top of page
  • Jones Chiropractic

Understanding Chronic Pain

Chronic pain can be mild or excruciating, it can be episodic or continuous, it can be merely inconvenient or totally incapacitating. The pain can be from headaches, or joint pain, it can be neck pain, back pain or pain from an injury.

The common thing with all these types of pain is that the actual feeling of pain is always, 100% of the time, created in your brain.

Neuroscience Research

Did you know that imagining a movement influences the brain in a very similar way to actually doing the movement? This can help to retrain your brain to understand that the movement is not dangerous – because imagining doing the movement will not hurt. You can basically trick your brain into giving you back pain-free movement.


The movement of your spine is also very important. Yoga or simple spinal exercises can be great for this and chiropractic care may be really important to help you move too. The main focus of chiropractic care is to improve the movement and function of your spine.


Video Transcript

Experiencing pain is normal. Everyone experiences pain now and then.1 Pain is supposed to be a protective experience to make sure you stop doing things that may be dangerous.2 But chronic pain, that is pain that has persisted for more than 3 months, is no longer protective, nor informative. 3 Let’s look at what chronic pain is and what you can do about getting rid of it.


All pain is created by your brain, because your brain has decided that you are threatened or in danger and need protecting. 4-10  The interesting thing here is that you don’t actually have to have any actual tissue damage to feel pain. 10-12 And if your brain is not aware of tissue damage, you may not feel any pain at all, even when you’ve injured yourself. 4 6 


Chronic pain is the second-most common reason people see a doctor and miss work. 13 14 More than one-third of people with chronic pain become disabled by their pain to some degree. 14-16 Chronic pain can be mild or excruciating, it can be episodic or continuous, it can be merely inconvenient or totally incapacitating. The pain can be from headaches, or joint pain, it can be neck pain, back pain or pain from an injury. Other kinds of chronic pain include tendinitis, or sinus pain, carpal tunnel syndrome, and pain affecting specific parts of the body, such as shoulders, elbows, wrists, hands, hips, knees ankles or feet. 


The common thing with all these types of pain is that the actual feeling of pain is always, 100% of the time, created in your brain. 5 8 10 12 17 18 This does not mean it’s not a real experience – you know if you have felt pain that it is a very real experience – but understanding that the pain itself is created in your brain has major implications for how you can get rid of it. And because pain depends so much on what you think and feel about the pain,2  it’s very important you understand pain properly.


Your pain experience depends on why your brain has decided you need to be protected – why it’s creating the feeling of pain for you in the first place.2 14 It can therefore be very useful for you to try to figure out why your brain may be creating pain for you. What was happening at or around the time your pain started. What makes it worse? What makes it better? Why it this so important? Because we know that the brain can be retrained, 19 so you need to use all the tools available to you to retrain your brain out of pain.19 Some of the keys to retraining your brain are staying active,20-22 staying positive,23 eating well,24 25 and sleeping well. 14 26


Today let’s look at why staying active is so important. Your posture and how you move plays an important role in how you feel and how you experience pain.21 22 Even as little as a short walk every day can help. 22 27 28 If there are movements, you cannot do because of your pain you can still help yourself by imagining those movements.29 We know from neuroscience research that imagining a movement influences the brain in a very similar way to actually doing the movement.29-31  This can help to retrain your brain to understand that the movement is not dangerous – because imagining doing the movement will not hurt. You can basically trick your brain into giving you back pain-free movement.29 Play with these sorts of things. Make movement fun. Move in different emotional states, like when you’re happy or grateful. Move outside – in the sun, in a park with beautiful plants and flowers. Or move in water. 


The movement of your spine is also very important.32 Yoga or simple spinal exercises can be great for this and chiropractic care may be really important to help you move too.33-36 The main focus of chiropractic care is to improve the movement and function of your spine.37-41  


This is so important because proper movement of the spine helps the brain to know more accurately what is going on, not just in the spine, but also elsewhere in your body. 41-43 And chiropractic care is already well known in the research literature to help people who suffer with back pain,44-47 neck pain48-50 and some types of headaches.51-53 This is most likely because chiropractic care helps the brain know more accurately what is going on in the spine and body 41 42 54 and may help the brain to switch off the feelings of pain, when they are no longer needed.41   


So, if you suffer with chronic pain do your best to stay positive, move often, eat well, sleep well, and go see your family chiropractor to help retrain your brain out of pain.


