What Causes Chronic Pain?

Pain Theory
Pain Pathways
What Causes Chronic Pain (This Page)

The usual idea about what causes chronic pain is that something is damaged or diseased and that this causes pain proportional to the severity of the damage. On this view chronic pain treatment requires that we first find the injury or disease that is causing the pain. This is the mechanistic view of pain.

The mechanistic view is often completely correct. If you have a broken leg it is quite clear where the pain is coming from and what has caused it. If you have arthritis or a slipped disk or shingles, again you know where the pain originates and what causes it.

But what if you have a pain that no one can fathom? If no damage or injury can be found even on the most sophisticated tests? If even opening you up on the operating table has failed to find any source of the pain? This is frequently the case with chronic pain.

If you hold the mechanistic view, and let's face it most of us do, you are likely to feel frustrated and angry about the failure to discover what is causing your chronic pain. You may be angry with the doctors, and you may have shopped around for help from various quarters including on the internet.

Did you ever see that episode of "House" where a person with an undiagnosed pain holds House and his team at gunpoint refusing to free them until they find out what is causing his pain? Anyone in this position would hve enjoyed that episode and had some sympathy for the gunman!

Your Brain Can Cause Chronic Pain!

pain pathways Although the mechanistic view of pain is often right, or partially right, it isn't the whole truth about what causes chronic pain.

Pain perception varies both between people and between circumstances. For example it has been shown that soldiers with war wounds feel less pain than a civilian with comparable injuries. Pain theory says that this is because for the soldier a wound means a discharge home and an end to being in danger, whereas for a civilians it means anxiety, fear and possibly even the loss of a job.

What causes the pain in such a case is what the injured person feels about it. The patients aren't causing their pain but their feelings about having the injury are influencing how bad it feels.

Another example of how the mind can cause pain without an injury is phantom limb pain. This happens when someone has had a limb amputated because of a painful disease or an injury to it but the pain in the “limb” continues unabated after the injured part has been removed. This pain is caused by the brain not recognizing that the injury has gone. It shows that pain is created in and by by the brain and that the brain can sometimes get things badly wrong.

If you sufferer from chronic pain you will have noticed that when your mind or body is fully occupied with something other than your symptoms, your pain is not so bothersome. Isn’t it so that at these times you feel it much less, or perhaps you just don’t notice it at all? What do you think causes this lessening of pain in these circumstances? It must be your brain.

If pain was caused only by a physical condition or injury none these things would happen. The pain would be constant. The fact is that the process of pain perception isn’t a straightforward one of cause and effect.

Chronic pain can exist even when there is no obvious cause

chronic pain causes The mechanistic view of pain is too simplistic. Because we see it in a mechanistic way many people with chronic pain, whose diagnostic tests are negative, are sure that something has been missed. They spend their time searching for a treatment or investigation that will find the cause and fix them.

They frequently become angry with their doctors and may go from doctor to doctor seeking help. Desperate to find the cause of their chronic pain and to find a treatment that they are certain will cure it. They will try anything that gives even a glimmer of hope.

This mechanistic view is the reason so many people with chronic pain undergo endless tests and sometimes endure unnecessary, surgery. The anger and depression that ensues makes the pain feel worse.

You might even have done, or still are doing, some or all of this yourself, I did. Its natural to feel this way because it fits in with our past experiences of pain.

But it is that it is only when we stop being angry and begin to look for things that we can do to help ourselves, that we begin to manage or even heal our chronic pain.

Pain is now believed to be a complex process influenced by many factors including emotions and thoughts. This is not bad news!

It means that we have an opportunity to make a difference to its severity by working on our thoughts and emotions. We can do this whether the pain is brought about by a known injury or disease or an unknown one.

This is absolutely not the same as saying it is all in your head, meaning imaginary, or in other words “you are crazy” The body works as a whole and the brain is a part of that whole. The brain is the power house for all bodily processes.

There is nothing that you see, hear, smell, touch or think that is not brought to your attention solely by the brain. That includes pain. Your brain tells you about pain and you feel it. The cause of chronic pain is really and truly your brain. Therefore you can influence it and this is very good news!

Resources Chronic Pain

Train Your Mind Change Your Brain by Sharon Begley “It is very seldom that a science in its infancy is so skillfully unpacked that it reads like a detective novel. The fact that this science includes collaborative efforts of neuroscientists, psychologists, contemplatives, philosophers, and the full engagement of the genius of the Dalai Lama is not only fascinating, but uplifting and inspiring. This book lets you know that how you pay attention to your experience can change your entire way of being.” --Jon Kabat-Zinn, author of Coming to Our Senses

Managing Chronic Pain Workbook This is the workbook that goes with the Managing Chronic Pain guide above. You can buy both of these together.
Cognitive Therapy for Chronic Pain: A Step-by-Step Guide "You'll just have to learn to live with it." That's what many patients hear when there is nothing else that can be medically done to alleviate their pain. But how is a patient supposed to learn to "live with it?" Where this statement leaves off, Dr. Thorn's book begins. Cognitive Therapy for Chronic Pain book is a monumental work on the topic of how pain and suffering are influenced, for better or for worse, by a patient's belief system. Beyond this, this book does an extraordinary job of taking current scientific theory and research about the nature of pain, and distilling from that concrete advice for both clinicians and their patients... ...Dr. Thorn's book is eminently practical. Cognitive Therapy for Chronic Pain walks the reader through the types of the beliefs that influence pain, how to assess them, therapeutic strategies, and homework assignment for the patients. Dr. Thorn's approach is at the same time sympathetic to the plight of patients with pain, while still offering hope. While never judgmental, she still challenges patients to identify ineffective coping strategies, and to learn better ones. Although this book is written as a guide for clinicians who treat pain, this book can also be a useful self-help guide for a motivated patient with pain. (from a reviewer) Cognitive Therapy for Chronic Pain: A Step-by-Step Guide