Why do we get long-term pain?

Why do we get long-term pain?

A lot of this is about learning and positive feedback loops.

The pain is designed to be uncomfortable. That’s why pain is stressful; it’s a discomfort you’d prefer to avoid. In due time it’s common to see that it turns into a fear of pain, which is reasonable. The point is for us to avoid the pain because it’s unpleasant. The fear of pain turns into a fear of movement since movement often provokes it in one way or another. The fear of movement is what we call kinesophobia. That is often one of the most apparent positive feedback loops. Pain makes you avoid activity when movement is good for you and a way to get healthier and hurt less.

The more time we spend doing something, the better we get at it. The more this happens, the more it continues to happen because we get more sensitive to pain the more we experience it, and pain is something we learn rather than a good objective valuation of an injury. It’s rather a system there to warn you than a system to tell you how injured you are. As you get better at feeling pain, you get more. When you get more, you generally connect the pain to more things – including activities and movements and places, thoughts, and whatever else there could be.

The more this happens, the more it continues unless there’s a thought-through solution that you actively go for while trying to change things. Behaviors, ways of thinking, and emotions work the same way. Do something, and you’ll get better at it. It’ll become a habit, and you’ll likely do it more and more. The further you go on with behaviors, the harder they stick, and they get harder to change. Unfortunately, it’ll work with pain, the thought patterns of depression, anxiety, and most other things as well. You could do plenty of silly things often. That doesn’t make them right.

Everything we do and practice is skills, so we’re getting better at everything we do. Do more, get even better. You won’t get LESS pain; you’ll become a pro at feeling pain. That’s what we call central sensitization – the brain gets even more sensitive to the pain. More or less the same thing as if you were to slap your arm repeatedly. Once is fine, but you’ll become sore, and it’ll be more discomfort with every hit, even if you hit with less power. That’s the essence of what happens with long-term pain, but it comes as a package deal where you get other things as well, either as something you learn or as symptoms.

Learned helplessness could be one of these, and it’s something you learn. Pain is more or less a tool for the brain to tell you no and to warn you. If you get constant reminders about how you shouldn’t do this, that – or practically ANYTHING BECAUSE IT HURTS – and a beating when you’re told so – you’ll soon learn how futile everything is.

Other parts of the package deal are burnout and depression, of course. Constant stress from the pain and becoming more and more of a victim to it, where it runs your life rather than you, are great reasons to become incredibly stressed over time. That doesn’t work for months and years. It’s bound to have consequences.

Learned helplessness and depression are the best of friends. Misery loves company, I guess. When you can’t do anything because you’re told no by your brain and learn that everything is futile, depression almost sounds reasonable. The mental suffering from pain, both as pure pain and as life gets less worth living, has made anti-depressants a common approach to treating long-term pain patients. You’re practically grounded and told to stay in your room, like a kid – but by your brain. If you don’t follow directions, it comes with a decent punishment instantly – every time.

Both burnout and depression are exhausting in and of themselves. The lack of energy turns into a dysfunctional everyday life. Everything gets difficult. The pain, stress, and depression could bother sleep, giving you even more pain and stress, less energy, worse mood, and even more pain in the long run. Again with the positive feedback loops. On and on it goes.

Pain gives more pain, and the other two in the equation. More of all of those are… horrible. That makes you more sensitive and more prone to feeling pain. Just being annoyed or tired after a long day could cause more pain. Depression could be the mother of annoyance and burnout the father of tired after a long day.

One doesn’t necessarily come with all three, however. Just the pain is more than enough. If you want more, the book is available at www.mbdolor.com/book. You’ll find a bunch of pain science relevant to you if you’re in long-term pain and a few pages on learned helplessness.

Full series:
The Big Three: What Is Long-Term Pain?
Why Do We Get Long-Term Pain?
Treat Long-Term Pain