What Is Chronic Pain?

Chronic pain can be confusing at times. This article will help you navigate the maze.
Understanding and explaining pain can be confusing at times, but it doesn’t have to be.

Confused by terms like: chronic pain, persistent pain, mind body syndrome, or TMS?

There is no denying the jargon can get overwhelming.

And it doesn’t help when they get swapped interchangeably at will (are you guilty of this?).

After reading this article you’ll have more confidence in what pain is. After all, knowledge is the first step in fixing pain forever.

First, What Is Pain?

Chronic conditions aside, pain evokes words like “hurt”, “danger”, or “bad”. But if you are on this page it’s likely you have a more nuanced appreciation of pain, to say the least.

Before we go any further, we need a strong foundation and robust working definition of what pain is. For this, we’ll leave it to the experts at the International Association for the Study of Pain (IASP), who describe pain as:

“[Pain is] an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”

It’s revolutionary for pain sufferers like myself to know that pain is more than just physical damage to our bodies.

Pain captures our emotional experience and even the potential for damage. Pain is complex!

The IASP have helped out here with six points to help with interpretation:

  • Pain is a very personal experience and usually influenced by biological, psychological, and social factors.
  • Pain and nociception (the neural process of encoding and processing painful stimuli) are different phenomena.
  • The concept of pain is something we learn during our life experience.
  • Your experience of pain should be respected.
  • Pain is designed to be an adaptive role – to help us avoid bad situations. For some it may have an adverse effect on our way of life.
  • Verbally describing our pain is only one of several modes of expressing pain. Inability to communicate does not negate pain.
Diagram illustrating nociception in the context of pain.
Nociception triggered by the mechanical stimulation of a nerve (by action of a nail). This signal is sent to the spinal chord and brain to be experienced as pain.

Let’s talk about what pain isn’t.

It isn’t something physical that we can touch, hold or see – like a toxic molecule or a COVID-19 virus cell. We can’t observe pain with a microscope or treat it directly with medication.

Pain is more kin to an experience or how we perceive something. It’s an alarm signal telling us that something is not right, and if we don’t act, it’s about to get a lot worse.

This is really helpful if we accidentally grab the handle of a hot oven dish with our bare hands. Pain is telling us: stop now! Let go of the pot before more damage is done to your hand.

Pain helps us avoid danger, and is a good thing. But there is more to the story.

Acute Pain

Before we look at chronic pain, we need to talk about the more common pain experience: acute pain.

The name here can be misleading. Acute is not in reference to the seriousness of the pain, for example, an excruciating “11 out of 10” pain rating for a broken bone contrasted to a “1 out of 10” paper cut.

It doesn’t matter whether it hurts a lot or not much at all. It can last for a few minutes or a few months.

“Acute” is a reference to the suddenness or external causation of the pain. Classic examples are broken bones, lacerations, or sprained muscles. Sporting injuries, workplace mishaps, and vehicle accidents are all common causes of acute pain.

Pain of this form normally resolves (gets better) once the injury site has healed. For example, a broken bone can take from 6-8 weeks to heal. After that timeframe it would almost be impossible to recognize the injury site on an x-ray. Acute pain is done for when healing is complete.

But what happens if the pain doesn’t get better once an injury has healed?

So What Is Chronic Pain?

Chronic pain is pain that continues once the initial injury site has healed.

Think of a building alarm that is left ringing and flashing once the burglar has been arrested, stolen goods recovered, the police have completed and filed their report, and the court case closed! Not very helpful.

Chronic pain is sometimes referred to as persistent pain because it is pain that persists after the injury has healed. This is usually in excess of three months. It can last for months to decades.

Sufferers brains have learned to experience stimuli in this way whereby unhelpful neural pathways have been created. But don’t worry, they can be unlearnt thanks to neuroplasticity.

This is like the classic Pavlovian conditioning. Where a scientist fed a captive dog upon the chiming of a bell. The over enthusiastic dog would salivate at the sight of the food and the sound of the bell. Eventually the food was no longer offered, but the dog would salivate on queue once bell was rung.

Some sufferers don’t even have a primary cause of injury. Other sufferers of chronic pain have reported issues occurring at a stressful time of life, a marriage breakdown, a death in the family, or losing a job. For others it may just appear as if it had a will of its own.

Remember that your pain is very real and does hurt, regardless of how you came to suffer from chronic pain.

Acute and chronic pain have some significant differences. Both pain experiences are horrible!

Why Do Some People Call It Tension Myositis Syndrome (TMS)?

Let’s be clear; chronic pain and tension myositis syndrome are not the same thing.

TMS is a mechanism than can cause chronic pain, rather than the pain experience itself – just like how the nail causes acute pain in the image above. The terms TMS and chronic pain are often incorrectly used synonymously. But you’re smarter than that now 😉

Some sufferers even refer to themselves as TMS’ers. Or as suffering from tensionalgia. Some even blur the lines between chronic pain, TMS, and mindbody syndrome described below.

Tension myositis syndrome (also called tension myoneural syndrome or musculoskeletal mindbody syndrome) was popularized by Dr John Sarno in texts such as Mind Over Back Pain (1984), Healing Back Pain: The Mind-Body Connection (1991), and The Divided Mind: The Epidemic of Mindbody Disorder (2006). Sarno used TMS to describe a wide range of mindbody symptoms such as chronic back and neck pain, IBS, migraines, or fibromyalgia. These are all very real and hurt indeed.

