Understanding Chronic Pain

Chronic pain has become one of the most debilitating medical conditions that our country deals with in today’s day in age. Every year there are millions of dollars that are sunk into researching and treating Chronic pain, and this is not counting the millions of dollars that are lost in workman’s compensation claims and sick days throughout the year. Our treatment methods have been less than successful, and the “pain-masking approaches” have even began to cause deeper problems of their own such as drug-dependency and addiction. Research compiled by TheGoodBody.com shows that 100 million Americans suffer from Chronic pain, and 1 in every 10 people have experienced pain every day for three months or more. Because chronic pain can have so many different causes such as previous injury or repetitive stress, it can be a very tough condition to understand. To fully understand what Chronic pain is, you must first have groundwork knowledge on your nervous system and how it functions. Before we dive in to the causes of Chronic pain, we will break down the function of the nervous system in three easy to understand steps that are occurring every millisecond throughout your body.

How Your Nervous System Works

1. Sensory Feedback
Our body is riddled with “sensors” that are housed in our nerves endings. These sensors analyze all stimuli from the outside world (touch, taste, smell, vision, sound, balance, temperature, etc.) and reports ALL of that information to the somatosensory cortex, the area of our brain responsible for interpreting sensory stimuli.

2. Processing and Prioritizing
When the stimuli sent from our sensors (nerve endings) reach the brain for processing (the somatosensory cortex), the brain sorts through all of this information and begins to prioritize the stimuli as important (action-worthy) or less important (not action-worthy). A good example of this is being at a concert. At the beginning of the concert you don’t even notice the sensation of your feet standing on the asphalt because your brain is bombarded with stimuli by the extremely loud music. But after two hours of standing you have no idea what song the band just played because your feet are barking! Your brain is constantly sorting through information and weeding out the less important information; and making your mind aware of the important or potentially harmful sensations.

3. Motor Response
After the brain determines if a sensation is action worthy it then sends motor signals back down the nerve pathway that originally reported the sensation to react accordingly.

back to Chronic Pain...

So, what does all this mean? Take into account a repetitive stress type injury. Let’s take a look at your accountant who’s spent the last 15 years of his life slouched over a keyboard. He’s been doing the same daily routine year-after-year for the last 15 years, but all of a sudden last Tuesday “out of nowhere”, he developed this unbearable pain near the base of his neck and into his shoulders. How does this happen?

It’s a concept called Central Sensitization. For forty hours per week over the last 15 years, the nerve-endings (mechanoreceptors) at the base of your accountant’s neck have been sending signals to his brain that sound something like, “Hey man, your posture stinks, let’s fix this!”. But the other stimuli from his office (the computer monitor being too bright, the phone ringing too loud, the room being too cold, etc.) require immediate response and are processed as “action-worthy” and are prioritized by the brain. Therefore, the sensations that are being sent from the sensors in the neck have been classified as low priority and “not-action worthy” by the brain. These signals from the neck are ignored and your accountant continues to slouch.

Fortunately, the receptors in his neck know before he does that if he continues down this path for much longer there are more serious consequences to pay (degenerative changes, disc herniation, pinched nerves, etc.). So, one rainy Tuesday the nerves from the base of his neck decide that their cry for help has been ignored for too long and they’ve had enough. They react by pulling the metaphorical fire-alarm and cranking up the volume of their signal. This forces the brain to see these signals as “action worthy”. This is called up-regulation and it occurs throughout the entire neuro-pathway, from the nerve endings at the base of the neck all the way up to the nerve itself where it finally terminates in the area of somatosensory cortex of the brain. The somatosensory cortex is where the signal is interpreting as pain. Ask your accountant if he noticed how cold his office was or how loud his phone was on that Tuesday. I would confidently bet that he does not remember those details because the brain has now prioritized the up-regulated signal coming from the base of his neck, making the details such as temperature and sound “not-action worthy” and these signals go un-noticed. 

