Chronic pain is pain that lasts three months or longer. The term covers many different pain conditions, including chronic low back pain, chronic headaches, fibromyalgia, chronic fatigue syndrome (myalgic encephalomyelitis) and chronic jaw joint (TMJ) disorders. These conditions are not fully understood and often occur together in the same person. The National Institutes of Health calls them chronic overlapping pain conditions (1).
Chronic pain should be evaluated by your physician to make sure a serious underlying cause hasn’t been missed. Chronic pain can take a heavy toll on mood. If you are struggling with thoughts of harming yourself, call or text 988 to reach the 988 Suicide & Crisis Lifeline, or call 911.
What Are the Symptoms of Chronic Pain?
Research suggests that these conditions share some common underlying mechanisms in the nervous and immune systems. According to the Chronic Pain Research Alliance, people with chronic overlapping pain conditions show changes in how they process sensation. They feel more pain in the area where they hurt, and pressure, touch or vibration can also cause pain in areas far from the main problem (2).
What Happens in the Nervous System With Chronic Pain?
It’s important to understand that pain is not just a sensation. It is a perception and an experience created by the brain. Most people think of their pain system as an on-off switch, so if they aren’t feeling pain, the system must be off. But that’s not how it works.
Your body has sensors called nociceptors that respond to heat, cold, chemical irritants and pressure. When they’re stimulated enough, they send signals through small nerve fibers into the spinal cord. Like other nerve cells, they always have some background level of activity. So why aren’t we in pain all the time?
The answer is that your spinal cord and brainstem have systems that filter and block these signals before they reach the conscious parts of your brain. When there is enough input, such as from tissue damage or inflammation, these filters are overwhelmed, and the signal reaches the parts of the brain that map the body, mainly in the parietal lobe. Even then, the signal doesn’t become pain until the brain attaches a negative emotional meaning to it. That doesn’t mean pain is imaginary. It means pain is real and is shaped by the brain, which is also why the brain is an important target for treatment.
The brain’s pain-control circuits are normally very good at blocking incoming signals before they reach awareness. These circuits involve the frontal and prefrontal cortex, the parietal lobe, the vestibular system, the brainstem and the spinal cord. After an injury, pain signals help the body heal by directing blood flow and inflammation to the injured tissue. Once healing happens, those signals need to be turned back down.
Other brain areas shape how unpleasant pain feels. The amygdala helps detect threats and process fear. The hypothalamus and pituitary gland release stress hormones that help us respond to threats, and some of these hormones can make pain sensors more sensitive. The anterior cingulate cortex is involved in the experience of suffering, and when it’s highly active, pain signals feel more distressing.
Chronic pain is best understood as a loss of balance between the systems that send pain signals and the systems that turn them down, combined with emotional distress that keeps the pain experience going. In acute pain, pain signals tell your brain that tissue has been injured. In chronic pain, these signals persist and grow stronger, and they may continue long after the tissue has healed.
Normally, when you stub your toe or burn your hand, the signal travels from your skin to your spinal cord and up to your brain. Your brain locates the problem, triggers healing, and the pain fades. In chronic pain, these pathways can overreact, and pain can continue weeks later. This is called central sensitization. When the pain-control systems don’t turn the signals back down after healing, the pain nerves keep firing and become more sensitive. Eventually, light touch, gentle pressure and even the normal chemical environment of the body can trigger pain (3).
Chronic pain also changes the brain’s maps of the body. As the brain’s map of the affected area is reorganized by ongoing pain signals, the brain may have more trouble knowing exactly where that body part is, and more trouble sending signals to turn down the pain coming from it (4).
The brain areas involved in the unpleasant side of pain also change in chronic pain. The anterior cingulate cortex can become highly sensitized (3). Many people with chronic pain notice that negative emotions feel stronger than before their injury and that negative thoughts are harder to manage. This is one reason depression and anxiety are so common with chronic pain (5).
These changes can also affect the body’s stress system, called the hypothalamic-pituitary-adrenal axis, raising stress hormone levels, which can further feed chronic pain (6). They also promote inflammation in the spinal cord and brain, which can make it even harder to turn pain down (7).
The result is that pain responses can become exaggerated and long-lasting. Pain can become disconnected from tissue damage and continue long after the tissue has healed, or in response to normal everyday sensations. The emotional effects of chronic pain can also spill into every part of a person’s life, affecting mood, motivation and thinking (3).
Many people with chronic pain move from provider to provider and try increasingly invasive treatments aimed at the injured tissue. When pain continues after the tissue has healed, it often means the nervous system itself has changed, and those changes need attention too.
How Common Is Chronic Pain?
According to National Institutes of Health research, about 11% of U.S. adults live with daily chronic pain. Chronic pain leads to billions of dollars in lost productivity every year from missed work and reduced ability to work (8).
How Is Chronic Pain Usually Managed?
Chronic pain is often managed with medications. Treatment often starts with anti-inflammatory medications. Antidepressants, gabapentin and related medications are commonly prescribed, and opioids are sometimes used, though they carry significant risks of dependence and overdose and are now generally used with more caution. These medications help some people, and their benefits and side effects vary. For many types of chronic pain, especially pain without a clear structural cause, research has found that opioids offer limited long-term benefit (8). Your physician can help you weigh the options.
