All throughout the body we have nerve cells called nociceptors which measure excessive pressure, temperature, or other stimuli which could cause or suggest tissue damage such as inflammation. These nociceptors send electrical impulses up to your central nervous system (e.g. your brain) which then gets interpreted as pain. Specific areas of your brain that are activated include: your parietal lobes (where most of your sensory nerve cells are located), amygdala (a big connection area of your brain that impacts emotional responses such as fear), and hippocampus (another large connection area of your brain which helps with memory and other emotional responses). These areas activate so you know where the pain is, have an idea what may have caused it, and try to avoid doing the painful movement again. Normally, once the painful stimulus is removed, these areas deactivate and once any tissues that were damaged are healed, you do not feel pain anymore.

With chronic pain and Central Sensitization, these regions of your brain do not turn off and become more interconnected (which has been shown on functional MRI studies). While the exact mechanism is not understood, these brain regions also can begin to sense stimuli, which are normally not painful like lightly touching the affected area, as causing tissue damage as well. Because of this it is even a common phenomenon in the clinic to see someone perform a simple act like bending forward to pick something up from the floor cause agonizing pain because their brain BELIEVES it will hurt, but then do other forward bending motions without thinking about it without an increase in symptoms. One might say this is all in a person’s head, and they would be right because the brain is where the whole idea of pain is constructed anyway! The consensus now, however, is that because the brain is where the sensation of pain is constructed, that person is very well experiencing pain because their brain BELIEVES they are!

So what should one do about this? Taking pain medications might not help as they work by either reducing inflammation (which in this case may or may not be there) or on the brain’s ability to identify nociceptor signals (which may not be what your brain is responding to that is causing the pain). The research shows that the best treatment to combat chronic pain is a graded and individualized exercise program with gradual progression, and this is exactly what Physical Therapy is about!. Along the way we can also examine you to see if there are any muscle imbalances, faulty movement patterns, or other factors that are contributing to your pain, and we can help you work to address them accordingly.

If you or someone you know are having problems with chronic pain, see your doctor for a Physical Therapy referral.