Pain- Why it Still Hurts

Why is your lower back still sore after all this time? Surely it should be better by now?

When we hurt or overuse our back, swelling and inflammation happen quickly to create healing. That inflammation causes spinal nerves to send signals to the brain to bring healing chemicals and stop us from moving so that it doesn't get worse. 

Central sensitisation 

In chronic pain, those brain signals from the nerves around the spine become very sensitive, and the flow of information between the low back and the brain often becomes frantic and unhealthy. The nerves and brain change the way they work when pain is constant, and that change can happen quickly. 

Over time, your nerves become more reactive, making you feel pain more intensely, even to things that shouldn't hurt much. This is called Central Sensitisation. It's like the volume on your body's pain signals gets turned up, making the pain feel stronger and spread to more areas. Emotional factors, like stress or anxiety, can also make it worse.

In summary, chronic pain is not only about the physical sensations in the body; it's also a complex interplay of signals, processing, and interpretation in the brain. Emotional and cognitive factors further influence the experience of chronic pain, making it a multi-dimensional and individualised phenomenon. 

Central sensitisation in chronic back pain can manifest through various symptoms. It's important to note that these symptoms may vary among individuals, and not everyone with chronic back pain experiences central sensitisation. Common symptoms associated with central sensitisation in chronic back pain include:

1. Increased pain sensitivity: What would typically be a mild or moderate pain sensation may feel more intense. 

2. Widespread pain: Central sensitisation can lead to the spread of pain beyond the initial site of injury or discomfort. The pain may affect larger areas of the body, contributing to a sense of widespread discomfort.

3. Pain amplification: The perception of pain may be amplified, meaning that stimuli that wouldn't usually cause significant discomfort can trigger more pronounced pain sensations.

4. Pain without obvious cause: Individuals with central sensitisation may experience pain without an obvious cause or in the absence of ongoing tissue damage. The pain may persist beyond the expected healing time.

5. Increased response to non-painful stimuli: Everyday activities or stimuli that are not typically painful may trigger a heightened pain response in individuals with central sensitisation. For example, light touch may be perceived as painful as can bright lights, loud noises, smells and foods. 

6. Allodynia: This is the experience of pain in response to stimuli that are not typically painful. For instance, even a gentle touch or clothing brushing against the skin may cause discomfort.

7. Hyperalgesia: This is an increased sensitivity to painful stimuli. Individuals with central sensitisation may feel more pain than expected in response to stimuli that would be mildly painful for others.

8. Sleep disturbances: Chronic pain, including central sensitisation, can contribute to sleep disturbances such as difficulty falling asleep or staying asleep.

Symptoms of central sensitisation can overlap with other conditions and often vary greatly between people. You may have all, some or none of these symptoms. Central sensitisation explains why you are still having back pain as well as other symptoms. The tools you are learning in this program can help you master it and enjoy life again. 

(Main video courtesy of Pain Management Network)