Why Does Pain Persist? How Your Nervous System Shapes What You Feel
The nervous system is a complex network that alerts your brain to pain or danger. It is split into two major parts; the central nervous system (CNS) and the peripheral nervous system (PNS). The CNS acts as the body’s control centre and consists of the brain and spinal cord, whilst the PNS consists of the nerves that connect the CNS to the rest of the body.
The brain is in constant communication with the body through the nervous system to control movement, thoughts, and automatic functions such as breathing. The nervous system is designed to perceive sensory stimuli through receptors, integrate that data within the CNS, adapt by adjusting sensitivity or formulating response strategies, and execute a coordinated motor response. You can think of the Nervous System as the “Master” system of the body. All other systems such as our digestive, cardiovascular, and musculoskeletal systems rely on the nervous system to function properly. When discussing injury and pain, the nervous system is sometimes referred to as the body’s “alarm system” because it can be triggered by certain stimuli. When negative stimuli is perceived, the nervous system then activates quick responses, such as pain or the ‘fight or flight’ response, in an attempt to keep the body safe from harm. However, sometimes the alarm ‘dialed up’ and your body can become trapped in a state of hypersensitivity or heightened stress.
Ongoing perceived or real trauma can trap the body in a state of high-alert, which often presents in tight muscles, persistent pain, poor sleep and digestive issues. Even when your scans are clear, you have been told that ‘nothing is wrong’ and you feel like you have done everything you can to manage your symptoms, pain can linger and the answer may lie in understanding the nervous system and its connection to pain.
Pain is not a damage meter
Often we associate pain as being a binary concept – that a minor incident causes a proportionally small amount of pain, and vice versa with a major event causing severe pain. However, it is far more complex than that and our experiences of pain can vary from person to person. For example, hitting your funny bone or stubbing your toe can cause excruciating pain, but rarely causes a lasting injury. Inversely, some people can completely tear a ligament in their knee or shoulder and only feel mild pain. In both cases, the amount of pain doesn’t match the amount of damage. This is because different tissues in the body have different nerve supply. Furthermore, when those nerves carrying pain information get to your brain, centres in your brain can dial up or down your awareness of pain based on how much danger it believes you are in at that moment. Your brain weighs up everything happening around you – the situation, your stress levels, previous experiences, and what feels most important right now – before deciding how much pain to make you aware of.
What changes when pain sticks around?
Chronic pain refers to any pain that lasts for more than 3 months. Chronic pain can often be an indicator of nervous system dysregulation, especially if it has spread throughout the body or to a different area of the body. Your nervous system is constantly adapting structurally, functionally, and chemically. If your brain has received input from the PNS and decided that danger is present, it can crank up the pain. This is called central sensitisation. The CNS acts like a hyperactive alarm and amplifies signals, so that minor touches or normal movements cause real pain, sometimes even after an injury heals at the cellular level.
Chronic or recurrent low back pain is a common area affected by central sensitisation. Your nervous system gets used to constantly conveying pain signals, and over time it requires less stimulus to set off the pain alarm. This is why having a past episode of low back pain is the strongest predictor for future episodes of low back pain. Cognitive factors such as fear-avoidance, perceived risk of persistence, and pain catastrophizing are also known to increase the risk of chronic low back pain. For example, someone experiencing a first-time episode of low back pain after lifting a heavy box. They avoid lifting for months in fear of further injury. Months later, the low back has become hyper-sensitive and even light touch is triggering the pain response.
Why your scan doesn't tell the whole story
Whilst Xray Images provide an important insight into structural issues, it does not reveal muscular or nerve problems, nor does it reveal pain. Your nervous system sensitivity and function is discovered through various physical examinations and tests performed by chiropractors. An X-Ray shows bones, alignment, joints and joint spaces, whilst an MRI or CT scan shows soft tissues, discs and nerves. Discomfort and pain often comes from nervous system sensitivity, inflammation, or muscle tension that imaging cannot picture. Many people have visible wear, degeneration, or disc bulges on a scan but present with zero pain, while others have severe pain with a completely “normal” scan. If you find yourself relating to the latter, it does not make your pain any less real. Imaging is simply a tool that we use in conjunction with your symptoms and other tests, not a diagnosis or a verdict. When a scan doesn’t tell the whole story, it marks the beginning of the investigation, not the end. The next step isn’t another scan – it is understanding the nervous system and evaluating how your body is functioning by undergoing a physical examination.
