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The Psychobiology of Chronic Pain

Chronic pain is one of the most common conditions in the United States, with an estimated 25% of the total adult population experiencing it. That means more Americans are affected by it than heart disease, diabetes, and cancer combined. It can be seriously debilitating and challenging to live with, whether it occurs in the joints, back, neck, head, or anywhere else in the body. 

To make matters worse, the source of chronic pain, as well as the best course of treatment, can be somewhat ambiguous, with numerous psychological and physiological elements often acting as contributing factors. Keep reading to learn more about chronic pain, where it comes from, and what treatment options are available to alleviate symptoms.

Symptoms of Chronic Pain 

Chronic pain is defined as any pain lasting more than three months. It can be further broken down into two categories: nociceptive and neuropathic. Nociceptive chronic pain results from tissue damage, such as that caused by arthritis or surgery. Neuropathic chronic pain, on the other hand, occurs when there is damage to the nervous system itself.

Chronic pain can happen anywhere in the body and can either come and go or persist constantly. The most common types of chronic pain include:

  • Arthritis
  • Neck pain
  • Back Pain
  • General muscle pain (such as the pain caused by fibromyalgia)
  • Headaches and migraines

The pain itself can also manifest in different sensations. Commonly reported pain includes:

  • Aching
  • Shooting pain
  • Stiffness
  • Stinging sensations
  • Throbbing pain
  • Burning pain

Chronic pain can come from many different sources, so treatment methods and rate of success can vary greatly between cases.

The Mental Effects of Chronic Pain

More often than not, chronic pain takes a toll on the mind just as heavily as on the body. Prolonged stress and discomfort caused by chronic pain can cause several psychological reactions in people, including:

  • Depression
  • Anxiety 
  • Fatigue
  • Mood swings
  • Insomnia 

These emotional effects can be linked to how your pain manifests and how you feel about your pain. For example, you may experience mood swings of anger or sadness during flare-ups in your pain, or you may develop anxiety and fear around the pain getting worse. 

Additionally, these psychological effects can actually make the pain worse. Anxiety is linked to its own types of pain, such as stress headaches, chest tightness, and prolonged muscle tension. Some of these symptoms can easily exacerbate existing pain. Similarly, lack of sleep and insomnia can give your body less time to repair and regenerate overnight, leading to inflammation that makes the pain worse. 

Sources of Chronic Pain

Unfortunately for those searching for an easy answer, the sources of chronic pain are as numerous and variable as the manifestations of the pain. Some familiar sources are:

  • Long-lasting diseases, like cancer or arthritis
  • Acute injuries that cause lasting changes or sensitivity to pain, such as a broken bone or an infection
  • Degenerative changes from aging
  • Activities and conditions that cause long-term strain on certain body parts, like being overweight or repeated heavy lifting with improper form
  • Simple, everyday wear and tear, like years of improper posture or sleeping on a bad mattress

In many cases, chronic pain doesn’t have just one source. It can come from a variety of the above factors as well as others that haven’t been mentioned.

The Mind-Body Connection of Chronic Pain

Chronic pain can also have no immediate physical cause. Physicians call this type of pain psychogenic or psychosomatic. This means the pain comes from somewhere in the mind and may be linked to factors like prolonged anxiety, stress, or depression. 

Psychosomatic pain can also happen in conjunction with physical pain, or begin occurring after an initial pain-triggering event, such as an injury or disease onset. 

More Complex Than “All In Your Head”

For sufferers of psychosomatic pain, getting a proper diagnosis and treatment can be challenging. When no physical cause is determined, doctors may dismiss the pain as being imagined and recommend solutions such as trying mindfulness or taking psychiatric medication. While these solutions may sometimes help, the reality is that the source of the pain can be far more complex than simply being “all in your head.”

How Psychosomatic Pain Happens

Pain stems from signals from the nervous system telling the brain that something is wrong. These signals are transmitted through neurotransmitters, which are chemicals that relay messages between cells. When we experience pain, our nervous system sends a message to our brain about something being wrong. 

However, the body isn’t perfect, and sometimes these messages can get mixed up. If the nervous system becomes hypersensitive from chronic stress or anxiety, even small things can trigger pain responses. 

Additionally, when we experience trauma or an injury, the pain signals can get “stuck” on repeat even after the injury heals, sending the message to our brain that something is wrong even when it’s not. This phenomenon is known as “pain memory.”

Finally, the nervous system can simply get confused between mental and physical pain. When someone suffers from anxiety, depression, bipolar disorder, or stress, receptors in the body may accidentally interpret mental distress as physical distress and send pain signals to a certain part of the body as a response.

Inflammation

Another major factor to both physical and mental conditions is inflammation. Inflammation is a complex, biological response to infection, injury, or stress that’s meant to protect and heal the body. Since inflammation causes general irritation, it is linked to a myriad of health problems, including chronic pain.

When someone experiences chronic stress or anxiety, they often also experience chronic, low-grade inflammation. This can make existing pain in the body worse and contribute to the development of new pain. 

Treating Chronic Pain

While chronic pain may have a variety of causes, in most people, it stems from a mix of physical and psychosomatic elements. This can make treatment difficult, and often, the best course of action is to combine lifestyle changes with medications and other medical treatments. Some standard treatment methods are:

  • Over-the-counter painkillers such as ibuprofen or aspirin
  • Prescribed painkillers like opioids
  • Acupuncture
  • Trigger point injections
  • Exercise and physical therapy
  • Bioelectric therapy

For those who have tried multiple treatments and still haven’t found relief, alternative treatments may offer some hope. Ketamine has been shown to decrease chronic pain symptoms in 75% of patients after just one dose. It does this by blocking the activation of a neurotransmitter related to pain, glutamate, which allows the effects of chronic pain to be muted. It also may encourage the brain to reset and restore nerve connections that interfere with normal pain responses.

To learn more about how you can receive ketamine treatments to relieve chronic pain, visit Thrive Center for Health’s website.

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