4 – The “Modifiers”

posted in: Stage 1, Stage 1: Step 1

There is a sequence of events that results in chronic pain. It is complex and not linear. The first step is to acknowledge a source that can originate from soft tissues, a structural abnormality, or the brain can “short circuit” and spontaneously generate pain. It is also critical to understand that chronic pain is a disease of the brain, and regardless of where the pain starts, it becomes embedded and memorized.

With ongoing exposure to pain impulses, your brain adapts quickly and becomes sensitized. This results a dramatic increase in pain without additional trauma.

Then over a short period of time the pain is memorized and this is a permanent situation. A comparable process would be that of learning to ride a bicycle. Your skills may drop but you’ll always know how to ride it.

This sequence is intertwined with another series of events we’ll call the “modifiers.” The modifiers are the sum of the emotional responses to the chronic pain. Patients often become anxious, frustrated and angry; they lose sleep as their stress level rises.

Pain “modifiers” are important to understand because stress altars your body chemistry. Your stress hormones, including histamines, cytokines, cortisol, and adrenaline, become elevated. Adrenaline is the “fight or flight” hormone; when secreted, it causes your heart to race, your blood pressure to go up, and you experience anxiety. Cortisol has more of a chronic effect by mobilizing energy stores and increasing your baseline metabolism.



Sleep is a major issue having an effect on almost every physical function in your body. It is linked that high levels of stress chemicals inhibit sleep and lack of sleep affects these same chemicals.

As a result, several things happen. Your pain receptors and nervous system now exist in a different chemical environment, even if there’s no physical affliction. What is the ultimate result? Your senses are heightened and you may experience even more pain. Your decision-making skills are also affected. That’s why it’s so crucial to address these issues before deciding whether to proceed with surgery.

The “modifiers” that we’ll discuss are sleep, anxiety, and anger.