Video References

  1. Katz WA. The needs of a patient in pain. The American Journal of Medicine 1998;105(1, Supplement 2):2S-7S. doi: https://doi.org/10.1016/S0002-9343(98)00068-0

  2. Seymour B. Pain: A Precision Signal for Reinforcement Learning and Control. Neuron 2019;101(6):1029-41. doi: 10.1016/j.neuron.2019.01.055 [published Online First: 2019/03/22]

  3. Holt K, Russell D, Cooperstein R, et al. Interexaminer reliability of a multidimensional battery of tests used to assess for vertebral subluxations. Chiropr J Aust 2018;46(1):101-17.

  4. Fenton BW, Shih E, Zolton J. The neurobiology of pain perception in normal and persistent pain. Pain management 2015;5(4):297-317. doi: 10.2217/pmt.15.27 [published Online First: 2015/06/20]

  5. Koyama T, McHaffie JG, Laurienti PJ, et al. The subjective experience of pain: Where expectations become reality. Proceedings of the National Academy of Sciences 2005;102(36):12950-55. doi: 10.1073/pnas.0408576102

  6. Mitsi V, Zachariou V. Modulation of pain, nociception, and analgesia by the brain reward center. Neuroscience 2016;338:81-92. doi: 10.1016/j.neuroscience.2016.05.017

  7. Ploghaus A. Dissociating Pain from Its Anticipation in the Human Brain. Science 1999;284(5422):1979-81. doi: 10.1126/science.284.5422.1979

  8. Wager TD. Placebo-Induced Changes in fMRI in the Anticipation and Experience of Pain. Science 2004;303(5661):1162-67. doi: 10.1126/science.1093065

  9. Wiech K. Deconstructing the sensation of pain: The influence of cognitive processes on pain perception. Science 2016;354(6312):584-87. doi: 10.1126/science.aaf8934 [published Online First: 2016/11/05]

  10. Świeboda P, Filip R, Prystupa A, et al. Assessment of pain: types, mechanism and treatment. Pain 2013;2(7)

  11. Costigan M, Scholz J, Woolf CJ. Neuropathic Pain: A Maladaptive Response of the Nervous System to Damage. Annual Review of Neuroscience 2009;32(1):1-32. doi: 10.1146/annurev.neuro.051508.135531

  12. Bannister K, Kucharczyk M, Dickenson AH. Hopes for the future of pain control. Pain and Therapy 2017;6(2):117-28.

  13. St Sauver JL, Warner DO, Yawn BP, et al. Why patients visit their doctors: assessing the most prevalent conditions in a defined American population. Mayo Clin Proc 2013;88(1):56-67. doi: 10.1016/j.mayocp.2012.08.020 [published Online First: 2013/01/01]

  14. Bonakdar RA. Integrative pain management. Medical Clinics 2017;101(5):987-1004.

  15. Webb R, Brammah T, Lunt M, et al. Prevalence and Predictors of Intense, Chronic, and Disabling Neck and Back Pain in the UK General Population. Spine 2003;28(11):1195-202. doi: 10.1097/01.brs.0000067430.49169.01

  16. Mallen C, Peat G, Thomas E, et al. Severely disabling chronic pain in young adults: prevalence from a population-based postal survey in North Staffordshire. BMC Musculoskeletal Disorders 2005;6(1):42. doi: 10.1186/1471-2474-6-42

  17. Apkarian AV, Hashmi JA, Baliki MN. Pain and the brain: specificity and plasticity of the brain in clinical chronic pain. Pain 2011;152(3 Suppl):S49.

  18. Atlas LY, Bolger N, Lindquist MA, et al. Brain Mediators of Predictive Cue Effects on Perceived Pain. 2010;30(39):12964-77. doi: 10.1523/jneurosci.0057-10.2010

  19. deCharms RC, Maeda F, Glover GH, et al. Control over brain activation and pain learned by using real-time functional MRI. Proc Natl Acad Sci U S A 2005;102(51):18626-31. doi: 10.1073/pnas.0505210102

  20. Geneen LJ, Moore RA, Clarke C, et al. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. The Cochrane database of systematic reviews 2017;4:Cd011279. doi: 10.1002/14651858.CD011279.pub3 [published Online First: 2017/04/25]

