Why do I have Chronic Pain?

Before you read this article you must know and understand that I am not a doctor. You must consult for advice with your doctor regarding your condition. Everything mentioned in the article below is knowledge that I have accumulated from my own personal experiences and books I have read on the topic of chronic pain.

It is normal to feel pain when you’re injured. After some time, the injury heals and pain eventually goes away. But there are times when an individual will experience pain long after the injury has healed. Pain can be recurrent or persistent. In my opinion if your pain lasts longer than 3-6 months you fall under the category of chronic pain which is a disease in itself.

Consult with your doctor first. Make sure you don’t have a fracture, arthritis, rheumatoid arthritis, an infection, tumor or inflammation. It is also common to get chronic pain from bone spurs in your neck or spine pinching on a nerve. I am not a doctor so I don’t know what other conditions to look for exactly depending on your case, but make sure with your doctor that there is nothing physically wrong with your body. Usually when the doctors have exhausted all they could look for they might say some of the things I have mentioned below and this basically means the doctor at this point can’t find anything wrong with you and doesn’t know what else to tell you.

1.You have a soft tissue injury:  Unless you can see a muscle tear or tendinitis on an ultrasound or an MRI, this is hard to believe. The human body can heal a broken bone in 6 weeks; it is bit hard for me to believe that a soft tissue injury or whiplash that occurred 6 months ago has still not healed and causing pain.

2. You have bad posture, try physiotherapy:  I do agree that good posture is important for good health and to minimize wear and tear on your joints and the body in general. But I do not believe that bad posture can cause chronic pain. If that was the case all hunchbacks walking the planet would be in pain all the time and everyone with perfect posture would never have any pain. And we all know that that’s not true.

 3.Your spine is misaligned, try a chiropractor:  This one is also debatable. Some people do see an improvement from getting their backs cracked. In my opinion, if you’re going to a chiropractor, go to one that takes before and after X-rays so that you understand what is actually misaligned and if anything has actually realigned after the adjustments. If your chronic pain disappears after 2-3 months of adjustments, then maybe a misalignment was the root cause of your pain.

 4.Your muscles are tense and tight, try massage: Yes, I agree that trigger points in muscles are a common complaint and cause of pain but my question is why are your muscles chronically tight? If you go for a massage regularly and it keeps your pain at bay, then great. You can also try Trigger Point Injections where a physician injects a local anesthetic such as Lidocaine in the knotted muscles. But if you go for a massage and your muscles tighten up again in less than a month, I don’t think massage is going to work for you long term. And it also means that the root cause of your pain is not tight muscles.

 5.You have ligament laxity: I have heard doctors say that you have lose ligaments and as a result your muscles are overworked. This could explain why your muscles are tight all the time. But my question again is why are my ligaments lax all of a sudden? Were they not lax before I had chronic pain? Unless you just delivered a baby, this doesn’t make sense to me. If you really believe that this could be your issue then injection therapies such as Prolotherapy, PRP or Stem Cell Therapy should be able to fix this. These therapies work by healing and regenerating soft tissue such as ligaments and tendons. Try it and see if it works for you.

6. Rest and stop exercising: This is the worst advice a doctor can give you unless you have an acute injury. If you have had pain for 6 months and a doctor tells you to rest and stop exercise (if you were already exercising) then please get a new doctor. By reducing activity you are only going to make the area weaker and lose muscle mass.

7. You have repetitive strain injury: This one is debatable. If you work in front of a computer all day it is likely that you will have bad posture and you will be using certain muscles repetitively and straining them whereas certain muscles will be inactive and will atrophy. But why would that cause chronic pain? If you’re typing on a keyboard all day you might get repetitive strain injury in your wrist or fingers. My question is then do pianists have the same problem? I don’t know the answer. We walk every day, shower, clean and do dishes everyday straining different muscles repeatedly. We are tired and sometimes achy at the end of the day but after a good night’s sleep we are fresh as new the next morning (most of us).  Does that mean some people heal faster and better than others? Maybe!

What is the root cause of chronic pain? 

Are you one of those people who have tried every modality – physiotherapy, chiropractic, massage, osteopathy, rolfing, hellerwork, acupuncture, prolotherapy etc. and nothing worked? If yes, then you are up against a beast that is not easy to tame. It will require a lot more effort and time on your part in order to get your pain under control or to completely get rid of your pain.

