Chronic Pain Causes You Need to Know

I talked with one of my patients this week about how she can use her understanding of energy flow to recognize the power she has to heal her chronic pain. I’ve included the transcript from the 9th lesson from the Energy Module in the New Healing Connection course in today’s blog post. You can use this information as you start to change your perspective on pain and other aspects of health.

Two of my patients have stories that are good examples of how chronic pain progresses.

The first patient is a woman in her forties who started to have migraine headaches when she was a teenager. At first her headaches weren’t so bad. They’d occur every few months after a big event, like a big test in school or when she didn’t get enough sleep. She’d get better with rest and some Tylenol.

Over the years her headaches got worse. She went to college and then got a job as a high school teacher. She enjoyed her work. But some days the kids could be a bit much, and the stress would trigger a migraine. She saw her doctor and was started on prescription migraine medicine.

A few years after she started teaching, she got married and had two kids. She kept working full time while raising her kids. Her husband helped some, but the pressure of housekeeping and childcare was mostly on her shoulders. If the kids were sick, she’d be up all night with them, and then she’d have to go to work the next day. She was exhausted all the time. Her headaches kept getting worse.

By the time her kids were out of diapers, she started to get chronic body aches. She’d have neck pain one day and back pain the next. It seemed that every day her pain would move to a different spot. She didn’t think about it much in the beginning because she was so busy.

She also started to get stomach problems and was diagnosed with irritable bowel syndrome. And as her kids got older, her headaches and body aches continued to get worse.

Then she developed insomnia. At night she couldn’t fall asleep. Part of the reason was her pain. Part of the reason was the fact that she couldn’t turn off her mind. She kept thinking of all the things she needed to do the next day. She worried about her pain. She worried about her kids and their problems.

By the time her kids were in their teens, her pain was becoming the center of her life. She was always trying to push past it, so that she could do her work and take care of her family. But it started to weigh on her, and she started getting depressed and anxious. She went to multiple doctors trying to find an answer. But it seemed that the medications they gave her just caused more side effects and didn’t help the pain. She tried physical therapy and meditation, and those things didn’t help. By the time she came to see me, she felt lost and hopeless.

The second patient was also a wife and mom who worked full time. She said her life was perfect until she was badly injured in a car accident. But actually, when she thought about it, the car accident wasn’t truly the start.

Her problems really started a few years before the car accident. She slipped and fell on some ice and injured her arm. She recovered but life started to get harder for her after that injury. She was more tired, and things didn’t come as easily for her. But she kept trying to do it all. She wanted to be a good wife and mother. She wanted her employer to be happy with her work. So she kept pushing herself.

Then she had two car accidents. The first only gave her a minor whiplash injury, and she recovered quickly. But the second was the one that almost killed her. She suffered a traumatic brain injury and developed many problems, including weakness on one side of her body. She developed chronic headaches and neck pain. She needed long-term hospitalization and rehab to help her recover.

She had three months off work and could have used more. But she had to go back so she wouldn’t lose her job. When she returned to work, it was harder to function than before the accident. Because of her brain injury, she was slower, both physically and mentally. She was more sensitive to the loud noises in the office, and she had trouble making judgment calls about social issues with coworkers.

Her coworkers started to gang up on her, trying to get her fired. And her home life was difficult too. Her husband wasn’t helpful. He expected her to take care of everything like she used to. Even her kids started to have problems. Her son started to hang out with the wrong crowd, and her daughter started having behavioral problems. When she came to see me, all areas of her life were falling apart.

These patients were referred to me because of their chronic pain. But I quickly realized that their pain was only the tip of the iceberg. The stories that led to chronic pain were just as important as the pain itself. I knew that if we didn’t address all the other issues involved, they’d never improve.

When I manage chronic pain, I look at my patients’ health from more than just a physical standpoint.

Of course I do a physical exam and make a conventional Western medicine diagnosis. But I don’t stop there. I also think about the rest of their lives. If we treat chronic pain with conventional Western medicine alone, often patients either don’t get significantly better or their improvement is short lived. I know that to be most successful, I need to look at this bigger, more holistic picture. I might not always tell my patients all the details about this different approach. Some of them aren’t ready to hear it yet. But I use it to guide my treatment, whether they understand it or not.