  21. Booth J, Moseley GL, Schiltenwolf M, et al. Exercise for chronic musculoskeletal pain: A biopsychosocial approach. Musculoskeletal care 2017;15(4):413-21. doi: 10.1002/msc.1191 [published Online First: 2017/04/04]

  22. O’Connor SR, Tully MA, Ryan B, et al. Walking exercise for chronic musculoskeletal pain: systematic review and meta-analysis. Archives of physical medicine and rehabilitation 2015;96(4):724-34.e3. doi: 10.1016/j.apmr.2014.12.003 [published Online First: 2014/12/23]

  23. Schutze R, Rees C, Slater H, et al. ‘I call it stinkin’ thinkin”: A qualitative analysis of metacognition in people with chronic low back pain and elevated catastrophizing. British journal of health psychology 2017;22(3):463-80. doi: 10.1111/bjhp.12240 [published Online First: 2017/04/05]

  24. Masino SA, Ruskin DN. Ketogenic diets and pain. Journal of child neurology 2013;28(8):993-1001. doi: 10.1177/0883073813487595 [published Online First: 2013/05/18]

  25. Silva AR, Bernardo A, Costa J, et al. Dietary interventions in Fibromyalgia: a systematic review. Annals of medicine 2019:1-29. doi: 10.1080/07853890.2018.1564360 [published Online First: 2019/02/09]

  26. Burgess HJ, Burns JW, Buvanendran A, et al. Associations Between Sleep Disturbance and Chronic Pain Intensity and Function: A Test of Direct and Indirect Pathways. The Clinical journal of pain 2019 doi: 10.1097/ajp.0000000000000711 [published Online First: 2019/03/27]

  27. Kocur P, Pospieszna B, Choszczewski D, et al. The effects of Nordic walking training on selected upper-body muscle groups in female-office workers: a randomized trial. Work 2017;56(2):277-83.

  28. O’Connor SR, Tully MA, Ryan B, et al. Walking exercise for chronic musculoskeletal pain: systematic review and meta-analysis. Archives of physical medicine and rehabilitation 2015;96(4):724-34. e3.

  29. Bowering KJ, O’Connell NE, Tabor A, et al. The effects of graded motor imagery and its components on chronic pain: a systematic review and meta-analysis. The journal of pain : official journal of the American Pain Society 2013;14(1):3-13. doi: 10.1016/j.jpain.2012.09.007 [published Online First: 2012/11/20]

  30. Mulder T. Motor imagery and action observation: cognitive tools for rehabilitation. Journal of neural transmission (Vienna, Austria : 1996) 2007;114(10):1265-78. doi: 10.1007/s00702-007-0763-z [published Online First: 06/20]

  31. Ruffino C, Papaxanthis C, Lebon F. Neural plasticity during motor learning with motor imagery practice: Review and perspectives. Neuroscience 2017;341:61-78.

  32. Laird RA, Keating JL, Ussing K, et al. Does movement matter in people with back pain? Investigating ‘atypical’ lumbo-pelvic kinematics in people with and without back pain using wireless movement sensors. BMC Musculoskelet Disord 2019;20(1):28. doi: 10.1186/s12891-018-2387-x [published Online First: 2019/01/20]

  33. Eliks M, Zgorzalewicz-Stachowiak M, Zenczak-Praga K. Application of Pilates-based exercises in the treatment of chronic non-specific low back pain: state of the art. Postgraduate medical journal 2019;95(1119):41-45. doi: 10.1136/postgradmedj-2018-135920 [published Online First: 2019/01/14]

  34. Li Y, Li S, Jiang J, et al. Effects of yoga on patients with chronic nonspecific neck pain: A PRISMA systematic review and meta-analysis. Medicine 2019;98(8):e14649. doi: 10.1097/md.0000000000014649 [published Online First: 2019/03/01]

  35. Galindez-Ibarbengoetxea X, Setuain I, Andersen LL, et al. Effects of Cervical High-Velocity Low-Amplitude Techniques on Range of Motion, Strength Performance, and Cardiovascular Outcomes: A Review. Journal of alternative and complementary medicine (New York, NY) 2017;23(9):667-75. doi: 10.1089/acm.2017.0002 [published Online First: 2017/07/22]

  36. Shaw L, Descarreaux M, Bryans R, et al. A systematic review of chiropractic management of adults with Whiplash-Associated Disorders: recommendations for advancing evidence-based practice and research. Work 2010;35(3):369-94.