Many treatment guidelines now also recommend non-drug approaches, such as exercise, physical therapy, manual therapy, cognitive behavioral therapy and other forms of rehabilitation.
How the NeuroRescue Program Can Help
Our care is designed to work alongside your physician and other providers, never in place of them. Please don’t change or stop any medication without talking with your prescriber.
We understand how hard it is to live with chronic pain. Our care focuses on the nervous system side of chronic pain: how your brain and spinal cord process sensory information and how well the systems that turn pain down are working. We look for systems that are overactive, underactive or not working well together, and we design a personal program aimed at bringing them back into better balance.
One of the brain’s most important jobs is figuring out where you are in the world. It uses your inner ear to sense where your head is in relation to gravity and how it’s moving, your muscles and joints to sense where your body is and what it’s doing, and your eyes to sense where you are in relation to everything around you. Your brain combines all of this into a picture of where you are, so you can respond to the world around you.
Your brain organizes this information as a set of maps: a vestibular map from your inner ear, a body map from your muscles and joints, a visual map from your eyes, and others. These maps need to agree with each other about where you are. In some people with chronic pain, these maps may not match, and research shows that in chronic pain, the brain’s body maps can reorganize in ways that make it harder to turn down pain signals (4).
Structural care. As you’d expect from any provider treating chronic pain, we use structural rehabilitation where appropriate, including therapeutic exercise, manual therapy and spinal and extremity adjustments, used when appropriate and safe for you. The structure of the body matters, and we’re well equipped to address it.
Research suggests spinal adjustments may do more than move a joint. Studies using EEG, brain stimulation and brain imaging have found that adjustments can produce short-term changes in how the brain processes sensory and movement information, including in the prefrontal cortex and the areas that plan and control movement (9, 10, 11, 12). Research also suggests spinal manipulation can reduce pain sensitivity, likely in part through effects on how the spinal cord processes pain signals (13). Researchers are still working to understand how long these changes last and how they relate to symptoms, but they help explain why we look at how your whole nervous system is working, not just the painful area.
Many people come to us after already trying several treatments for the structural side of their pain. That’s why we also focus closely on the brain and nervous system factors that can keep pain going.
Depending on your needs and test results, your program may also include:
Transcranial magnetic stimulation (TMS). TMS uses magnetic pulses to stimulate specific areas of the brain, such as the prefrontal cortex, which helps drive the brain’s pain-control systems. It has been studied for many chronic pain conditions (14) and for the depression that often comes with chronic pain (15). At our clinic, TMS is provided by our psychiatric mental health nurse practitioner, who will evaluate whether it may be appropriate for you.
Movement with visual feedback. Combining movement exercises with visual feedback has been studied as a way to help retrain the brain’s maps of the body, ease movement and reduce pain (16).
Transcutaneous vagus nerve stimulation (tVNS), gentle electrical stimulation on the skin of the ear, which has been studied for central pain (17).
Light therapy. Photobiomodulation, using low-level laser and LED light, has been studied for a range of chronic pain conditions (18).
Electrical stimulation. Several types of electrical stimulation have been studied for chronic pain, including in combination with laser and LED therapy, as non-drug options for managing pain (19).
Vestibular rehabilitation. Your inner ear provides one of the brain’s foundational maps of where your head is and how it’s moving. Vestibular stimulation has been studied for reducing chronic pain (20), and vestibular rehabilitation is often an important part of our care.
Eye movement training. Studies have found eye movement problems in conditions such as chronic neck pain (21). We carefully test specific types of eye movements and train any that need it.
Virtual reality. Virtual reality therapy can help integrate visual, vestibular and body-position input, and it has been studied for both short-term and chronic pain (22).
The therapies we recommend are always chosen based on your testing and exam findings, and we pace your program carefully so it challenges your nervous system without flaring your pain.
How the NeuroRescue Program Works
Your NeuroRescue Program begins with your Discovery Day. We start with a detailed history of your condition and your life on a timeline. This helps us understand the factors that may have contributed to where you are now, and identify related conditions that may be making it harder to move forward.
We measure how your visual, vestibular and balance systems are working through computerized analysis of your eye movements, inner ear reflexes and balance under different conditions. Our testing includes videonystagmography and saccadometry to measure several types of eye movements, the video head impulse test to measure inner ear reflexes, and CAPS computerized posturography to assess your balance under different sensory conditions. We also use NeuroSensoryMotor Integration testing to evaluate hand-eye coordination and cognition, and Virtualis testing to assess dynamic eye tracking and your perception of vertical in a virtual reality environment.
We combine this with a thorough physical and neurological exam of your sensory, motor, autonomic and cognitive systems. We also review any relevant lab work, imaging and prior testing, and integrate it with our findings.
Together, this helps us understand which parts of your nervous system are working well, which are struggling, and how quickly they tire. We use that information to design your personal NeuroRescue Program, aimed at improving function in the systems that need support and helping them work together. Our testing also helps us decide when to push and when to let you rest.
Our goal is to help turn the volume down on your pain, so you can move, sleep and live with more comfort and confidence.
Your Next Step
Living with chronic pain can wear you down, especially after trying treatment after treatment. You don’t have to keep searching alone. To find out if the NeuroRescue Program is right for you, contact one of our patient care coordinators to schedule your Discovery Day.
