An example of what usually happens with cases of back pain

Unlike people who develop chronic pain, here\’s an example of my own as well as an explanation of how \”normal\” recovery differs from the development of chronic pain. This is a story that is no doubt being played out by millions of people around the world right now as you’re reading this.

I developed what I’d call a “deep and severe ache” in my right shoulder blade, with some strong tingling down my right arm and into my hand and fingers. While I waited to see a doctor I took pain killers and basically went on with my life as best I could. Within about 3 weeks the pain just suddenly went away, literally overnight. The tingling remained, although it reduced a bit. During that time I got an x-ray, CT scan, and MRI. What showed up was pretty appalling, problems with bulging discs, deformed vertebrae (arthritis) and impingement of several nerves. Sounds dire, right? But my neuro surgeon laughed off my and my doctor\’s worries, explaining that it was all \”normal\” for someone my age, and to just stay active and keep taking painkillers if need be, but that there was really nothing to worry about at that stage.

And I felt pretty comfortable accepting that because by then just about all those dramatic symptoms had gone anyway.

\"\"So why did my pain and other symptoms stop? The answer is my brain. My brain did what 80% of people’s brains do with “back stuff” and switched off the pain signalling. If I were one of the approximately 20% of people whose brains didn’t “behave” I could still have the pain and in fact it could be worsening, spreading, or generating a number of different symptoms, because that’s what chronic pain often does.

The nerve impingement is another matter. With severe enough impingement (my own case was not severe), left untreated the nerve could be permanently damaged or even die, leading to loss of function. But’s that’s another story. In my own case all the arthritis and other issues in my spine were what the neurosurgeon called “typical for a person of your age” and not severe enough to need any treatment at all. A couple of months later the tingling had reduced as well and as I write it has completely disappeared. All this is “normal”.

What we need to clearly understand here is that the “default” or “programmed” action of the brain is to shut down this type of pain signalling. In the 20% of people who develop chronic pain that “shutting down” doesn’t happen because their brain learns to keep generating the pain signals. It might sound incredible, but there’s an overwhelming mass of excellent research which shows exactly this. I’ll explain a lot more about that at another time.

There are some types of pain that are labelled as “chronic” even though the pain itself is from an acute cause. You see, “chronic” is simply a definition that means “long term”, and some long-term pain is from actual nerve damage, or could be something like endometriosis or adenomyosis, or active rheumatoid arthritis (meaning that the disease is in an inflammatory phase), or migraine, all of which involve the brain very correctly and appropriately responding to danger signs to let you know that damage is occurring, so that you can do something about it.

This last type of pain (that is chronic pain from an acute cause) is much less common, and tends to be responsive to medication or other strategies. In those cases SDR Therapy might not be able to help very much. But if that’s you don’t lose hope because even if you have that kind of pain, you can still use SDR Therapy as an adjunct to what you’re doing with your doctor or pain team to help minimise the pain by addressing comorbidity and other issues and thereby enjoy a much better quality of life. Promise.

\"\"Recent research

Most scientists and health professionals now realise that true chronic pain works completely differently to acute pain, and that chronic pain does not respond to currently-used treatment in the great majority of cases. In the last decade there’s been a great deal of research investigating the nature of chronic pain and trying to understand why 80% of people don’t develop it, and why around 20% do. Lately that research has become very exciting, as you’ll read in my research papers HERE if you\’re interested in the detail.

Without exception chronic pain originally stems from some kind of initial injury or trauma, so there’s pretty much always something that “kicks it off”. But there are some risk factors which increase the likelihood of chronic pain developing. One is when people aren’t given good enough pain relief in the initial acute pain stage (at the time of injury/surgery/recovery). We now know that inadequate pain relief can trigger sensitization in some people and that’s why this is something that’s nowadays watched very closely after surgery or injury. In the bad old days hospitals used to be very stingy with pain medication on the basis that they feared people would become dependent (also I think doctors and other health staff unfortunately weren’t particularly compassionate and thought people should tough it out). Now we know the truth is opposite to false fears about becoming addicted, or “needing more if they’re given more” and it’s better to give too much initially than not enough – the pain simply must be kept under control! As well as reducing the chance of developing chronic pain, it turns out that by giving more rather than less pain medication in the early stages, people end up taking less medication overall and also requiring medication for a shorter time. It pays massively not to be stingy with pain relief in the acute pain stage following surgery or injury. I think you’d agree it’s also the humane thing to do.

Other risk factors for the development of chronic pain are psychological (for instance if the person is traumatized, highly stressed, anxious, or has depression) and the reason for this is that the nervous system of such a person is already sensitized or vulnerable. You could think of this as having a nervous system that’s on “high alert” ready to go off at the merest stimulation. If you add injury or surgery to this, it’s understandable that it may tip the nervous system over the edge and trigger sensitization, especially if there’s a genetic or other predisposition.

This is how environmental/social issues can come into play. If you’re living alone or in an uncomfortable environment, or if you have stressful relationships or work hard in a poorly-paid job, then you’re also vulnerable to additional stress. If you smoke, over-use alcohol, use cannabis or other drugs, are overweight/obese, sleep badly, or are inactive, you’re also more likely to develop chronic pain than most people.

It’s thought that genetic factors can play a role in the development of chronic pain and a lot of work has gone into identifying genes that work against the nervous system returning to normal function, or which make people physiologically more sensitive. Recent research tends to show a correlational relationship between genes and chronic pain, but experiments to address gene activity have not so far shown any promise at all. It may well be that chronic pain in those cases is rather like depression because after all those two things have so much in common neurologically speaking. In the case of depression the fact that the depression may have a genetic component is irrelevant when it comes to the therapy strategy explained in the main SDR Therapy text – it works anyway.

So this is the good news. Regardless of the risk factors behind your unique chronic pain, the likelihood that you can reduce or eliminate that pain is very high, no matter how severe your pain, and regardless of how long you’ve suffered. As you’ll see, it’s not the severity or duration of the chronic pain that tells us how long it might take to get relief. Rather it’s the complexity of your own unique case. It could be that your pain is severe but very simple, due only to conditioned activity in your nervous system. Or it could be that your pain is moderate but highly complex, so that you have that conditioned activity, but you also have a lot going on in your life that works against your nervous system returning to normal function. It could also be a case of just how much chronic pain has stuffed up your life and how much work we need to do to support your recovery. And you’re entitled to that support.



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