Pain has a lot of effects: From the way we think about our bodies to the way we approach activities and the choices we make about our surroundings. It changes the amount of time we spend socializing, our athletic and physical pursuits, even when, if, or how we run errands. It’s easy to measure all these external ways that pain changes us, but pain can also change our brains in ways we may not see. We share a lot of information about the pain-brain connection, let’s touch on some of the ways that chronic pain affects our brains.
Let’s paint a picture; maybe you can relate.
It’s 5 pm on a Saturday. You’ve been looking forward to dinner with friends all week, and you’re scheduled to head out in about an hour. But your lower back is in full spasm, and there’s not much you can do to get the pain to settle down. When you live with chronic pain, this is not an unusual scenario.
How Chronic Pain Isolates Us
As much as you want to have dinner with your friends, there’s a good chance that your back pain will pull rank more than once. So, you stay home to nurse your pain and get a few “we missed you” texts. Then you scroll on social media and see pictures of your friends out there, having a blast- without you. Loneliness and depression begin to creep in. Then the pain, somehow, starts to seem worse, kicking off a whole new wave of anxiety as you start to worry about the increasing pain.
And the cycle continues. You make new plans, have to cancel, feel bad about missing out, feel worse physically, and get nervous about worsening pain.
People who live with chronic pain talk about losing friendships, romantic partners, and jobs because of their pain. For some of us, relationships are impacted because our friends or significant others don’t know how to talk with us about our pain. Social isolation can kick into high gear because of the near-constant withdrawal from social occasions, like the dinner example. Some of us realize, perhaps a little too late, that we’ve lost connection with the ones we love because our own chronic pain experience refuses to cede any bit of the limelight to anyone else’s hardships.
Since pain is a “hidden” disability and so often misunderstood, those of us living with chronic pain can feel very alone, even when surrounded by people who love us. We can become physically, socially, and emotionally isolated from the world and those we care about the most. We don’t necessarily want to withdraw, but pain puts its foot down and says, “not today,” enough that we regularly miss out.
How Isolation Can Turn Into More
When the pain→miss out→more pain cycle happens again and again, it’s easy to see why so many people living with chronic pain also live with emotional pain like depression, loneliness, and anxiety.
A feeling of loss of control often accompanies chronic pain, which inevitably breeds more depression and anxiety. Many people with chronic pain see mood changes over time: becoming tense and curt with spouses; intolerant of children, snapping over little things; or at its most extreme, developing a feeling that life has lost its joy and meaning.
There is a direct correlation between pain and emotional imbalance. Studies show a link not only between pain and mood disorders but between methods of treating our pain and mood improvements. As scientists learn more about how physical pain affects the mind, they’ve learned that techniques and medications that treat one problem can often help treat the other. We at Lin Health developed our coaching program in response to this emerging science uncovering how the brain translates both painful and emotional stimuli in the same regions.
But when chronic pain isn’t treated adequately and carries on for months or years, the effects begin to pile up.
Chronic Pain Leads to Memory and Concentration Issues
Doctors have found that misfiring pain signals can alter memory and concentration. Chronic pain interferes with the way our brains encode memories—so we don’t process information the same way—and hinders long-term memory storage. These changes can be temporary or permanent (researchers are still working on studies on the extent changes), but they affect not only the ability to remember something but also the ability to concentrate and focus.
The Connection Between Chronic Pain and Movement
Speaking of forgetting, those of us with chronic pain can’t count all the times our bodies say, “forget about going for a walk today.” Sometimes the brain’s overreaction can lead to actual fear of physical movement called “kinesiophobia”. Skipping the gym now and then because of pain is one thing. But if severe chronic pain leads to kinesiophobia and we begin to avoid not just going for a walk but any physical exertion we anticipate will cause more pain, this can make chronic pain worse.
Suppose you’ve stopped walking to the mailbox, taking the stairs at work, or going to the grocery store because even the thought of that exertion leading to more pain is overwhelming. If that’s the case, you might be surprised to learn that avoiding physical activity is the last thing doctors and scientists recommend.
