Chronic or Persistent Pain

When pain persists beyond 3 months it is not generally considered to be caused by tissue damage anymore. In this situation, the brain acts as a faulty over-sensitive alarm system and produces pain sensations even though the injury is healed.  A small innocuous movement, for example, is interpreted as dangerous by the brain, so it produces pain as a warning signal and muscle contraction for protection.   When the brain becomes sensitive like this, it is also influenced by negative thoughts and emotions such as fear, which can increase the symptoms further.  This can also be called ‘neural-pathway induced pain’, neuroplastic pain, Tension Myositis Syndrome (TMS), or ’psychophysiological disorder’ (PPD).  This is all confusing, but they all refer to the same thing – an oversensitive pain system.

‘Pain is not providing a measure of the condition of your tissues but it is providing a measure of your brain’s evaluation of your need to protect your tissues’. Dr L Moseley

Chronic or persistent pain

Persistent symptoms for over 12 weeks after an acute episode or gradually building up

Symptoms shift from one area to another, or may be bilateral

May be other stress-related illnesses eg IBS

Onset and symptoms correlate with stressful events or situations

Examinations such as scans or x rays may not identify any damage

Structural diagnosis after physical examination is uncertain

Not usually associated with inflammation (though swelling can still occur)

May not respond to traditional treatment

A Typical Example

You will often have heard people say something like “3 months ago I was bending down to pick up a piece of paper and my back went!”

This is an innocuous event – and hardly the cause of any tissue damage, so why is there so much pain? Clearly, there is more to the story, and when the history is explored, it might emerge that there was a car accident perhaps 15 years previously.  This may have led  to some pain which although the body had resolved as best it could, but which had left a ‘body-memory’ of the pain, a prior pain ‘‘neural pathway’.  This perhaps combined with some unaddressed emotional trauma around the accident could have made the pain system vulnerable to triggering a future episode. So combined with a current emotional stress or even physical postural strain,  the body is overwhelmed and a small incident becomes the last straw – “the straw that breaks the camel’s back.”.

Here are 2 videos which explain this in more detail: