Why do some people experience chronic pain and others have complete resolution of that pain? One in six Australians suffer from chronic pain and there are a number of factors which can predispose you to experience that condition. Chronic pain is defined as pain that continues for more than 12 weeks after the initial trauma or injury.

First up the concept of pain is more complex than originally thought. When you experience an injury the tissue that is damaged sends a series of signals through nerves to the brain. The brain then decides how to interpret that signal. It usually regards it as pain initially and then over time as the tissue heals the signal decreases and the brain usually acknowledges the signal as reduced pain. There can be times however in the presence of high levels of stress or anxiety that the signal to the brain is not adjusted as the tissue heals, this is what can happen with chronic pain.

The brain also interprets those signals through a filter of previous experiences and emotions, factors which may lead to an increased risk of chronic pain being experienced.

For many people testing or scans may no longer reveal the presence of an injury but they are still experiencing pain. This may lead to the feedback from practitioners that the sensation is not real, however it is real and the patient is still experiencing that sensation.

So what are the major risk factors for developing chronic pain (1);

• Based on the earlier description you can probably guess that one of the major risk factors for chronic pain is a prior experience of chronic pain. That’s right the brain in filtering this information “remembers” a prior experience and this can increase your risk for developing chronic pain.
• Two other significant contributors can be related to your workplace. Being in an environment where the injury is subject to compensation or being in an environment where your relationship with your boss is strained both lead to a higher risk of chronic pain. To a certain extent this relates to the elevated cortisol you produce when you are in a stressful situation which then leads to a reduction in the ability to modulate or reduce pain signals in the brain. When your nervous system is in overdrive you are less able to calm the signals.
• There are gender differences in the experience of pain and responses to pain management. Women are more likely to express more sensitivity to pain and less likely to respond to conventional treatment. (2) In a 2007 review of pain research 79% of studies had been conducted solely in male animals and only 8% in female animals. Further women are more likely to experience chronic pain conditions than men.
• Significant distress during the initial phase of the injury and high levels of anxiety in relation to the injury both predispose you to developing a chronic pain condition.
• History of domestic violence or abuse increased the odds ratio of pain to 1.6. The data was based on a three year population study of over 24,000 women (3).

For those people who experience chronic pain it needs to be treated with a holistic approach that looks at physical, psychological and social factors. Whilst manual therapies for example can be of assistance in treating acute pain and assist in managing symptoms, graded exercise therapy provides more significant benefit in most of the research done to date. Combining this with appropriate counselling or stress management as well improves the overall resolution. Effectively this condition requires a team approach.

It also is clear that a lot more research is needed on the type of pain and what the best approach is in regards to it. Much of the research is 10-15 years old and often limited to common conditions like low back pain. For this reason you may find that you get more relief from a particular treatment than indicated as more commonly treatments like remedial massage are researched but there are very few studies on other forms of manual therapy such as lymphatic massage, myofascial release and Bowen therapy.

If you are suffering from aches and pains and would like to understand more about how to support yourself then this free webinar on my site could be really helpful, 6 Tips for Ageing Outrageously .

References

(1) Mills SEE, Nicolson KP, Smith BH. Chronic pain: a review of its epidemiology and associated factors in population-based studies. Br J Anaesth. 2019 Aug;123(2):e273-e283. doi: 10.1016/j.bja.2019.03.023. Epub 2019 May 10. PMID: 31079836; PMCID: PMC6676152.

(2) reenspan JD, Craft RM, LeResche L, Arendt-Nielsen L, Berkley KJ, Fillingim RB, Gold MS, Holdcroft A, Lautenbacher S, Mayer EA, Mogil JS, Murphy AZ, Traub RJ; Consensus Working Group of the Sex, Gender, and Pain SIG of the IASP. Studying sex and gender differences in pain and analgesia: a consensus report. Pain. 2007 Nov;132 Suppl 1(Suppl 1):S26-S45. doi: 10.1016/j.pain.2007.10.014. Epub 2007 Oct 25. PMID: 17964077; PMCID: PMC2823483.

(3) M Ellsberg, H Jansen, L Heise, et al. Intimate partner violence and women’s physical and mental health in the WHO multi-country study on women’s health and domestic violence: an observational study Lancet, 371 (2008), pp. 1165-1172