Chronic pain is a pain that has persisted beyond the normal anticipated duration of recovery. For example, a broken bone or back strain is expected to recover within 6-8 weeks, but if you are still hurting and are unable to function “normally” 6 months later, it has become chronic pain.
But “delayed recovery” is not the only definition of chronic pain.
Here, it is not just about “the injury” any more. In chronic pain, the person who has become injured becomes an important factor.
“Who you are” plays a role here.
“Who you are” is defined by your personality, your life, your relationships and your job; it is the totality of who you are.
Each of us is a unique individual, based on our life experiences, our childhood, our parenting, our attitudes and beliefs as well as our ethnic and cultural background.
Thus, each person responds differently to pain and has different coping styles. This plays a role in development, perception and perpetuation of chronic pain.
So, simply put, if you are a happy optimistic person who is content with your current life, you are better able to deal with pain and the body heals more efficiently, but if you have many stressful situations in your life dragging you down, then the body’s healing ability slows down leading to and perpetuating chronic pain.
Chronic pain is impacted by your ability to handle and cope with pain. Has pain taken over your life or are you in control of your pain?
Factors that can put you at risk for developing chronic pain are:
Past experience of pain
Certain ethnic and cultural factors
Some people are just more sensitive to pain, have less pain tolerance
Secondary gain (getting rewarded for illness behavior)
History of difficult childhood
Substance abuse history
These factors can become barriers to recovery. They do not necessarily mean that a person will develop chronic pain. But physicians need to be aware that they may be present in their injured patients, especially if their patients are not responding to treatment. If present, these issues need to be addressed sooner rather than later.
This is called the BIO-PSYCHO-SOCIAL MODEL OF CHRONIC PAIN.
Chronic pain here is not a symptom of an injury, but has become a disease in itself.
Your acute injury may have involved your neck or low back or knee, but by the time it develops into chronic pain, the location of injury does not matter any more. Chronic pain behaves the same, no matter what part of the body is involved.
In fact, in many of these cases the tissue damage at the site of injury has already healed, but the brain continues to perceive pain impulses. Thus it has become a disease of the nervous system. That does not mean that the pain is “in your head.” It is real pain; but the treatment approach is different.
Multiple areas of the brain are now participating together in the experience of pain. Pain triggers past memories in the brain and this impacts how our psyche interacts with situations in our life to create our own individual and unique pain experience. How the brain integrates all this information has to be taken into account to understand and treat chronic pain.
You can see now that it is not about determining who is to blame for chronic pain, but about understanding pain so we can then manage it skillfully.