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Good article on chronic pain
Just wanted to share a great article on chronic pain. I think this information could be useful for folks that may be dealing with chronic pain resulting from numerous hernia surgeries. Even in the absence of lasting tissue damage and other structural issues, pain can still persist when we’re healed. I’ve spoken with some prominent pain specialists who have suggested that scar tissue should not be a true source of ongoing pain, and nerve damage tends to slowly resolve or lessen over time. The more common culprit of lasting chronic pain in many cases is central sensitization. Basically our nervous system learns to be in pain and can’t forget, even after we heal.
There’s some interesting stuff in here, including this, which suggests that inflammation itself has aspects to it that can help prevent chronic pain, and that suppressing inflammation could in fact do the opposite:
“Another emerging idea is that some immune-system processes that drive sensitization might also be important in driving pain away. Last year, scientists at McGill University published an analysis of gene-expression patterns in people with lower-back pain. Although clinical trials are needed to verify the results, their data indicate that if inflammation is blocked by drugs, neutrophils don’t do what they are supposed to do to resolve pain.
This flies in the face of expectation, says Clifford Woolf, a neuroscientist also at Harvard Medical School — and the first to demonstrate central sensitization. Physicians have long prescribed anti-inflammatory drugs on the premise that if pain is allowed to persist, it might become chronic. “This paper suggests the complete unexpected opposite, which is that the inflammation is actually helping,” Woolf says.”
Anyway, I’ve long thought some of my chronic issues are related to central sensitization. I have the personality for it (obsessive, high anxiety, depressive, etc). I’ve had similar issues related to my back, IBS, and other things. Thought this might help some folks. Pain is complex, and it isn’t always caused by lasting damage.
https://www.nature.com/immersive/d41586-023-00869-6/index.html?lid=8k1rntx8s6a5
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2 Replies
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There could be different causes for the pain in different cases. Nerves don’t always heal, or they may heal poorly (neuroma, etc.) Scar tissue can be persistent and cause pain. The pain centralization you mentioned may play a part as well in some cases, but that’s essentially a type nervous system damage – a domino effect caused by surgical trauma.
Once damage is done, one thing can lead to another in complex ways which vary from case to case. That’s the reason it’s critical to minimize the number of surgeries (zero is best!), and make them the least extensive and least traumatic as possible. Unfortunately, many surgeons aren’t careful enough.
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I also think pain is one of those things that feeds itself. Given neuroplasticity, we can get in a state of chronic pain that is incredibly difficult to get out of and worsens over time. But that same neuroplasticity is a potential road to healing as well.
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