What turns the volume up?
Nervous system pain, often referred to as neuropathic or centralised pain, can be worsened when triggers activate an oversensitive nervous system. Chronic pain is persistent over more than three months with no predictable end point, whereas acute pain is a sudden, short-term warning that usually occurs as a result of trauma or injury and can be treated. But what are some other factors that influence pain?
- Stress and Anxiety: High stress and worry release chemicals such as cortisol, which keep your brain’s alarm system on high alert and can amplify pain signals.
- Poor Sleep: Quality sleep allows your nervous system time to rest and repair. Without this, your body’s pain threshold is lowered and your brain’s capacity to cope with unpleasant stimuli is reduced.
- Temperature Changes: Both warm weather and cold weather can cause symptoms to fluctuate. Whilst the physiological mechanisms underpinning this effect are not yet fully understood, studies have found clear relationships between pain and ambient temperature.
- Emotions and Behaviour: Emotions are powerful and periods of high stress, fear or uncertainty can put your nervous system into an oversensitive state, causing the amplification of pain intensity. Certain behavioural cycles, such as hyper-vigilance (where your brain is constantly scanning your body for alarms) or fear-avoidance (where you avoid activities for fear that they will worsen the pain)
- Light Touch or Movement: As previously mentioned, central sensitisation makes normal, non-sensitive touch, such as clothing brushing your skin, or routine movement, increasingly painful.
What helps turn it down?
Although this might sound overwhelming, there are things you can do to help regulate your nervous system and manage your pain. Often, getting back to basics and taking care of your body can make a big difference, especially when coupled with chiropractic care. Holistic health and wellbeing is extremely important and can have a significant impact on your body’s capacity to cope with pain.
- Knowledge is power: Understanding what is actually happening in your body can be the key to unlocking strategies that work best for you.
- Consistency is key: Gradual and gentle movement is often more beneficial for your nervous system than sporadic bursts of high intensity exercise, as your body is already on high alert.
- Sleep is the secret: Sleep is when your body works its magic to reset and recharge, so getting your eight hours every night is crucial. Maintaining consistent sleep and wake times is also going to help kickstart your recovery.
- Stress less: Sometimes, stress is simply inevitable. However, mindfulness techniques, breathwork, mediation and other stress-relieving strategies send signals to your brain that it is safe, which allows your nervous system to enter its resting state.
- Hands-on care: Chiropractic care includes manual adjustments, dry needling, soft tissue work, simple exercises and tailored strength or mobility plans, and may be combined with remedial massage for additional benefits.
- Take your time: Unfortunately, it is unlikely that your pain will disappear overnight. However, the best results come from staying committed to your care and being patient with your progress.
What this means for you
If you’ve ever been told that nothing is wrong and your scans are clear but you’re still in pain, you are not imagining it and you are definitely not out of options! We are here to listen and get a holistic view of what’s going on for you. Chiropractic care can help you find lasting relief through a holistic treatment approach that is uniquely tailored to you and your goals.
Common Questions
Two things can be true at the same time - your scan can be clear and you can be experiencing pain. This doesn’t mean that you are lying, or that there is nothing wrong with you. You deserve to have your health viewed holistically and the answer might lie in regulating your nervous system.
Whilst we cannot guarantee that your pain will completely subside, chiropractic care methods can provide immediate and lasting relief for acute and chronic pain. For most people, reducing flare up frequency and severity is achievable.
As Chiropractors, we perform a full physical examination to determine how your body is functioning. Once we have a clear understanding of the joints, muscles and nerves that are contributing to your pain, we do hands on therapy. This can include manual adjustments, instrument assisted adjustments, dry needling, or soft tissue work. Our treatment plans are curated for you specifically and include home advice and rehabilitative exercises.
It can be a good idea to seek advice from your GP if you are unsure of the best course of action. We are always happy to work alongside your GP or other healthcare provider to ensure you receive the best care possible for you. If you come to us first, we will let you know if you’re in the right place, or we will refer you to another service if required.
Book a consultation at our Yokine clinic, or call us directly at (08) 6285 0243 to start your journey toward better health.
