin to recruit other structures in your body to protect this adhesion.  For example, your liver might be slightly stuck on another organ near by.  Your rib cage might be bent forward to help protect this adhesion.  Then your vertebrae follow.  Here at the spine there are plenty of nocioceptors, and then your brain finally gets the signal that something is awry.  This can lead to chronic pain if the original culprit, the liver, was never dealt with.  I have described this dynamic in previous newsletters.  Rolfing using Visceral Manipulation can be very helpful when this has occurred.

What is to be done?


Language.  Be mindful of how you talk about your pain.  More importantly, be alert to how others describe or interpret your chronic pain.  Language is very powerful.  If you find yourself referring to your pain in a demeaning and harsh way, there is a good chance your brain will continue to sense danger on some level and perpetuate your discomfort.  "God damn toe...I'll never be better...I'm all screwed up...I'm a train wreck... there's something wrong with me...what did I do wrong..." etc. et al. are all shame based interpretations of something quite benign yet confused in your nervous system.  When visiting a health care provider, and they use language that is. . .harsh, take a moment to either remind them of the power of their words or perhaps find a new practitioner. 

Body work.  Manual therapy, in particular Rolfing, can be of great help for those dealing with chronic pain.  Without going into great detail about what happens on a physiological level, just know that the continual loop of survival and inflammation gets re-worked and worked out on multiple levels.  Also, your brain begins to re-map it's awareness of perceived injuries and sites of pain.  With chronic pain, your proprioception and or awareness of your own body becomes skewed.  With body work, healthy proprioception takes hold, and your mind begins to realize that all is well, everything is as it should be.  There is no damage as it once thought there was.

Movement.  Subtle and gentle movement can work wonders for those dealing with chronic pain.  Movement which helps differentiate sensations.  When we are feeling chronic pain, unfortunately ANY sensation can be interpreted as being a threat or as being painful in of itself.  Movement that re-awakens proprioception, as mentioned above, is very helpful.  Painful areas certainly draw our attention but not necessarily our sensitivity and awareness. Gentle yoga and feldenkrais are two approaches I can think of right off hand.  If you ever need a referral, just let me know!

Just one last thought.  Next time you are dealing with any undue or chronic pain, I have one suggestion above all others...


Sometimes, when I am experiencing pain, whether it be physical or even emotional, I take my hand and gently caress that which hurts.  If it is emotional, I caress and sooth my heart and forehead.  If it is physical pain, such as my left knee, I close my eyes and with true intention, gently caress my knee and kindly, oh so kindly, tell myself that all is well.  The pain doesn't "go away" but it does lessen...and I feel more whole.

When pain begins to manifest again, I sooth myself in return.  This helps create new and healthy neurological pathways.

Those parts of my nervous system and the executive players in my brain begin to realize that the loop of hyper-vigilance and pain may not be needed after all.