Chronic Pain, Part 2: Treating the Nervous System
Wednesday, December 28th, 2016
by Stef Cordes and Lisa Baird
As we said in a previous post, chronic pain is not terribly well understood. But we have learned a great deal in the last decade about how pain works. We know that it’s not the tissues (muscles, joints and ligaments) but the nervous system and brain that are the real sources of pain.
Tissues usually heal in three to six months, but in cases of persistent pain, we need perceive beyond just the muscles, joints and ligaments to get the full picture. Pain that lasts longer than the normal healing period is more likely due to a hyper-sensitive nervous system.
A common, but awful, saying is that “the pain is all in your head.” The saying implies that it’s not real, that you’re making it up to get attention, which isn’t true. Yes, pain is located in your head, within your brain, and it’s very real. How your brain and nervous system process information has a huge impact on how much you hurt, and for how long. At GCA we believe you when you say it hurts, and we can treat you for the pain whether it is due to a current injury, or something more long-term and complex.
The brain produces pain signals when it believes that you need protection from danger. A common way of explaining this is to consider an ankle sprain, bad enough to make you completely unable to bear your own weight. But if you got that sprain while crossing a busy street just as a truck was bearing down on you, you’d be able to run at least a short distance. Your brain would decide that the truck was more dangerous than the ankle sprain. So, tissue injury and pain aren’t necessarily the same thing. You can have one without the other.
The brain produces potent pain medicine. These “happy chemicals” have a calming effect and change the danger messages. In people with chronic pain, as the brain becomes more and more worried about what’s going on, it takes the numbing medicine out of the body, making you more sensitive in order to get you to protect yourself.
Nerves work like an alarm system. Ideally, as soon as the alarm goes off and sends the message, the alarm system will start to return to its resting point. In some people, the nerves that send pain signals to alert you to danger in your tissues settle down very slowly, remaining elevated and “buzzing.” In this case the body’s alarm system has become hyper-sensitive. (This is why medications like Cymbalta, Lyrica or diazepam, which calm your nerves, are sometimes given to people with chronic pain.)
Of course, this doesn’t happen to everyone. Some people get an injury and recover fully. But for others, there are so many stressors around the pain experience that the brain assumes that it needs to keep the alarm systems elevated in order to maintain as much safety as possible. These stressors can include failed medical treatment, unpleasant side effects from medications, financial problems due to lost time at work and/or unemployment, fear and anxiety from confusion around your condition—as well as ongoing pain.
Yes, ongoing pain is a stressor that can keep the alarm system elevated, which is a really unfortunate vicious cycle. Many of us who have experience with chronic pain have noticed that the chronic pain hurts more when we’re tense. If we are able to deeply relax, then it hurts less and we suffer less, even if the pain is still there. This is why so many chronic pain management programs focus on relaxation techniques.
Another deeply unfortunate vicious cycle that we commonly see in patients with chronic pain has to do with sleep. Pain causes insomnia or poor quality of rest, which causes worse pain. Being underslept is a big stressor that will elevate our alarm system.
The good news is that acupuncture is quite effective at interrupting both of these vicious cycles. It is possible to “turn down” a hyper-sensitive nervous system.
For the vast majority of our patients, acupuncture is incredibly relaxing. First-time patients are regularly blown away by how deeply they relax and/or sleep in one of our recliners. The most common side-effects of acupuncture are reduced stress & tension, and a good night’s sleep. Most people are delighted by this but people who have interrupted sleep from persistent pain tend to be especially pleased.
Acupuncture is very effective at shifting our nervous systems from a fight or flight state into the rest and digest state, which is the mode we need to be in for our bodies to repair. We believe that this is why acupuncture can reliably help ease us out of a tense, hyperalert state and into a state of deep relaxation, breaking that terrible vicious cycle of “I hurt, so I’m tense, so I hurt, so I’m tense” and turning the alarm system down, bit by bit.
This is a sophisticated alarm system, remember, so if you’ve been living with persistent pain for quite awhile, the system will probably shift a little bit at a time. Therefore we generally recommend 10-12 treatments at 2-3 treatments per week to start with. Acupuncture is only effective in the right dose; treatments have a cumulative effect, meaning, they build on each other.
If you have questions about how community acupuncture can help you with persistent pain, please get in touch.