Why chronic pain gets worse over time

Why chronic pain gets worse over time

May 29, 2020 Off By Ravi Mantha

Inside each one of us is something I like to call a homeostatic donkey. Homeostasis refers to the internal equilibrium that we have between all the physical and emotional processes in our body, which lead to stability, wellness, positivity, and a pursuit of a higher calling.

Now think of the many daily stresses in life, which are unavoidable and even necessary. Work, family, relationships, money, any colds or other bouts of illness, traumas like accidents or deaths of loved ones, these are all things that cause stress, which affect homeostasis. Essentially, each of these is like loading a bale of hay on top of the homeostatic donkey. With the proverbial last straw, the donkey collapses, and you now have a state of illness as your equilibrium. In this situation, you tend to blame the last straw or stressor, and say “I lost my job so I fell ill from stress”, or “my dog died and I couldn’t cope”. But what you don’t realize is that all of those bales of straw are together responsible for overloading the donkey, and not just the last one.

The main reason why chronic pain in patients seems to get worse with time is a phenomenon called “central sensitization”, where the central nervous system becomes more and more sensitive the longer the pain goes on. This actually results in more debilitation and more sensitivity to lesser and lesser stimuli. I have treated many patients who have had chronic pain for a long period of time, years, and decades, and they become so sensitive that even ordinary touch causes them pain. This is the very definition of a “software” and not a “hardware” problem because there is no apparent reason why the brain should create this level of sensitivity, other than that there is some kind of amplification effect that occurs in people over time if they do not address and find a cure for their chronic pain condition.

It is easy to theorize that a condition like fibromyalgia could simply be an initial bout of neck pain that gets out of control and creates an amplified effect where debilitating pain is felt in the absence of any actual physical problem. And the problem gets worse. Over time, chronic pain damages the brain and creates trauma that affects many areas of cognition and cognitive abilities. It really is a vicious cycle and one that needs to be broken with great urgency.

What is interesting is that this kind of sensitization happens in some people, but not in others. This is simply because those people have very low homeostatic resilience, compared to those people who get better and recover quickly. If the donkey is pretty much spent and has no reserves left to handle stress, every time there is a stressor you are likely to create another neurological dysfunction. The crucial element in getting better, and not getting worse, is to develop some spare capacity in the homeostatic donkey.

In other words, create a buffer so that you are not running at full capacity all the time in terms of the stress you take on. This is easier said than done of course, but once we realize that it’s the difference between good health and really bad health, we are bound to adjust our priorities and learn to not be in a state of chronic stress overload all the time.
But it is important to understand the latest breakthroughs in neuroscience, which really do offer hope for these conditions. Conventional wisdom still holds that there is physical damage to the nervous system that results from this cycle of chronic pain, but in my clinical experience I find that most of the time it is actually a software issue, and we can reverse and cure this.