Chronic Pain: It’s Not all in Your Head

Have you ever wondered why you can injure one part of your body and have another one hurt? Or maybe your pain tolerance isn’t what it used to be. It isn’t in your head. In the last 10 years, much has been learned about the basic science of pain.

When you twist or injure a local part of your body (we will use an ankle for an example) two things happen: you get pain and swelling. This happens because there are little naked nerve endings in all your connective tissue. That connective tissue (soft tissue) wraps around every muscle, nerve, bone, organ, and vessel. Those microscopic nerve fibers are everywhere in the body.

When you overstretch or crush soft tissue two things happen, you get (1) pain and (2) swelling.

Naked nerve endings are called Nocioceptors or pain fibers. They get triggered when the soft tissue they live in is overstretched or crushed. Overstretching or pinching the connective tissue stimulates the nerve to send a pain message to your brain that it HURTS and to release pro-inflammatory proteins, which bring fluid to the area to make it SWELL. The body creates pain and swelling to stabilize your ankle and to prevent you from using it so it won't get further damaged.

In the best-case scenario, the swelling goes away over the next 72 hours, and healing begins. Simple sprains and strains heal in 2 weeks. In cases of partial tears, it can take 6 to 12 weeks, depending on the complexity.

Now just moving it hurts

If the area was previously injured, or you have an underlying medical condition or you keep reinjuring the area, you are set up for trouble. There is a special type of naked nerve ending that normally sleeps. This pain fiber can spend its whole life living in connective tissue and may never be used. These are called silent naked nerve endings or Silent Nocioceptors. They just sleep in the connective tissue until they are awakened by constant inflammation or reinjury.

Now there are more pain nerve endings, nocioceptors, and silent nocioceptors than you had before the injury. You get pain and swelling from overstretching, crushing, or even just moving the injured area.

The longer the injury is there, the more the nerve sends messages up to the spinal cord and brain that something hurts. Constant messages cause chemical changes at the spinal cord that allow the pain fibers to fire more times per second. This lowers the threshold for pain, making you hurt more intensely with a smaller injury.

I hit my thumb and my ankle hurts

Have you ever wondered why when you have a new injury in your body, you feel pain at an old injury site? Each time one of these pain fibers fires, a message is sent up the spinal cord. Over time, the spinal cord segment related to the original injury gets overwhelmed and becomes more sensitive. This segment can be triggered by any stimulation in your body, even far away (like hitting your thumb). Illness or emotional stress can also activate the spinal cord, causing the original injury to hurt again.

So is it in my head?

Messages traveling up the pain tracts into the brain can change the job of certain cells. This change is reversible if treated early, but if not, it can lead to lower production of neurotransmitters like serotonin and norepinephrine, which can cause chemical depression and anxiety.

Why am I so jumpy when I used to be calm?

Other parts of the brain control the flight or fight response. When you’re in constant pain, your body stays in a heightened state of alert. Even minor stimuli, like loud noises or someone startling you, can make you anxious or jumpy.

So now what?

Chronic pain changes how your body responds to pain, illness, and stress. Treatment must address four levels: local injury, spinal cord, brain, and flight-or-fight response. Using a combination of medications, natural substances, and Osteopathic Manipulation can help calm the nervous system.

Osteopathic physicians specializing in Neuromusculoskeletal Medicine and Osteopathic Manipulative Medicine can help with a personalized approach. They treat not just the bones and soft tissues but also the body’s fluids, nervous system, and energy.

Laura Rampil, DO is Board Certified in Neuromusculoskeletal Medicine and Osteopathic Manipulative Medicine. Her address is: Laura T. Rampil, DO, PA, 1850 Lee Road, Suite 240, Winter Park, FL 32789. For more information call 407-380-7799.