How big of a problem is Chronic Pain?

 

How big a problem is chronic pain?

Chronic pain has been linked to numerous physical and mental conditions, and contributes to high health care costs and lost productivity. (1)

Chronic pain, one of the most common reasons adults seek medical care. (2)

It is estimated that between at least 20% and in some sub-groups 40% of people are experiencing chronic pain at any given time.

This is linked to:
 - restrictions in mobility and daily activities (3,4),
 - dependence on opioids (5),
 - anxiety and depression (3),
 - and poor perceived health or reduced quality of life 

Chronic pain is a huge problem. In the USA alone chronic pain contributes to an estimated $560 billion each year in direct medical costs, lost productivity, and disability programs.

Despite an abundance of pain killers on the market, and a wide variety of physical therapies, chronic pain continues to be the experience for hundreds of millions of people. Plus, it's incidence is on the rise. (6)

Is there any good news?

The good news is that our scientific understanding of pain has evolved in the last few decades. And this is leading to new solutions.

For years, experts erroneously believed that pain was a purely biomedical phenomenon – a 'physical' problem.

Many people and some clinical professionals still think of their own pain in these terms.

This is illustrated with the references they may make to 'their back', or 'their fibromyalgia.'

It is illustrated with the language used to describe conditions such as 'crushed discs', 'trapped nerves' and things being 'worn out.'

A physical problem pertains purely to biological processes, such as tissue damage, genetics and system dysfunction alone.

Pain has therefore, until quite recently, been primarily treated with biomedical solutions, like medications such as pain killers, and physical manipulation.

This often leads to excessive investigations, a search for a physical cause, which may find, and unnecessarily treat things, which are actually incidental.

However, in the light of modern scientific research, the game has changed. Two ideas in particular have made a huge difference.

The 'bio-psycho-social' model

The first update to the traditional view is that pain is never purely physical.

It should not be explained only with reference to the biomedical model. (7, 8)

Instead the updated model is 'biopsychosocial' in nature.

As the term implies pain has three elements, rather than one.

 - Biological - tissue damage, genetics, system dysfunction.
 - Psychological - perceptions, thoughts, emotions, beliefs, coping behaviours.
 - Sociological - socioeconomic status, care and support, environment.

All three domains play their part in the creation, maintenance and reduction of pain.

Purely biomedical solutions like pain killers and physical manipulation, that fail to address the psychosocial factors miss two-thirds of the chronic pain problem.

Once we are aware that psychological and social factors play a part, we can begin to address them.

Pain as output of the brain

The other major reframe that has occurred in our understanding, is that pain is now seen as an output from the brain, rather than simply as an input from the body.

Yes, the brain receives signals from the nervous system, and in it's wisdom, if it gauges these signals to signify a threat, then it produces pain.

It produces pain, because it is a protector. It is trying to preserve you.

Again, this is useful when the threat is genuine, especially in the acute phase.

It is problematic, when the danger has gone, healing has begun, but the brain is still perceiving a threat. 

The more of a threat the brain perceives, the more the pain signal is amplified.

When the threat decreases so does the pain.

Think of this mechanism like a “pain dial” in our central nervous system. (9)

When the pain signal is amplified, our sensory information increases and we typically go into freeze, flight or fight mode. Usually with pain, with no real need to run, our instinctive response is to freeze.

We brace ourselves. This creates tension in the muscles. It generates anxiety and fear.

We then experience a rise in adrenaline and cortisol.

Cortisol is an essential hormone for survival after injury. It produces and maintains high levels of glucose, for rapid response after injury, threat or other emergency.

However, cortisol production has a downside. It is potentially a highly destructive substance because, to ensure a high level of glucose, it breaks down the protein in muscle and inhibits the ongoing replacement of calcium in bone.

If the output of cortisol is prolonged or excessive, it may produce destruction of muscle, bone and neural tissue and produce the conditions for many kinds of chronic pain. Furthermore, it suppresses the immune system. (10)

To reverse this, we need to understand why the brain is getting continuing to the idea that the body is under threat and to change that message. Hypnotherapy provides a variety of tools to do this. The Arrow Technique developed by Freddy Jacquin is an excellent choice.

Help yourself. Download The Painkillr App

You can experience The Arrow Technique for yourself by downloading the Painkillr App and using it to reduce or eliminate your chronic physical or emotional pain.

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