Choosing to become sedentary to avoid pain leads to a whole host of new issues like muscle weakness or atrophy, skeletal degeneration, problems with memory and concentration, cardiovascular issues, and–say it with us–depression, anxiety, and mood changes.
It’s a compounding effect, a vicious cycle. Pain causes us to stop activities, which generates more pain, which causes more avoidance, which…well, you get the picture. Movement is critical to managing chronic pain. But of course, we need to be smart about the types of movement we incorporate into our routines.
Chronic Pain and the Central Nervous System
The effects of chronic pain extend beyond our social lives, movement, and moods. Chronic pain can change the brain.
Maybe you’ve heard of nociplastic pain, when our wires have essentially crossed? The central nervous system takes all kinds of signals to our brains, translating them into pain, even when they’re emotional or memory signals. The body remembers it felt pain the last time it was in this situation—like missing dinner with friends—so it says, “I must be in pain again now because the signals are the same.”
When the central nervous system becomes hypersensitive like this, we can start having odd physical reactions to various stimuli: From a gentle touch feeling like a burning pain to a minor back tweak feeling like a full-blown spasm.
Chronic Pain and Structural Changes to the Brain
While memory and concentration problems and mood changes might be worrying enough, studies now show that chronic pain can change the structure and function of our brains. When and where does that happen?
We’ve all heard of grey matter; it’s not just a feature of crime show dialogue though, it serves an important role. Grey matter is responsible for processing sensory signals our brains receive and then firing synapses in response. An overabundance of signals puts it at risk of getting worn out.
Studies show that to be the case: People living with chronic pain have up to an 11% decrease in grey matter! That’s equivalent to the brain aging 10 to 20 years more than its actual age. The longer we live with chronic pain, the more grey matter we lose.
However, these studies also found that this grey matter loss is completely reversible once chronic pain is properly treated. This means the sooner treatment is sought, the sooner the brain can start healing from years of overstimulation.
Left untreated—and/or overly medicated, as many of us have experienced—overstimulation can change our neurochemistry (a.k.a., the processes of the nervous system and nerve tissues), leading to even more hypersensitivity. This neurochemistry change disrupts the brain’s equilibrium or the balance of functions that the brain usually spreads out to various areas.
Typically, when one region is hard at work, say, trying to work out the tip at dinner, the other regions are quiet. But in the brains of people with chronic pain, the whole brain is constantly noisy (think Grand Central Station at rush hour), leaving it tough to concentrate or complete a seemingly simple task.
Changes to neurochemistry can also mean a big shift in hormones because the hypothalamus is another one of those noisy regions. The hypothalamus plays a role in what hormones our bodies release and when, such as stress hormones, regulating hunger, weight gain, insulin resistance, body temperature, blood pressure, and sleep. In the bodies of folks living with chronic pain, the hypothalamus is being sent too many signals, so it goes a bit haywire, producing too many or too few hormones.
That can mean the brain tells the body it’s scared, causing blood pressure to skyrocket, perpetuating the pain cycle. Over time, overall inflammation increases, can result in cardiovascular damage, and make chronic pain even worse.
But You CAN Take Control
You can get off the chronic pain roller coaster. Research shows that a change in mindset can make a huge difference. As one pain researcher put it, “If you perceive yourself to be disabled, you’re going to act like it.”
Even if you aren’t dropping everything to go out for a run right now, take a page from research on budding athletes. The old thinking said that we should tune into our bodies when working out. Well, new research is saying, “Maybe not so much.”
It turns out the best strategy for getting back into physical activity may be to distract ourselves from that activity completely. For example, instead of focusing on every ache and pain on a walk, try listening to a podcast, or singing along to a favorite song, or having a conversation with a friend. The idea is to shift focus from pain to something that brings joy or entertainment. In the end, it’s likely the walk won’t feel so hard; maybe it’ll motivate you to do it again, and the benefits will begin adding up.
Get Help When You Need It
Remember, you don’t have to do this alone. When you need help getting out of the pain cycle, a Lin health coach is here with encouragement and professional advice. Sign up to get started today to begin feeling relief and reversing chronic pain's effects on your body and mind. And hopefully, one day, really soon, you’ll be able to make dinner plans with your friends and show up the way you want to.