This holistic approach requires me to look at all different areas of my patients’ lives. I pay attention to everything—from their childhoods, to their relationships and work situations, to their habits and anything else that comes up. I treat them from the Western medicine standpoint, using medications and conventional therapies. I also incorporate my understanding of energy in both diagnosing and treating their pain.

When I talk about energy with my patients, sometimes they’ll ask, “What do you think is causing my pain, a physical problem or an energy imbalance?” I tell them that I don’t see this as an either/or question. Instead the answer is inclusive. It’s caused by both a physical problem and an energy imbalance.

On the physical level, we can see the changes in the physical body and we can understand the pathophysiology of disease. At the same time, on the energy level we can appreciate that energy imbalances also cause disease. The imbalances in the energy flow occur at a more microscopic level, and we might not be able to see them, but those changes are sitting at the root of the physical disease.

You can view physical and mental illness, along with problems in all aspects of your life, as being caused by a combination of two things:

First, you have your Achilles’ heels—your vulnerable areas that are especially sensitive to energy imbalances.

Second, you have an energy imbalance—a situation where you’ve allowed your energy flow to become stagnant or depleted. The combination of these two things causes and perpetuates disease.

You can apply this concept to chronic pain:

Consider the common Achilles’ heels, or vulnerable areas, that are present in patients with chronic pain. Start with the area where the pain originates. Often pain starts in a specific area of the body because of an injury or disease. For example, many patients have pain caused by arthritis. For them the pain originates in their joints. Their vulnerable areas are their joints. The second patient I talked about at the beginning of this lesson had headaches and neck pain that were triggered by her traumatic brain injury from a car accident. The trauma to her head and neck region activated her pain, so this is her vulnerable area.

There are two other body systems that are also usually active in patients with chronic pain, no matter what the original source of the pain is. These are the musculoskeletal and nervous systems. Your muscles and nerves can be activated because of an injury or disease in any other system. If you have a herniated disc in your low back, the muscles in that area can tighten up in reaction to the local inflammation from the disc herniation. The pain nerves can also be activated in that area. You can consider both the muscles and the nerves to be vulnerable areas in addition to the original herniated disc.

But frequently muscles and nerves aren’t just secondary actors. Often muscle or nerve dysfunction is the source of the problem. Let’s talk about muscle dysfunction. You may have heard a few different terms to describe this muscle dysfunction. It’s called myofascial dysfunction, muscle tightness, or muscle spasm. Whenever your muscles are tight, painful, and irritated, you can assume you have some aspect of muscle dysfunction associated with your pain.

There are many ways that muscle dysfunction can be triggered.

You can have a direct injury to your muscles that cuts or tears them. You can have a mechanical injury that doesn’t act directly on them but strains them. This can happen with a whiplash injury that strains the muscles in your neck. You can also have an overuse injury, where you injure your muscles because of repetitive use. For example, if you do a lot of work with your shoulders with repeated pushing and pulling or lifting, you can develop rotator cuff tendonitis.

If you do a lot of heavy lifting or other repetitive use, your muscles can get tired and be more prone to injury and pain. And if you have poor posture, you can put a lot of stress on certain muscles in your neck and back, and this makes them more prone to dysfunction and pain.

Muscle pain can also start in response to stress. If you have any type of stress, whether it’s physical or emotional, you may find yourself tightening your muscles. Think about a time in your life when you were stressed. How did you respond physically? Did you tighten the muscles in any part of your body?

Some people tend to clench their jaws when they’re stressed, and this can lead to headaches, jaw pain, and neck pain. Clenching is a common trigger for headaches, but it’s frequently overlooked. If you have headaches, whether they’re tension-type or migraine, pay attention to whether you’re a clencher. If so, working on jaw relaxation techniques can be very helpful in improving your pain.

Some people tighten up their neck and shoulders in response to stress. This triggers not only headaches, but also neck and upper back pain. Some people tighten up their low back muscles and develop low back pain. This is an interesting thing for me. I’ve never been able to consciously tighten up my low back muscles. They’re just sort of there for me. I use them to straighten up my spine, along with help from my abdominal muscles. But I can’t actively tighten them up. My patients with chronic low back pain tell me that they can actively tighten and relax their low back muscles. They recognize the sensation of how their low back muscles tighten up when they’re stressed. They’ve learned how to consciously work with those muscles to relax them. They can use this understanding to help manage their chronic pain.