  37. Brown RA. Spinal Health: The Backbone of Chiropractic’s Identity. Journal of Chiropractic Humanities 2016;23(1):22-28. doi: https://doi.org/10.1016/j.echu.2016.07.002

  38. Hart J. Analysis and Adjustment of Vertebral Subluxation as a Separate and Distinct Identity for the Chiropractic Profession: A Commentary. J Chiropr Humanit 2016;23(1):46-52. doi: 10.1016/j.echu.2016.09.002 [published Online First: 2016/12/07]

  39.  The Rubicon Group. Definition and Position Statement on the Chiropractic Subluxation. [Online] Available at: http://www.therubicongroup.org/#/policies/: The Rubicon Group, 2017:4.

  40. Henderson CN. The basis for spinal manipulation: chiropractic perspective of indications and theory. Journal of electromyography and kinesiology 2012;22(5):632-42.

  41. Haavik H, Kumari N, Holt K, et al. The contemporary model of vertebral column joint dysfunction and impact of high-velocity, low-amplitude controlled vertebral thrusts on neuromuscular function. European Journal of Applied Physiology 2021:1-46.

  42. Haavik H, Murphy B. Subclinical neck pain and the effects of cervical manipulation on elbow joint position sense. J Manipulative Physiol Ther 2011;34(2):88-97. doi: 10.1016/j.jmpt.2010.12.009 [published Online First: 2011/02/22]

  43. Korakakis V, Giakas G, Sideris V, et al. Repeated end range spinal movement while seated abolishes the proprioceptive deficit induced by prolonged flexed sitting posture. A study assessing the statistical and clinical significance of spinal position sense. Musculoskeletal science & practice 2017;31:9-20. doi: 10.1016/j.msksp.2017.06.003 [published Online First: 2017/06/19]

  44. Ruddock JK, Sallis H, Ness A, et al. Spinal manipulation vs sham manipulation for nonspecific low back pain: a systematic review and meta-analysis. Journal of chiropractic medicine 2016;15(3):165-83.

  45. Goertz C, Pohlman K, Vining R, et al. Patient-centered outcomes of high-velocity, low-amplitude spinal manipulation for low back pain: a systematic review. Journal of Electromyography and Kinesiology 2012;22(5):670-91.

  46. Hidalgo B, Detrembleur C, Hall T, et al. The efficacy of manual therapy and exercise for different stages of non-specific low back pain: an update of systematic reviews. Journal of Manual & Manipulative Therapy 2014;22(2):59-74.

  47. Paige NM, Miake-Lye IM, Booth MS, et al. Association of spinal manipulative therapy with clinical benefit and harm for acute low back pain: systematic review and meta-analysis. Jama 2017;317(14):1451-60.

  48. Bryans R, Decina P, Descarreaux M, et al. Evidence-based guidelines for the chiropractic treatment of adults with neck pain. Journal of manipulative and physiological therapeutics 2014;37(1):42-63.

  49. Wong JJ, Shearer HM, Mior S, et al. Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the OPTIMa collaboration. The Spine Journal 2016;16(12):1598-630.

  50. Gross A, Miller J, D’Sylva J, et al. Manipulation or mobilisation for neck pain: a Cochrane Review. Manual therapy 2010;15(4):315-33.

  51. Bryans R, Descarreaux M, Duranleau M, et al. Evidence-based guidelines for the chiropractic treatment of adults with headache. Journal of manipulative and physiological therapeutics 2011;34(5):274-89.

  52. Rist PM, Hernandez A, Bernstein C, et al. The impact of spinal manipulation on migraine pain and disability: a systematic review and meta‐analysis. Headache: The Journal of Head and Face Pain 2019;59(4):532-42.

  53. Fernandez M, Moore C, Tan J, et al. Spinal manipulation for the management of cervicogenic headache: A systematic review and meta‐analysis. European Journal of Pain 2020;24(9):1687-702.

  54. Holt KR, Haavik H, Lee AC, et al. Effectiveness of Chiropractic Care to Improve Sensorimotor Function Associated With Falls Risk in Older People: A Randomized Controlled Trial. J Manipulative Physiol Ther 2016 doi: 10.1016/j.jmpt.2016.02.003 [published Online First: 2016/04/07]

Comments


Commenting has been turned off.
bottom of page