Chronic Pain Can Exist Without Physical Injury

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Chronic pain is not like pain from an injury. It has a different cause and a different treatment. Chronic pain often arises from the brain, while injury pain comes from damaged tissue in the body like a joint.

Scientific studies show that chronic pain often develops when the brain continues to send out pain messages even after an injury has healed. This happens because a problem with the way the brain processes pain has developed. When this occurs, the treatment must be focused on the nervous system, because it is now the source of the problem.

Conventional thinking dictates that pain comes from structural damage in the body, such as a sprained ankle or broken bone. Pain is protective. It’s your brain’s way of telling you to rest the injured area. The symptoms should resolve when the injury heals. But not all pain falls into this definition.

The latest research demonstrates that chronic pain doesn’t necessarily mean a physical injury is present. A nervous system signaling problem can develop during the healing process and cause the pain to continue even after the injury that initially prompted the pain has healed.

This pain—called “nociplastic pain”—is not of the protective variety, but a false alarm. This pain type underlies the most common chronic pain conditions: chronic back pain, widespread body pain, migraines, irritable bowel syndrome, and pelvic pain. When this condition is the culprit behind your pain, you require a different treatment approach. Rest won’t resolve nociplastic pain. Turning off the nerve signaling problem in the brain will.

Complexity of Chronic Pain

When pain becomes chronic, the brain changes the way it processes the signals, and more regions in the brain are involved. With acute pain—such as a broken bone—the injury signal is relayed: It hurts. You don't put weight on the injured bone. With chronic pain, multiple brain areas are tied into processing the pain signal. A negative emotional state turns up the pain level you feel. Low mood, depression, and anxiety increase the pain level. And fear, stress, and a history of trauma can also dial up the pain level.

Help for chronic pain

Paying attention to how emotions, mood, and stress affect your symptoms helps you manage these factors and turn down the volume of the pain signal you feel. For many people I have treated, addressing these factors has reduced pain by 50 percent. Additionally, there are a few medications that have been modestly helpful for nociplastic pain.

Finding a provider who knows how to diagnose and treat nociplastic pain is imperative. Physicians who work at pain specialty clinics are most familiar with this condition. Physical medicine and rehabilitation doctors are trained in this area as well. Many psychologists specialize in chronic pain treatment.

I explain the modifiable factors of chronic pain in my online class and book, Sunbreak: Healing the Pain No One Can Explain.

To find a therapist, visit the Psychology Today Therapy Directory.