Chronic pain is an interesting condition. It's something I'm privileged (or unlucky?) enough to see from two angles. Firstly, I'm a medical student. I find Chronic pain really interesting, and I see the unique challenge it presents to a medical team. Pain that doesn't respond very well to many of our pain killers. Pain that is incredibly severe, often out of proportion to the actual injury or illness causing the pain.
Secondly, I am a chronic pain patient. Some of my earliest memories are of pain. I can't remember a moment of my life where pain wasn't... present. For a long time, I assumed it was normal, I lived under the assumption that everyone had sore knees, sore ankles, a sore back. When I was a teenager, I began to challenge that assumption. I started trying to find out why I had so much pain.
I would say that it took years for me to find answers, but the truth is... I haven't yet. Some of my pains are explicable, others... aren't. Unfortunately, this is the reality of chronic pain. A large number of people have severe pain, for which a cause is never found.
Why? Well... pain is complicated. In theory, pain happens like this. (This is a massively oversimplified explanation, more metaphorical than anything else. It helps for me to think about it this way, but please don't take this as any kind of medical advice). A tiger runs up behind you, and bites your leg. There are nerves in your leg that are stimulated when a lot pressure (enough to cause tissue damage) is put on them. These fire off a message, which travels up your spinal cord and into the brain.
For this metaphor to be... easier to describe, let's imagine that the brain is like an office. Lots of workers sit in their little cubicles, each interpreting data arriving from a different part of the body. These data signals are analyzed by the workers, and the important ones are sent to the office upstairs, where the boss (that's your conscious mind!) lives. The consciousness can then send a message down to anotehr group of workers telling them what to make the body do in response.
In the case of pain, a worker on the sensory floor sees a massive pressure reading coming from the leg. This suggests that some damage might be being done to the leg. This worker needs to send an urgent message to the boss, the consciousness, that something bad is happening, so that the boss can do something about it.
This message from the worker to the boss is pain. It's a way of quickly alerting the consciousness that something needs to be done. It's designed to convey urgency, to be difficult to ignore and to prompt rapid action. In the case of a tiger chewing on the leg, the consciousness can pull the leg away, shout for help, or try to run. The conscious mind panics until something is done.
The problem with chronic pain, is that sometimes the worker in the sensory data department starts messing up. They might receive a signal of light touch, and interpret it as a dangerous level of pressure. They might have no signal at all, but still want to signal to the brain that something on the leg is unbearably, damagingly hot.
The result is that the conscious mind is being constantly made aware of something terrible happening, even when there is no damage being done.
Why does this happen? Well...there are scientific explanations. (https://www.solent.nhs.uk/media/2409/explain-pain-booklet-v2-read-version.pdf) I will take a more metaphorical approach. The little people in the sensory part of my brain/office have got used to stamping every report they get with "danger- alert consciousness" that they don't notice when a report shows no damage happening. Years of repeatedly sprained ankles, dislocated shoulders and sore muscles have made my brain used to damaging stimuli, and now it presumes that that damage is continuing even if it isn't. That's what I think, I'm not sure if there's actually evidence to back that up but it makes sense as an explanation that applies for me.
The result of this disregulation, the constant signalling from your subconscious to your conscious? Pain. More than that though. Your brain isn't just saying "ooh, that's a bit sore, you should get that looked at". It is constantly screaming "AAAAHHHH!!!! TIIGEEERRRR!!!! RUN! GET HELP! PANIC!!!!!!"
My brain is constantly telling me that something terrible is happening to my body. It is telling me that I need to fight back. It is telling me that I need to get help.
The problem is that... there isn't a tiger chewing on my leg. But my brain is convinced that there is, and so it generates pain, to try and get me to act.
For me, this is why Chronic Pain is so dangerous. It doesn't just give you pain. It means that I am constantly at war with myself. Half of my brain is trying to tell the other half that something terrible is happening, the other half is trying to calmly say that, no, everything is fine.
Sometimes, I can't fight it anymore. There have been periods where I can't stop thinking about it, where I can't stop wandering if, perhaps, the subconscious part of my mind is right. Perhaps there is, actually, something terribly wrong with my leg. Perhaps there is a tiger, or a tumour, or a slipped disk, or a patch of inflammation around my joint. Even if, rationally, I know that none of those things are true, I have had scans that show that none of those things are true, I can't fight the doubt. At these times, I often end up going to see my GP. I feel terrible for it, because, rationally, I know that there's nothing wrong. I know from experience that there is nothing more to be done. I go anyway, because sometimes, it is easier to convince myself that everything is fine when I've heard someone I trust say it. I feel guilty for wasting people's time, I feel anxious that the GP will be angry with me for booking that appointment.
I am good at managing my pain by myself most of the time. I have had some help from fantastic healthcare professionals, and I employ hydrotherapy, pacing and distraction techniques to manage my pain. Sometimes, though, I can't do it on my own.
As a medical student, I see things from the other side. I think a lot of healthcare professionals find chronic pain... frustrating. We like to be able to fix people, but chronic pain doesn't have a "fix". Not yet.
The other problem is that chronic pain really toes the line between medicine and psychiatry. The problem in chronic disregulated pain is rooted in the brain, and is influenced by other things that influence the brain. Things like trauma, depression, stress. Treating those things, however, doesn't necessarily get rid of the pain. There are also, often (but not always), measurably, biological reasons for pain to be present. An arthritic joint, tense muscles, a slipped disk. But correcting that also might not fix the pain.
Chronic pain is hard to treat. It's hard to diagnose. It's hard to tell someone who's brain is screaming at them to "find help!" that... you can't help them. That you can't take the pain away.
As a chronic pain patient, and a medical student, what would I like healthcare professionals to know? Well, firstly, underneath the panic, the pain, the anxiety is a rational, sensible person. 99% of the time, that person may be able to block out their nervous system screaming at them that the world is ending. You probably meet them on their worst days, when they are just too tired, too worn down to keep fighting. You meet them on the days when they can't convince themselves that there isn't a tiger chewing on their leg.
The thing that I would most love you to do it... be blunt. Be honest. If you think someone has pain, and will always have pain, tell them. Take the time to work out what they need to get back to normal. If you were looking after me, I would want you to focus not on pain control, but on functionality. On maintaining ability.
Chronic pain is all too common. It's a leading cause of disability. It's incredibly difficult to manage, and incredibly difficult to live with. These are uncomfortable truths, but we have to face them. We have to spread awareness of chronic pain. People have to know that they don't have to deal with this alone. Healthcare professionals need to feel confident in treating it, and they need to have the resources and time to help the chronic pain patients they encounter.
If you would like to learn more about chronic pain, here are some fantastic resources:
https://www.solent.nhs.uk/media/2409/explain-pain-booklet-v2-read-version.pdf
https://www.youtube.com/watch?v=RYoGXv22G3k&ab_channel=Happy%26Well
https://www.nhs.uk/live-well/healthy-body/ways-to-manage-chronic-pain/
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