If you are one of the unfortunate people who experience pain longer than a couple of months, your brain has changed. In addition to your soft tissue injury or structural problem—your pain has evolved into a neurological problem.

How did this happen? When the nervous system is barraged day after day with pain impulses, many changes occur within the brain itself.  The brain sends out signals that alter the body’s chemistry. The brain and the pathways to the brain become sensitized to these pain signals. Eventually, the central nervous system “memorizes” the pain. If  you have chronic pain, this is what has happened to your brain.

This phenomenon is not a “psychological” problem as much as it is “programming” problem. Repetitive impulses to the brain in the form of negative thinking or pain will create neurological “circuits” that will take on a life of their own.

The final phase in the development of chronic pain is that the “modifiers” come into play.  After a period of time, sleep is commonly disrupted, and you become more anxious and frustrated.  These factors not only add to your misery, they change your body chemistry and you actually feel the pain more.  This whole sequence must be addressed to successfully improve the quality of your life.

Read a related story here.

BF

I was treating Gordon, a 32 year old patient. He had been in constant low back pain for over four years after being rear-ended in a car accident. He had undergone two laminectomies before he saw me. Both were done between the 4th and 5th lumbar vertebrae. I was practicing in Sun Valley, Idaho and had a fairly good idea of the effect of stress and lack of sleep on pain. I did not understand any of the stress management tools I outline in the DOCC Project.

His complaint was just low back pain. He had only a degenerated disc with very little motion. There is little if any correlation between pain and disc degeneration. As there was not an identifiable structural source of the pain, I did not recommend any surgery.

I was determined to get him back on track. I saw him every one to two weeks for over eight months. He had some personal stresses and was very anxious. I tried everything I could to help his pain, but nothing seemed to work.

He finally fired me and saw a surgeon in a neighboring town.  That surgeon performed a fusion at L4-5, both from the front and back of his spine.  Gordon felt so great, he took out an ad in the local paper thanking the neighboring surgeon for doing such a great job.

I did not feel great about it. It is not as if a fusion never works. It just does not work often enough in a predictable manner to warrant it being done in someone so young. In five to ten years, there is the additional chance of the spine severely breaking down around the fusion. Having been so exposed to this scenario, I was not willing to move forward with surgery.

He then filed a malpractice lawsuit against me for not performing the surgery that would have helped him. I was quickly cleared, but I had to engage the services of an attorney and go before a panel of peers to deal with it. I still, in retrospect, would not have done anything differently. I just wish I knew then what I know now about the mental health aspect of chronic pain. I did not understand the sensitization process or how to calm down the nervous system.

The situation was also awkward because I would frequently run into him while doing business around town. About a year after his surgery, during one of our awkward run-ins, he looked me right in the eye and said, “You were right.” A year after his spine surgery, Gordon’s pain was the same as when he was under my care.

How attached are you to your victim role? How willing are you to look at how it might be running your life? How victimized do you feel in regards to your pain and the circumstances surrounding it? How angry are you that no is willing to listen, believe, or care about your pain? How frustrating is it to feel that you might have to live the rest of your life with this pain?

The victim role is universal. The willingness to take an honest look at it is not.

BF