Why does pain become chronic? I pondered this question daily in my medical practice, where I specialized in chronic pelvic pain in women. Why did one patient, who fell and fractured her coccyx, develop long term disabling pelvic pain, while others with the same injury healed quickly? Why did another suffer from persistent vulvar pain, after a common type of vaginal infection that typically clears completely without residual pain?
Persistent pain is one of the top reasons people visit their doctors. It affects an estimated 100 million
people in the U.S., more than other common chronic illnesses combined, including diabetes, cancer, and heart disease.
A patient member of the Pudendal Neuralgia Association summed up the impact of chronic pain: “Chronic pain can capture the mind so completely that identification with True Self (the Source of life and healing), may be given over to identification with sickness as self. It can be difficult to liberate the pain-mind and ruminating leads to further depression, despair and separation.”
Our healthcare system has been slow to recognize the huge toll that chronic pain is placing on society; in addition to causing physical and emotional suffering, it results in social and economic stresses, as people in pain may be unable to work and find it difficult to maintain their roles in families and relationships.
We are waking up to this problem, and research on treatments, and the reasons that pain becomes chronic, has accelerated. Many potential causes are currently being investigated in the Western medicine perspective, including the following:
- Predisposition to developing chronic pain after an acute injury due to genetic differences
- Disturbances in inflammatory responses, and autoimmune conditions
- Pre-existing anxiety and depression
- Unrecognized nerve injury, that does not heal appropriately
- Age or injury-related structural changes in joints and connective tissues
In addition, much research is now centering on the central nervous system. People with chronic pain are found to have differences in several regions of their brains on imaging scans in comparison to a pain-free brain. This discovery has prompted excitement in Western medicine, as scientists can now “see” something different in these patients, fulfilling Western medicine's desire to find objective evidence of the pain process. Previously, chronic pain was measured mainly by patients’ own self-reports. A benefit for patients of this area of research is that it can validate their pain experience, as many have been distressed when their chronic pain was not taken seriously, or even believed, by some medical professionals.
Since our brains are like the main “processors” of our bodies, sensing, recording and running everything, it is not surprising that a persistent significant stress, such as chronic pain, would show on MRI scans. These scans depict changes in both brain structure (our hardware) and function (our software). Now that we have this technology to peek into the internal activities of our brains, we can scientifically prove what human beings have previously only felt intuitively - chronic pain truly does affect the “brain operating system”, or BOS
, to use the term developed by Ilchi Lee. This means that we now see the connection between chronic pain and how it can often make daily life feel nearly impossible energetically.
The autonomic nervous system, which manages our body’s “automatic” functions, like breathing and digestion so we don't have to consciously control them, is an underappreciated but integral part of our nervous system. Autonomic function has been known for years to be crucial for repair of injured tissue, i.e., the healing process. The proper balance and activity of its two subdivisions, the sympathetic and parasympathetic systems, may play a huge role in whether or not pain after an injury becomes chronic.
Fortunately, there is so much we can do naturally to keep our autonomic nervous system healthy so it can do its job. But unfortunately, many of us continue to hope that medical research will find the quick fix to “cure” chronic pain, rather than focusing on the root causes and solutions that are available to us within our own bodies.
Our current system of medical research, directed from a mainly conventional Western perspective, comes with obstacles. Research in general is expensive, and funding is mostly provided by the pharmaceutical industry, which has a tendency to focus on developing and selling drugs or devices to treat the symptom of pain, rather than the root cause. All medications and surgeries have risks. Sadly, the widespread method to treat chronic pain, opioid pain relievers, has led to a devastating epidemic of addiction and overdose, taking thousands of lives per year.
Alternate funding sources for research into safe, integrative, medical approaches for chronic pain, are the U.S. Department of Defense and the Veterans Administration. Both chronic pain and addiction to opioid pain relievers are huge problems in our military veterans, prompting governmental agencies to research better ways to help. The National Center for Complementary and Integrative Health, a part of the National Institutes of Health, also provides funding for non-pharmaceutical research on chronic diseases.
Chronic pain often results from a vicious cycle, where our physical, emotional, and spiritual reactions to pain beget more pain and suffering. In my own case, through awakenings from the practice of Body and Brain Yoga, I came to understand how my responses to my peripheral neuropathic pain were making it worse. In my next blog, I will discuss in more depth the causes of chronic pain, and integrative medical approaches, including mind-body therapies, to treat it.
Stay tuned, and be well!