Most of us have experienced this – persistent pain that different specialists can’t easily explain. They give us opposing diagnoses and ultimately do not know how to help us. Then they hurriedly prescribe painkillers or intrusive interventions that only make the pain come back worse. So is there a simple explanation of chronic pain?
How we experience pain
Dr Abdul-Ghaaliq Lalkhen has been studying pain and working in pain management for over two decades.
“Most people believe that the pain they have will be proportional to the tissue damage.”, says he and explains that there are only really three ways you can injure the body – mechanically, chemically and thermally. “Mechanically – be shot or stabbed or bump your toe. Chemically with acid or an alkali. And thermally either extremes of heat or cold. When the integrity of the body is damaged, the brain needs to know about it.”
When we are hurt, the damaged tissue releases inflammatory mediators, a sort of a chemical soup. They then attach to what are called nociceptors (pain receptors) which convert that mechanical, chemical or thermal signal into an electrical signal. The signal is transmitted, first to the spinal cord, and then a bit like fireworks, to the brain via various pathways, explains Dr Lalkhen.
The spinal cord and the brain are not passive in receiving that information – they analyse it. The signal goes to our amygdala, which is a primitive emotional aspect of the brain. It also goes to a part of the brain that
deals with location. There’s a part that checks if we have experienced this before. That means that how we experience pain depends a lot on the circumstances, the environment, our emotional state, our expectations and beliefs. You can watch a neuroscientist talking more about this here. Pain is not proportional to tissue injury. It has context., concludes Dr Lalkhen.
A simple explanation of chronic pain
When there is damage to the body, there is acute pain – the alarm system of the body. Then over time the wound heals, the inflammatory mediators go away and the system to its default quiet setting.
Chronic pain is pain which persists in the absence of ongoing tissue
damage. Occasionally, despite the healing of the damaged tissues, the alarm system of the body becomes dysfunctional.
“I always tell people, explains Dr Lalkhen, it’s a bit like a car alarm. Acute pain is somebody bashes into your car, the alarm goes off, you go out, you chase them away, you get the car fixed and the alarm switches off. But
sometime after that, or after that incident, now the alarm seems to go off whenever it wants to. You go outside, you keep checking the car, which is like having the repeated MRI scan and the repeated investigation and going to your doctor. But actually, the problem is in the alarm, the wiring is now being permanently affected and so the alarm goes off and it hasn’t got anything to do with your spark plugs or the fray tires.”
The vintage car
“And I always say to the patients, continues Dr Abdul-Ghaaliq Lalkhen, than vintage cars require more maintenance. But we have this weird thing where we get to a certain age and we retire from exercise. We go, well, we’ve done enough in our lives. And we don’t look after our mental health as well.”
“We need to be educating people that looking after your physical body and looking after your mental health is a lifelong journey. And if we did that, we would be able to prevent some of the lifestyle diseases, rather than trying to patch people up when they’re already broken.”
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