There can be many different reasons why you have chronic pain as listed below:

1. Tension Myoneural Syndrome (TMS)

This term was coined by Dr. John Sarno, the author of Healing Back Pain and a few other books on this subject. He is the pioneer in this field. I would suggest you read his books and some other books from doctors that have taken his work to the next level. Just to name some, Unlearn Your Pain by Dr. Howard Schubiner, Think Away Your Pain by Dr. David Schecter and Back in Control by Dr. David Hanscom.

The concept of TMS is actually pretty simple. You have pain not because there is something physically wrong with the body. Instead the pain is a result of ischemia (inadequate blood supply). Your autonomic nervous system has the ability to execute this phenomenon similar to when you get an adrenaline rush and your heart starts racing when you’re scared or excited. Or when your cheeks turn red and you blush when you’re embarrassed. Dr. Sarno in his book ‘Healing Back Pain’ has gone to the extent of explicitly stating that in most cases abnormalities of the spine as seen in an MRI or X-ray are not the cause of pain. They are just signs of normal aging and are no different than grey hair. So if you’re going for a back surgery please read Dr. Sarno’s books first. Dr. Sarno also explains how people with certain personality traits such as perfectionism, goodism, low self-esteem etc. are more susceptible to having TMS. There is an entire TMS community out there on www.tmswiki.org with tons of information and resources. Check it out.

So why does your body decide to all of a sudden reduce blood supply to your shoulder, back, neck or knee and cause pain? There is science behind it but I am not a doctor so I am going to stay away from the scientific details and explain it more in laymen terms. If you’re interested in the scientific details please refer to Dr. John Sarno’s book, Healing Back Pain as a starting point. Different books explain it in different ways but this is what I have gathered from them:

(i) Repressed emotions in our subconscious such as fear, anxiety and anger can cause pain. According to Dr. Sarno this is just your brain trying to distract you from whatever is going on in your life on a psychological or emotional level. He says that our brain chooses physical pain over emotional pain because physical ailments are more widely accepted in the society as compared to mental or psychological illnesses. These repressed emotions can be a result of a traumatic experience at some point during your life such as childhood abuse, a bad relationship, a terrible boss, emotionally disconnected parents or any other life altering events.

(ii) You are chronically stressed but you’re not aware of it. Stress can be caused due to external or environmental factors such as a rough day at work or it can be internal stress which is your thoughts and emotions causing anxiety about the future or anger about the past. This triggers the fight or flight response as dictated by the autonomic nervous system. Since in our current society we don’t have to fight a saber-tooth tiger or run from a mammoth it is possible that the autonomic nervous system has evolved to give you pain instead by reducing blood supply to an area. Pain is just a signal that your body sends to the brain when it is injured or in other words in danger. Might sound hard to believe but this is no different than the autonomic nervous system pumping more blood and oxygen to the muscles when our ancestors encountered a mammoth so that they can run as fast as possible.

But this is how your body reacts to short term stress or imminent danger. What happens when you’re stressed all the time? You might think I am not stressed all the time but let us look at an average person’s day. You wake up and drive to work in traffic trying to get to work on time. You have deadlines and pressures at work from your boss. You drive home again in rush hour trying to get home in time to take the kids for their extracurricular activities or to get dinner ready in time so that you can watch your favorite TV show after. If this sounds like you then you’re chronically stressed. During a stress response your body sends all the resources to either fight or flee the danger. Digestion can wait, so can healing mechanisms. But these processes can’t wait for a long period of time when you’re chronically stressed and this is the perfect recipe for pain and disease.

2. Neuroplasticity

Many books explain the chronic pain phenomenon from a neuroplasticity perspective. Neuroplasticity is your brain’s ability to change and form new neural pathways throughout your life. For example, once you have learned to ride a bicycle, you can get on it at any point in life and you don’t have to think about how to ride it. It just comes naturally. You can’t unlearn how to ride a bike. Same goes for pain. For some reason, your brain may have formed a neural pathway for pain. Even though there is nothing wrong with the tissue sending pain signals it is stuck in the cycle of sending pain signals to the brain. It is just a faulty neural pathway. The reasons for these pathways could be the same as explained above, stress, anxiety, anger, fear etc. This is common with chronic pain after an injury.

Find this hard to believe? Ever heard of phantom limb pain? It is a common condition in amputees where they feel ongoing pain that seems to be coming from the part of the limb that is no longer there. The pain is real because the nerves are still sending pain signals to the brain and can be seen on an f-MRI. If this interests you, I would recommend reading The Brain that Changes Itself and The Brain’s Way of Healing by Norman Doidge.