Some people tighten up their chest muscles in response to stress. This can cause severe pain that can be confused for a heart attack. I’ve seen many patients with chronic chest pain who have undergone extensive evaluations because of the chest muscle dysfunction. When I was a resident, I had a patient who had severe chronic chest pain that would get worse when she exerted herself. I referred her to multiple specialists, and all the tests they did were normal. It was worrisome because her pain was so severe. I don’t remember whether we diagnosed her pain as being caused by muscle dysfunction. But now that I look back, I’m sure that’s what was going on.

When people have trauma to their muscles, either from an injury or some other cause, those muscles get activated in a way that takes them from a natural, relaxed state to a more reactive, hyperirritable state. Even after the wound heals, the muscles have a memory of the activation and they’re more prone to tightness and spasm. Things like physical and emotional stress, that wouldn’t previously have activated their muscles, now make them tighten up and cause pain.

I see this a lot in people who’ve had abdominal or pelvic trauma, whether it’s due to surgery, an injury, or childbirth. The abdominal wall muscles can become activated, and patients can develop chronic abdominal pain. This can also happen with the pelvic floor. The pelvic floor is the bowl-shaped group of muscles at the base of the pelvis that supports your pelvic organs. Once those muscles have been activated, it can be easy to tighten them in response to stress. This can lead to chronic pain in that region in both men and women.

My patients who’ve had injuries in their arms and legs will tell me that when they pay attention to it, they can recognize tightness and dysfunction in their muscles in those areas. Even if they don’t actively clench their hands or curl their toes, the activation of muscles in those areas can lead to chronic pain.

The problem with muscle dysfunction is that you can get caught in an unhealthy cycle. When you have a habit of tightening up your muscles for any reason, whether it’s because of an injury or because of stress, you can start a vicious cycle. Your muscle dysfunction can lead to pain in that area. Because of the pain, you don’t want to move. When you don’t move, you get deconditioned and your muscles get weak. Then when you try to move again, you have even more pain and reactive tightness because you’re so weak and deconditioned. This creates a cycle that can be hard to break.

The other area of the body that tends to be an Achilles’ heel, or vulnerable area, in patients with chronic pain is the nervous system.

The nervous system is complex. It contains billions of nerve cells, or neurons. Different neurons have different functions. Some are sensory neurons, and their job is to recognize all the sensory input into our bodies, including our five senses and pain. They take that sensory information to the brain by way of the spinal cord. In the brain, other neurons talk to each other and decide what all that sensory input means and what to do about it.

There are motor neurons that take the commands from the brain back out to our bodies. They tell our muscles how to move according to what our brains want us to do. Our nervous systems are very complex, and the interaction between all the neurons is something that scientists still don’t know a lot about.

It’s important to recognize that the ability to feel pain is a healthy, protective function, at least in the short run. We need to be able to feel pain so that we can be aware of injuries that can harm us. If you cut yourself, you may not always realize that you’re bleeding. The pain from the laceration alerts you to get help so you don’t bleed to death.

The problem comes when pain turns chronic. Research has shown there are many changes that occur in the nervous systems of people with chronic pain. When you have chronic pain, the pain neurons change the way they carry pain information from your body to your brain. They change the types of neurotransmitters they use to communicate with each other. They sprout new endings and communicate with each other differently in that way too. They become more sensitive and have lower thresholds for firing. All these things become the new habit for the pain neurons, and they remember these changes. This is why you can continue to have chronic pain even after the original injury heals.

Pain neuron dysfunction can be caused by different things. For example, you can have an injury to nerves during surgery. Whenever surgeons operate, nerves are cut in the area that’s being operated on. This usually doesn’t cause a long-term problem, but sometimes the nerves don’t heal like they should and this leads to chronic pain. As the wound is healing, you also can develop scar tissue that entraps the nerves in the area and triggers chronic pain.

Another way that pain nerves can be injured is by diseases like diabetes. In diabetes, when blood sugars are chronically elevated, nerves can be damaged and this can lead to pain, numbness, and weakness.

In addition to reacting to direct injury, the pain nerves can also be activated by injuries to other organ systems. For example, you can have an injury to a bone in your foot. Even though the pain neurons taking the sensory information from your foot to your brain haven’t been injured, they can still become hyperactive and make you sense more pain. The nerves themselves haven’t been injured, but for some reason they become sensitized.

