Chronic pain involves a web of variables that can be complex, but often patients don’t want a complicated explanation for their pain. The pain is so severe, and so difficult to live with, that they just want to hear a simple root cause. They are often stuck on the idea that their pain is caused entirely by a physical injury. When presented with any alternative concepts, they can become very angry, demanding, and sometimes will storm out of my office. Others are more polite but not open to any new ideas. If this is the case, no explanation will change their mind about what is wrong with them and how it needs to be fixed.
In order to release yourself from chronic pain, it’s crucial to stop focusing on your physical condition and to consider your neurological experience. Your neurological system has a profound effect on your perception of pain.
When you’re in pain, your nerves are sending signals to your brain. With repetition, these signals turn into neurological “pain pathways” that become stronger over time. The process is similar to what happens to the brain of an athlete, artist, or musician with extensive practice. For example, if you practiced the violin for hundreds of hours over the course of a year, the nerve connections involved in the activity would become wrapped in a substance called myelin, which insulates the connections, improving the conductivity and improving your skill. The connections/pathways can become very strong.
The same happens with pain – if you’re in pain over an extended period of time, it’s like you’re “practicing” being in pain. Your neurological pain connections become lined with myelin, making it easier for you to feel pain, just as it becomes easier to play the violin. You become a “natural” at feeling pain, and it takes less of a stimulus for you to feel it, or no apparent stimulus at all. So you may have no physical injury, but you’re still experiencing pain.
Becoming “skilled” at feeling pain is not unlike what amputation patients sometimes experience. A common phenomenon that occurs in these patients is called phantom limb pain. Pre-amputation, these patients are usually in severe pain due to a lack of blood supply to the limb. After the amputation almost all amputees still feel sensations from the arm or leg; many cannot tell that the limb is gone. Forty to fifty percent experience pain similar to what they felt before surgery. These patients have insulated pain pathways that keep spinning post-surgery, similar to those of chronic pain patients. The source of their pain is gone, and yet they still feel the pain.
Chronic pain pathways are always accompanied by anxiety and frustration. Not only are the pain pathways becoming more myelinated, but anxiety and anger pathways are also becoming deeply etched into your nervous system.
Anxiety exists as a neurological response to danger that allows humans to increase their chances of survival. All living creatures experience some form of anxiety; it’s impossible to survive without it. But while we need anxiety, it makes us feel vulnerable and helpless. In response, the body reacts with a “fight or flight” response. In “flight” mode, we seek to avoid anxiety. One method of avoidance is to suppress it, but this never works: it’s been demonstrated that when you suppress an anxiety-related negative thought, it only becomes stronger.
In “fight” mode, we respond to anxiety by getting angry. The anger gives us a feeling of power that covers up our anxiety. It also increases our heart rate and muscle strength, improving our ability to defend ourselves. However, there are many downsides to anger: it’s so intense that you may see the person or situation you’re confronting less clearly, projecting your own reality onto it. This concept applies to chronic pain. Anger affects our perception of pain, firing up negative thoughts, making them spin much faster, and reinforcing the formation of anxiety-producing pathways.
Your body often physically responds to anxiety-producing thoughts such as “I’m not good enough,” or “I’ll never be able to accomplish this task,” with conditions such as poor sleep, a pit in the stomach, muscle tension, or increased heart rate. The physical response reinforces the spinning neurological circuits, making them seem even more real.
In my experience, these anxiety-related neurological circuits build on themselves. Uncontrollable anxiety causes more frustration, which increases the intensity of anxiety-producing thoughts. Eventually a major part of your emotional life is consumed with dealing with these pathways. If left unchecked, the general progression of anxiety is:
- Appropriate anxiety/ alertness
- Generalized anxiety/ “worrier”
- Mild to moderate anxiety-based reactions
- Panic disorder
- Obsessive-compulsive disorder
- Various forms of schizophrenia
- Manic-depressive disorder
Psychosis can develop independently of the surrounding environment, just as pain is present in phantom limb syndrome, even though the source of pain is gone. Psychotic disorders such as schizophrenia and manic-depressive illness are characterized by thoughts and behaviors that are detached from reality. The basis of these problems is progressive anxiety. Once the anxiety neurological pathways start firing, driven by anger, mental health is increasingly at risk.