3. Low Seretonin Levels

Seretonin is a neurotransmitter that regulates a variety of bodily functions such as mood, sleep, appetite, bowel movements etc. If you are depressed or feel like you are always having a bad day this might be your issue. It is not necessary to be clinically diagnosed with depression to have low serotonin levels. It is very common for physicians to prescribe anti-anxiety and anti-depressants to fibromyalgia patients for the same reason. Discuss this with your physician to see if your mood and pain would benefit from anti-depressant drugs (SSRI’s and SNRI’s in particular) even though you might not be clinically depressed. You can try them for a few months to see if they make a difference in your pain. These drugs do have side effects, so again, consult with your physician.

4. Impaired Healing Mechanisms

Consult with your physician to check for any kind of abnormality in your healing mechanisms. More specifically, testosterone levels (applies to both males and females), cortisol levels, thyroid issues, low immunity or any kind of inflammatory markers in the body. You could even consult a dietitian to ensure that your diet isn’t lacking in any of the ingredients necessary for the body to heal. For example calcium and magnesium are important for both bone and muscle health. Most people know that calcium is required for bone health but it also plays an important role in muscle health.

5. Microbiome/gut issues and systemic inflammation

I got to learn about this from the book Brain Maker by Dr. David Perlmutter. He explains how an imbalance in your gut bacteria can cause a variety of diseases. He talks mostly about mental health issues such as depression, anxiety etc. but he does mention how it can also cause pain. I connected the dots here from Dr. Sarno’s books where he talks about TMS equivalents. According to Dr. Sarno you can have a variety of problems that can fall under the TMS umbrella such as headaches, inflammatory bowel disease, acid reflux, allergies, tendinitis, stomach ulcers and surprisingly depression and anxiety plus many more. In a nutshell, the Brain Maker explains that an imbalance in your gut bacteria can cause a ‘leaky gut’ where inflammatory chemicals such as liposaccharides can pass through the gut lining into our blood stream and cause inflammation in the body. How do you know if you have an unhealthy microbiome? There can be many signs. It becomes easy to tell if you already suffer from gut issues, allergies or food sensitivities. Also, if you have been on antibiotics multiple times in your lifetime or if you were delivered by c-section, it is highly likely that you have an unhealthy microbiome.

The solution is simple. Eat a healthy diet rich in vegetables and fruits and incorporate fermented foods such as sauerkraut, yogurt, kombucha tea, kefir etc. to introduce healthy bacteria in your gut. Also, reduce the intake of refined sugars which is food for bad bacteria.

6. Low Vitamin D levels

This is very common in populations living in Canada and the United States. As we go further away from the equator, Vitamin D levels in the populations living in those regions starts to fall. Few years ago in Canada doctors stopped testing for Vitamin D levels in the blood altogether because it was reasonable to assume that everybody is deficient. Vitamin D is a key vitamin required for the absorption of calcium in the body. My physician here in Canada mentioned to me that even in the summer time we don’t get enough Vitamin D from the sun because we are in the northern hemisphere where the angle at which the suns rays hit your skin is not optimal for vitamin D production. Darker skinned people need longer exposure to the sun to produce optimal levels of Vitamin D. So if you live in Canada or anywhere far up north there is no option but to take Vitamin D supplements. Optimal Vitamin D levels in the blood are essential for preventing any disease in my opinion and especially for bones, joints and mental health.

7. Changes in Social support system/Life Event Changes

I strongly believe that any negative changes in your social support system such as friends, family, major life events etc. can trigger or cause chronic pain or disease in general. Even positive life changes such as marriage, birth of a child, buying a new house etc. can cause stress and pain. If you started to have pain or ill health in general after a major life event then that could be the trigger that started the catastrophe. So think back, think about what was happening in your life when you started experiencing pain? Did you move out of your parents house, did you just get married, did you just get a new job, did you just move to a new city, or are you a new parent?

If you’re thinking what does relationships with friends and family or community have to do with pain, happiness or health? Then I would suggest you look up the Harvard Study of Adult Development. This study started in 1938 and followed 724 men in their teens for over 75 years and the study still continues. The results of the study suggest that it isn’t wealth or fame that keeps us happy and healthy. Instead it is good relationships as well as the quality of those relationships. Conflicts are bad for health. A satisfactory relationship can protect you from the slings and arrows of aging. Robert Waldinger, the director of this Harvard study, presented the results on Ted Talks.

Your pain could be a result of any one or a combination of the seven reasons mentioned above. I hope that this information will help someone suffering from chronic pain to identify the root cause of their pain and treat it appropriately.

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