The Most Common ‘Whys’ of Chronic Pain

Clinical Expertise

Sep 25, 2020

Medical Reviewer: Anita Davis, PT, DPT, OCS
Last Updated: September 24, 2020

The pain experience can be as common as bumping your elbow on the door frame, rubbing your arm and going on with your day. Or pain could be a rare disease with no cure that makes clothing, wind and getting a hug painful. Even the familiar case of low back pain can become resistant to treatment and linger for months or even years.

When pain becomes chronic and treatments seem ineffective, it is understandable that people begin to utter many questions: “Why me?”, “When will this end?”, “Who else do I need to see?”, “What do I do now?” But the two most common questions I hear from patients are these:

 

  1. “If we’ve come so far in healthcare, why can’t they find what’s wrong with me?”
  2.  

  3. “Why can’t they fix this pain?”

 

Let’s look at the first one: Why can’t they find it. The heart of this question suggests that there is one cause for a person’s pain. While acute pain may be directly related to a single issue like bumping your elbow, chronic pain becomes messier. It turns out that there could be multiple factors contributing to a person’s pain experience. Persistent pain may be a response to poor sleep, stress, depression, foods, inflammation, genetics, altered nerve signals – to name a few. Although the initial pain may have been a back strain from lifting, other issues begin to take their toll on the body and recovery becomes less optimal.

It may seem that these other issues are too basic to make a pronounced impact on pain, but consider the consequences of just one variable – stress. Prolonged stress promotes muscle tension which constricts small vessels in the muscles. This constant compressive force can be sufficient to diminish blood flow and nerve function – neither of which feels good. Muscles that remain tense become fatigued and tight enough that they themselves become a pain generator. For some, stress changes the chemistry in the body and may lead to stomach ulcers for one person or migraines for another. If several of these other factors are present, it is possible that their combined effect magnifies and maintains the original pain.

Next: Why can’t they fix this? If we really understand the potential effects of the issues mentioned above, it may be easier to appreciate why finding a single cure is so challenging. While some conditions respond well to medication, if a person is taking three or four different medicines, the possibility of adverse side effects increases multiple times. Therefore, the medications may result in further complications. In other cases, the option of surgery may just not be appropriate, or surgery has been done but pain persists. There is also the reality that the body adapts over time – but not in such a good way. Nerve impulses and transmitters remain engaged; pro-inflammatory chemicals continue to circulate in the body and pain becomes a constant cycle for some people.

Is this where we leave things? Absolutely not! There are healthcare professionals that understand these concepts and can help you decipher your pain mechanisms. There are physicians, physical therapists and even psychologists who specialize in understanding the complexity of pain and can help you develop a plan to manage it instead of it managing you. As you apply new strategies, you may discover that you have the ability to control some of your pain.

Medical Reviewer

Anita Davis, PT, DPT, OCS

Anita has been practicing physical therapy since 1985. She completed residency training in 2007 and received her doctorate in 2009. She holds membership in the American Physical Therapy Association, the Orthopedic Section and Pain Management Special Interest Group, Academy of Integrative Pain Management and American Congress of Rehabilitation Medicine. Chronic pain rehabilitation has been her specialty since 1990.
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