Your ‘Pain is all in your Head‘, is something many chronic pain sufferers in particular Fibromyalgia sufferers hear many times from the medical profession so reading that they now know that is wrong was like a breath of fresh air.
According to an article in The Guardian ‘Sufferers of chronic pain have long been told it’s all in their head. We now know that’s wrong’.
To most people, pain is an unpleasant but short-lived sensation, occurring as a result of illness or injury. Although some people may experience ongoing or chronic pain, the assumption is there must be some kind of underlying physical injury, such as a crushed nerve, or an angry, inflamed joint.
Increasingly though, experts are waking up to the idea that chronic pain can occur without any obvious physical injury, or in a completely separate area of the body from the original site of tissue damage. There’s also mounting evidence that seemingly very different pain conditions – chronic headaches, low back pain and jaw pain, say – may share common underlying mechanisms, and that once a person develops one chronic pain condition, they’re predisposed to develop others.
The Covid-19 pandemic could make this situation even worse. One of the most common symptoms reported by people with “long Covid” is musculoskeletal pain, and those with existing musculoskeletal pain conditions seem to be at risk of experiencing stronger pain after a serious Covid infection.
The Guardian goes on to say that ‘the health profession as a whole does not treat people with chronic pain well. And it is about to be hit by a tsunami of severely ill people needing help.‘
Chronic pain is a leading cause of disability, affecting about 20% of people globally, but more than two-fifths of people in some countries, including the UK, and is predicted to increase as populations age.
Traditionally, doctors have divided pain into two categories: nociceptive pain, triggered by injuries such as bruises, burns, fractures, sprains or inflammatory conditions such as arthritis, and detected by pain receptors in our skin, bones and other tissues; and neuropathic pain triggered by damage to the nerves that carry sensory signals from these tissues to the brain and spinal cord.
But a few years ago, the IASP introduced a third category: nociplastic pain – pain arising from the altered processing of these sensory signals, without any evidence of actual or threatened tissue damage. One thing that can happen is that the pain signals carried by peripheral nerves from the skin, muscles, joints or internal organs to the spinal cord can become amplified, worsening the pain.
Prolonged activation of the body’s pain pathways can also lead to changes in the brain and spinal cord. According to the old way of thinking, the body’s pain pathways were arranged like a telephone switchboard, with fixed sets of wires (nerves) connecting our peripheral organs and tissues to the spinal cord, and further nerves connecting the spinal cord to the brain as well as feeding back down in the opposite direction.
It may also help explain why so many people with chronic pain conditions subsequently develop more of them. More than 200 million people around the world are affected by chronic overlapping pain conditions – a cluster of painful disorders which often coexist in the same patient.
“Over the past 10 years, there’s been the widespread recognition that pain can be a disease in and of itself, and a growing understanding that it is a multi-system illness, and that there are shared mechanisms of disease across these conditions,” says Christin Veasley co-founder and director of the US-based Chronic Pain Research Alliance.
“In many people with conditions like low back pain, endometriosis, irritable bowel, headache, fibromyalgia, you’re not going to find a problem in the area of the body where the person is experiencing pain. There’s more and more evidence that these are central nervous system, systemic conditions, where the pain can present in different areas of the body at different points in time over that person’s life,” says Daniel Clauw, a professor of anesthesiology, medicine and psychiatry at the University of Michigan.
A patient with third-degree burns is having their strings strummed extremely hard, whereas in someone with fibromyalgia – a long-term condition that causes pain all over the body – their amplifier has been set too loud. “They can have pain, without the strings even having to be strummed,” Clauw says.
Not everyone who develops a chronic pain condition will develop more of them but they seem to be particularly prevalent among women, and those affected also often suffer from non-pain conditions such as sleep and mood disorders, and fatigue.
Some of this variation between men and women may be due to immune system differences, with women also more prone to autoimmune disease. Immune cells trigger inflammation, which can trigger pain. Sex hormones such as oestrogen and testosterone can further exacerbate or dull pain, depending where they are released and in what quantities.
Unfortunately, our health systems are ill equipped to deal with chronic pain – and particularly patients with chronic overlapping pain conditions. Like many patients with chronic pain, Kalinowski takes multiple drugs to get through the day. Working out which ones work for her has taken years.
The good news is that attitudes to chronic pain are changing, even if it may take the wider medical community a bit of time to catch up. In July 2020 the IASP updated its definition of pain to cover nociplastic pain – that arising in the absence of obvious injury. Pain is “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”, it now says.
Sufferers of chronic pain have long been told it’s all in their head. We now know that’s not true. The pain that can’t be seen is a week-long investigation looking at why doctors are playing catch-up on chronic pain conditions like endometriosis, migraine and more – and what they have to do with long Covid. In the next part, you can read about why women are more likely to have long Covid and chronic pain and hear from 10 readers on their experiences living with theses illnesses.