You’ve been having pain for years and it just doesn’t seem to go away, no matter what you do. You finally go see your doctor and imaging results show everything is normal… WHAT?!? Your doctor’s diagnosis is simply, “It must be in your head!” The last thing you want to hear is that your pain is in your head; it makes you wonder if you are making up the symptoms and negates what you are truly feeling. However, scientifically speaking, all pain is actually felt in your brain and not in the injured body part. It is commonly believed that the amount of tissue damage should dictate the amount of pain experienced. Furthermore, once the tissue is healed, the pain should disappear. Unfortunately, it is not that simple, and it is possible that once the body has healed, that some people will continue to have pain.

How do you feel pain?

Pain begins with an injury that activates pain receptors called nociceptors. These receptors send a message up your spinal cord to an area in your brain called the thalamus. From the thalamus different areas of the brain are activated to help understand the pain. How you eventually perceive the pain will be based on your emotions at the time, the memory of having a similar pain and your attitude and behaviour following the painful experience. Because so many different aspects of the brain are involved, no two people will experience pain in the same way following the exact same injury. Furthermore, people will vary on time of recovery above and beyond the normal physiological healing time of the tissue.

How does chronic pain develop?

Chronic pain lasts longer than 3 months, and well after the injury should have healed. It is still not fully understood as to why some people continue to have long-standing pain. However, research has demonstrated that individuals with chronic pain have differences in brain activity that could be causing their long-term symptoms. More specifically, it has been shown that individuals who attach strong emotional reactions to the initial injury and over-monitor their symptoms afterwards can amplify the experience of pain. This may cause the brain to become more sensitive, so that even non-painful stimulus can be perceived as painful. For example, if you get into a minor fender bender on the way home from winning the lottery, you will likely attribute less negative emotions to the accident versus coming home from losing your job and getting into the same accident. If you are already in a negative state of mind at the time of accident, you will attribute more negative feelings around the accident, which may create a stronger emotional connection, and likely cause you more anxiety and distress. Studies have shown that anger, anxiety, depression and fear are all related to increased pain and symptoms following an injury.

Can chronic pain be prevented?