Once a neuro-pathway is up-regulated (or sensitized); it becomes extremely difficult to lower the volume of that pathway. This is where Chronic Pain is born. From this point forward not only are just the postural signals amplified and recognized as pain, but most other nerve-signals are up-regulated and perceived as pain.

There are four main ways that the brain reacts to these types of up-regulated signals:

Chemical Response
The body reacts by releasing pain-inducing chemicals that are designed to alert the person’s mind to seek action. Inflammatory chemicals are also released and are designed to promote healing of the tissue. (More on this in a minute)

Behavioral Response
People stop doing what they are accustomed and love out of fear, which causes them to become more inactive.

Physical Response
The person becomes physically deconditioned, the brain’s way of removing potential aggravating factors and preventing further injury. The patient is no longer physically capable of performing tasks that were once considered normal routine.

Emotional Response
Lastly, there is emotional distress. People who suffer from chronic pain often give up hope on their health and start sinking into this downward spiral of unhealthy behaviors.

By throwing medication at the problem we are not treating the cause of the injury, we are just masking the body’s chemical response to the up-regulation.
— Dr. Jesse Suess

By now, you’re probably starting to understand that the nervous system is the roadway that our brain utilizes to communicate with the rest of our body. This makes our spinal cord an information superhighway. Much like the interstate highway that you’re accustomed to, the spinal cord has several thousands, if not millions, of signals traveling to and from the brain with their own unique destination and purpose. When there is interference on our highways we experience traffic, which hinders our ability to reach our destination and serve our purpose. The same occurs when there is interference in our body’s superhighway, the spinal cord. Because of the direct relationship between the spine and the spinal cord, motion restrictions and other pathologies of the spinal column can cause traffic build-up in the spinal cord which in turn hinders the body’s ability to send signals to and from the brain. We call these “traffic-causing” motion restrictions Spinal Subluxations. These subluxations are not only the pre-cursor to many long-term spinal pathologies, they also impact the body’s ability to transmit important signals such as immune response, motor response, postural feedback, etc.

Where does Chiropractic come in to play in all of this? Chiropractors adjust the spine to remove the spinal subluxation, which reduces pressure on the nerve root and reduces interference, allowing the body to transmit signals to and from the brain more efficiently and more clearly.

I challenge you to think outside of the box on this last question. When do you think would be the right time for your accountant to present to his doctor? Because of the current state of healthcare in our country most people will answer, “When he begins feeling pain.” But as we just learned, by the time the pain has kicked in the neuro-pathway has already been up-regulated, the preverbal fire has already started. By throwing medication at the problem we are not treating the cause of the injury, we are just masking the body’s chemical response to the up-regulation. Your body surely doesn’t have an Advil deficiency that’s causing your pain. Also, pain is often the last symptom to present itself in any condition, and also usually the first symptom to leave. What if I suggested to you that your accountant should have seen his doctor years before he felt any pain in order to PREVENT this type of chronic pain down the road. What if we as a nation took more of a proactive approach to our health, rather than the reactive approach that we have become so accustomed to? In my opinion, we would be a lot healthier of a country with astronomically reduced healthcare costs. What do you think?

Here are some signs and signals from your body other than pain that may suggest you need preventative treatment:

  • A constant need to try and "crack" your neck or spine while in a seated position.
  • Tension throughout your spine and neck that tends to come and go.
  • A progressive achy type pain that is most notable at the end of your work day or in the morning upon waking.
  • FInding it more difficult to carry out physical tasks that were once considered to be ordinary (certain work-outs, job related actions, activities of daily living, etc.)

If you are experiencing any of the above symptoms I strongly recommend that you get in touch with a Chiropractor.

I hope you found this article informative and helpful. Please do not hesitate to contact me with any questions about the article, about chronic pain, or any other healthcare related questions that I may be able to help you with. 



Yours in Good Health,

Dr. Jesse J. Suess, D.C.
Suess Family Chiropractic, LLC
22 Wyckoff Ave., Suite 1
Waldwick, NJ 07463