John Sarno's works: Mind Over Back Pain, Healing Back Pain, and The Dividend Mind.
Dr John Sarno pioneered the study of tension myositis syndrome in his books.

The mechanism of TMS is believed to be a mild reduction in blood supply to the affected nerve experienced as pain via nociception (remember the nail). The theory being that blood vessels feeding surrounding nerves temporarily contract upon unconscious emotions and feelings bubbling below the surface. This has the effect of depriving nerves from oxygen causing the burning, tingling, or aching sensation. But don’t fear! Sarno stated that TMS is harmless and reversible.

Randomized control trials (the gold standard of medicine) have shown TMS treatments to be highly effective. This doesn’t necessarily prove the underlying mechanism. Personal note: I have found the TMS explanation incredibly useful, but I also acknowledge that the jury is out with mainstream science – talk about a fence sitter!

So what definition might my pain doctor use instead of TMS?

Pain Disorder Or Psychogenic Pain?

The reality is that many healthcare providers are unaware of TMS. They may well look at you with a quizzical look if you mention it. A more common diagnosis would be pain disorder or psychogenic pain. Pain of this form is described in the DSM-V, the psychologists Bible.

Pain of this type could also be described as persistent somatoform pain disorder or functional pain syndrome.

In both cases pain is caused and sustained by psychological stress and unhelpful emotions.

Within this definition there is no neurological or physiological basis for the pain, for instance, psychogenic pain is not caused by nerve or tissue damage. This has led to many less-than-helpful friends, family, and even medical professionals assuming that the pain is “all in your head” and “not real”.

That hurts, trust me.

If someone says your pain is not real, head on back to the IASP definition. Bonus points if you dutifully point them back to the best international practice.

Mic drop. 🎤

Mindbody Syndrome

“Mindbody” is a hot topic right now.

Take a walk through the self-help section of your bookstore, or even the best sellers in Amazon.

And I’m not the only one feeling it. Google trends shows a significant increase in searches for “mindbody”, compared to other pain related terms like “chronic pain”, “tension myositis syndrome”, or “pain disorder”.

Chronic pain is the clear winner for the public vernacular. Are we seeing a

The school of mindbody says that the physical body (flesh and bone) and the immaterial mind (thoughts and feelings) are one and the same.

We can see evidence of the mindbody relationship everyday. For instance, when we blush after seeing our crush walk by, or the racing heart and sick feeling in our stomach when we prepare to give a public speech. More formally, this could be called a psychosomatic symptom.

Mindbody syndrome (MBS) is when our mind works against us to produce chronic conditions. MBS is a catchall or umbrella term.

It’s not too much of a stretch to understand that other unconscious emotions are throwing parts of our body into seemingly unexplained pain.

MBS theory states that our bodies produce pain because bottled up and unresolved stresses are bursting to get out. These could be from your childhood, or from stressful events in your adulthood, or due to your personality traits like being over anxious or high achieving.

Clinically, the term psychophysiologic disorders (PPD) has been adopted by the PPD Association.

The search popularity of “mindbody” has increased much more than other descriptors for pain.

Back Pain, Fibromyalgia, and Complex Regional Pain Syndrome (CRPS)

These are just a few of the many manifestations of mindbody disorders.

If you have made it this far, you’d agree that that “back pain” is the tip of the iceberg when it comes to truly understanding pain. Scratch underneath the surface of back pain and you will find a rabbit hole of MBS, PPD, and TMS.

But enough of the three letter acronyms.

Authors such as Dr Sarno and Dr Schubiner have attributed the following conditions to mind body syndrome:

  • Back pain
  • Neck pain
  • Migraines
  • Repetitive strain injury
  • Heartburn
  • Psoriasis
  • Irritable bowel syndrome
  • Complex regional pain syndrome
  • Fibromyalgia
  • Dizziness
  • Tinnitus
  • Hip pain

Next time that knee injury flares up, or you get a bad bout of tinnitus – stop!

Think: could there be more at play here with emotions and my mind?

Summary

This has been a lot to digest, so don’t worry if you are feeling overwhelmed. You didn’t sign up for all this learning with a chronic pain diagnosis.

Take heart that both your vocabulary and understanding of pain has increased. This will give you the confidence and power to navigate conversations with doctors and fellow sufferers alike. Congrats!

Learning about pain is the first step in fixing it for good.

Here is a useful summary to recap what we’ve learnt.

PainAn unpleasant experience due to emotional or tissue emotional damage (or the potential for damage).
Acute painPain that is usually caused by rapid onset tissue damage.
Chronic pain/
Persistent pain
Pain that persists longer than 3 months.
Tension Myositis SyndromeA disorder that causes chronic pain. Suppressed emotions result in restriction to blood vessels, and a mild, harmless, and reversible oxygen deprivation.
Pain Disorder/
Psychogenic Pain
These diagnoses are listed in the DSM-V. They may be preferred by clinicians compared to TMS.
Mind Body SyndromeMindbody syndrome is a catchall term for the lay person.
Psychophysiologic DisorderThe clinical term for MBS
Back pain, etc.One of the many symptoms produced by PPD.

Bonus: now that you’ve learnt about pain, it’s time to start fixing it forever.

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