Why Does Pain Persist?

Do you have constant aches and pains that persist or keep coming back? Do medications, injections, chiropractic treatments, physiotherapy or massage give you temporary relief but you constantly need these treatments in order to function?

Part of the reason for this is due to "Perpetuating Factors". These are things that keep causing your pain to be triggered. Examples of perpetuating factors are: muscle tension from certain postures or movements; stress; strong emotions such as anger, fear or guilt; or difficult interactions with people around you.

How do all these things affect pain?

In order to answer this, we need to understand the process of how we feel pain. Let's first take a look at a process that we are more familiar with - vision, and then compare that to the process of pain.

Visual Pathway

Vision begins when receptors in your eyes detect light that is reflected off of something. The signals from the eyes then travel along nerves to specialized areas of the brain where an image is assembled and stored. Other parts of the brain (including areas for smell, taste, touch, emotions and memory) then interact with your vision centre to create a meaning for what you see.

Areas of the Brain

This process can be illustrated by the following example. When you meet a person for the first time, you'll probably forget what they look like quite quickly if they did not impact your life in any significant way. As you get to know them and they say and do things that you really like, you’ll associate their image with positive feelings and you'll begin to remember their appearance. Over time, just the smell of the perfume they wear or the sound of a song can bring their image to your mind even if they are not present!

Since what you see always has a context and that context is constructed by your entire brain, your vision can be affected anywhere along the visual pathway or anywhere in the brain: glasses affect the eyes themselves; diseases that damage your nerves disrupt the transmission of signals from your eyes to your brain; and numerous factors (including fatigue, drugs and your surroundings) can impact your thoughts, emotions and memories and thus alter how you see things. This last point is evident every time you're watching TV since the environmental cues in the shows, such as music and background scenery, can provoke you to feel a certain way about what you are seeing.

The Pain Pathway

Like the visual system, the process of pain begins with receptors in your body, but instead of receiving light, these receptors detect tactile information such as touch, pressure, heat and cold. Signals from these receptors travel along nerves to the spinal cord and brain where they interact with your thoughts, emotions, other sensations and memories. The result is a feeling of pain as well as a judgment of its relevance in your life. Unfortunately, you can also feel pain even when nothing is stimulating your pain receptors. This is similar to how you can see a person's image even in their absence.

Due to the complex nature of how pain signals are processed, people will have very different responses to similar experiences of pain. For instance, some people like the feeling of muscle soreness after exercising while others avoid exercise due to it. Another example is that some people fear getting into a car after being injured in a motor vehicle collision while others continue driving as if nothing happened.

Just as the visual system can be altered along its pathway, so can the pain system. At the beginning of the pain pathway, we can limit the activation of pressure sensors in the body by decreasing muscle tension with massage therapy. To decrease the transmission of pain signals along the nerves to the brain, Transcutaneous Electrical Nerve Stimulation (TENS) machines or nerve block injections can be used. At the level of the brain, various approaches can be used to modify your perception of the pain signals. For example, meditation and exercise can help to increase the "feel good" signals in your brain which compete with the pain signals; thereby, decreasing the pain signals' influence on you.

These popular treatments for pain can be very effective; however, unless perpetuating factors are addressed, the pain is likely to persist or come back. A common example occurs when a person's muscles quickly tighten up after a massage because they continue to sit or reach or lift improperly throughout the day. Additionally, if a person is constantly pushing themselves to excel in life, the high levels of stress chemicals present in their bodies will intensify any pain signals, so therapies aimed at blocking pain signals will be overpowered. On top of that, if a person does not know how to properly deal with an unpleasant co-worker or family member, the effects of meditation and exercise will only be short-lived. Lasting relief from pain requires finding out where the perpetuating factors in your life are and then directly dealing with them.

The reason why the pain system is so important and why it is such a significant source of healthcare expenditure as well as human suffering is that it is your main alarm system. It is meant to irritate you when it detects that something is wrong in your life! Since it is a compass for your well-being, it should not be ignored. In the next few blogs, we will discuss strategies to help you with physical, emotional and interpersonal perpetuating factors.

Dr. Trung Ngo founded Novah Healthcare in 2017, an interdisciplinary clinic that specializes in the conservative management of acute and chronic pain. His Novah clinic will continue the work he did from 2011 to 2016 at Mount Sinai Hospital, where he led an interdisciplinary team in assessing and treating complex, chronic, non-cancer pain. His Mount Sinai team helped patients decrease their pain, improve their daily and vocational functioning and reduce or eliminate their intake of pain medications (including opioids). Dr. Ngo graduated from the Canadian Memorial Chiropractic College and subsequently pursued a residency program at Hamilton General Hospital in which he furthered his training in orthopaedics and pain management.

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