Four Steps in the Evolution of Chronic Pain

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There are four phases in the evolution of chronic pain:

(1) There is a potential source for pain, which may or may not be readily identifiable

  • Structural–identifiable lesion with MATCHING symptoms
  • Non-structural–inflammation or irritation of the soft tissues, which cannot be seen on an imaging test
  • Neurophysiological Disorder (NPD)–the nervous system can spontaneously cause many physical symptoms in any part of the body without an identifiable source or reason.

(2) The brain becomes sensitized to the pain impulses.

(3) The nervous system memorizes the pain circuits.

(4) Emotional factors alter the pain experience

  • Sleep
  • Anxiety
  • Anger/frustration


Listen to the Back in Control Radio podcast The Evolution of Chronic Pain