Why Chronic Pain Changes Everything

In medical literature, there’s two kinds of pain: acute and chronic pain. By definition, chronic pain is any pain that lasts more than 3 months.

The terms ‘acute’ and ‘chronic’ have nothing to do with how severe the pain is. You can have a low grade pain in your back for a week and that would be acute pain. You can have severe back pain for 6 years (as I did) and that is chronic pain.

The crucial thing you need to know is that something that happens in your nervous system when you have a pain for more than 3 months. It’s called sensitisation. There are actual chemical and neurological changes in your body that cause the chronic pain to be amplified.

This means that the pain message you are receiving often has no relationship to physical damage.

This can be very hard to accept. In my case, my original pain came from a herniated disc and soft tissue damage when I crashed into a hillside at top speed while hanggliding. The damage was clearly evident on MRI scans. Six years later however, the damage was completely healed – but the pain remained.

And to me – the pain was 100% real – and precisely like the pain I had in the first months after my injury. Just as severe, just as destructive for my quality of life. The pain had become a neural pathway laid down in my brain. This happens all the time in less troubling ways – for instance when you learn to ride a bike you lay down neural pathways so you can always remember how to ride a bike.

In my case, the pain messages were switched on in my brain by certain triggers – like exercise (sore for three days after) or waking up (took my 5 minutes to get out of bed – my back was so sore.)

But the pain messages – while extremely disruptive – were not in any way related to physical damage in my back. The original problems caused by my hang gliding crash were healed – what I had was a pain sensitisation problem.

I’ve drawn two diagrams below to explain how this works.

Normal Process of Recovery from an Injury / Acute Pain



Chronic Pain Process


Notes on these diagrams: they’re conceptual – not absolute. 3 months is the generally accepted period of time for a pain condition to turn from acute to chronic. The recovery time for the original cause of the pain varies depending on the injury. And it’s unknown why in some people the process of sensitisation doesn’t reduce as the injury heals.

However….the possibility that your pain may be caused by a neurological rather than structural problem is especially difficult to consider when there was an obvious trauma that caused the initial pain. This diagram shows you how this can occur – and I hope that it will convince you to at least investigate mind body syndrome and pain sensitisation if you have had pain lasting more than 3 months.

The sensitisation process can last the rest of your life- there is no ‘use by’ date. Therefore it needs to be addressed formally and properly. So the key to almost all chronic pain is for the sensitisation process to turn off and finding out how to do this is the ‘holy grail’ of pain management.


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hidden driver of chronic pain?
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