When the pain neurons in the brain and spinal cord become more irritable and fire more often, it’s called central sensitization. When the pain neurons outside of the brain and spinal cord do this, it’s called peripheral sensitization. These changes in the pain neurons can end up being more of a problem than the original injury that triggered them. This is part of the reason why chronic pain is so difficult to treat.

Medical research still hasn’t been able to tell us why some people develop chronic pain and others don’t. We don’t know which factors make one person’s muscles or nerves more sensitive to being activated.

With conventional Western medicine, we treat chronic pain by helping the muscles relax and by calming the pain nerves so they don’t fire so often. We haven’t found a way to reverse the changes in the muscles or the nerves. We’re always chasing the pain, trying to manage it or mask it. But we can’t cure it.

This is why it’s so important for patients with chronic pain to recognize how energy affects their systems.

If you look at pain simply from a conventional Western medicine standpoint, there’s little hope to heal it. Chronic pain clinics tend to focus on helping patients learn how to live with their pain, rather than talking about healing it.

It may not be possible for everyone to resolve their pain. But you can take this new viewpoint and maybe you’ll discover a new way to heal yourself. In addition to receiving Western medicine and complementary therapies, see your pain as stemming from a combination of problems. First you can look at the vulnerable areas in your body. In what area of your body was your original injury? You can assume that is a vulnerable area, especially if it still bothers you. You can also assume that you probably have an aspect of muscle and/or nerve vulnerability too.

Now add the second part of the equation—the energy imbalance contributing to the situation. Remember that when you live with a chronic energy deficit, your body can pay the price. If you keep pushing yourself and spending more than your allotted energy units, you start borrowing energy from the cells in your body. You can get tired and depressed. And your vulnerable areas are the places in your body where you’re going to start to see problems first.

You might notice that on days when you’re more tired, your pain will be worse. And the more out of balance you get, the harder it will be to control. Eventually your pain may spread to other areas of your body and you may get other symptoms and diseases. Medications will be less effective as your symptoms worsen.

The first patient I talked about at the beginning of this lesson slowly developed an energy imbalance that manifested, initially, with headaches. Medications worked well at first, but then her pain spread and became more severe. More muscles and neurons became activated. The medications also stopped working as effectively. Her life became steadily more miserable and less tolerable. She spent more and more time and energy managing her pain.

When I started seeing her, we worked on a number of things. I tried acupuncture, but that didn’t work. I adjusted her medications, and that helped a little bit. But really, all her healing came from her own work on herself. She learned about energy and rest. She also learned to work with her emotions and thought patterns in a way that brought them into healthier alignment. It took some time, but her pain improved. She was able to recognize the triggers for her pain. She was able to recognize when she needed to give herself more time to rest. She also learned how to give herself permission to let her husband and her coworkers help her when she needed support. All these things contributed to her success.

The second patient I mentioned also had an energy imbalance. But it didn’t manifest slowly. Instead it seemed to hit out of the blue. She thought her life was perfect, and she had no idea about how close to the edge of the energy cliff she was. Then suddenly she started to have multiple accidents. And she had no energy reserves to deal with her injuries. So things seemed to snowball until quickly her whole life changed.

Luckily acupuncture and some nonopioid pain medications were helpful for her pain. And with the help of a pain psychologist, and her work with energy, emotions, and self-care, she was able to start the long process of learning to find more balance in her life. She had to make changes at home and at work. She had to learn how to stand up for herself and ask for the help she needed. But with time, she started to see changes.

You can use your vulnerable areas as barometers to help you know when to watch yourself. If your pain or other conditions get worse, you know there’s an energy imbalance to work on. As you work to take care of yourself, you’ll start to feel better. By approaching your life this way, you’ll find new aspects to healing that you hadn’t recognized before.

EXERCISE: Look at your pain using this new perspective. Identify your physical vulnerabilities—your Achilles’ heels—that have contributed to your pain. What parts of your body are sensitive and what organ systems are vulnerable? Remember that the muscles and nervous system are areas that are usually also sensitive in patients with chronic pain.

Then look at your energy flow and pay attention to the energy story of your life. Review your energy history. Pay attention to what was going on in your body regarding your energy expenditures before and after you got sick. What changes can you make to bring your energy flow into healthy balance?

To learn more about viewing health in a new way, click here to get a preview of the New Healing Connection course.

Remember, you have more power than you can imagine—power to heal yourself and change your life—starting from the inside out!