PAUL BIEGLER is a journalist and former specialist physician in emergency medicine. In Why Does It Still Hurt? Paul investigates the true source behind chronic pain and how this knowledge can help you heal.
AKINA HANSEN reports.
Pain is your nervous system’s way of signalling damage to your body and, in turn, protecting it from further harm. For many people, this sensation is felt acutely, such as when you bump your elbow or scald yourself with hot water. But for others, it can persist.
In fact, chronic pain afflicts one in five people and is categorised as ongoing pain that lasts for more than three months. This pain is usually unrelated to physical injury. So, why does this happen? And how do we treat it?
In Why Does It Still Hurt Paul Biegler investigates the history and true source of chronic pain by speaking to experts, doctors and chronic pain sufferers. Through his book he hopes to shed light on new studies and therapies that will help readers find the appropriate treatments to live pain free.
For Paul, this subject is particularly personal as he knows all too well about the suffering that can come with living with persistent, niggling pain. A few years ago, he injured himself when he carried some heavy groceries back from the market on his bike.
‘I was lugging too much weight and gave myself a case of patellofemoral pain syndrome – pain behind the left kneecap,’ he tells me.
Months passed but Paul’s pain persisted, leaving him basically immobile and frustrated. He sought advice from an orthopaedic surgeon who suggested surgery to trim the meniscal tear which would prevent his torn cartilage from rubbing against the knee joint and, in turn, relieve his pain. As a former doctor, Paul did his due diligence and researched the surgery prior to deciding whether he would go ahead with it. What he learnt was fascinating. One-third of people over the age of 50 have a torn meniscus, and of these, 60 per cent have no pain at all. So why was he still experiencing pain and why was surgery being suggested as the best approach to resolving his pain?
It’s important to point out that pain is a multibillion-dollar industry. Patients are prescribed expensive narcotics and invasive surgeries each year for their pain. And yet, Paul’s research found that when it comes to chronic pain, these treatments are often ineffective, as the source of the pain is unrelated to actual injury.
Upon discovering this, he decided to see a sports and exercise physician. He was told that ‘given the pain was now officially chronic, a good part of it was no longer coming from the knee, but from sensitised nerves in my spinal cord and brain, something called “central sensitisation”.’
Our nervous system is constantly forging new pathways between neurons in the brain, which is also referred to as ‘neuroplasticity’. This happens, for instance, when you’re learning a new language.
‘You can also forge unhelpful “maladaptive” pathways, and that’s what happens in chronic pain,’ Paul says. ‘When a damaged part radios in pain signals for too long, neuroplastic changes in the spinal cord and brain can make a person super sensitive to any signals coming from that part. Even simple pressure, which wouldn’t normally hurt, can be interpreted as pain.’
In most cases the injury has long healed, but a trick of our nervous system prolongs the sensation of pain. The brain is in fact, making a mistake. This mistake is central sensitisation.
‘The process is those unhelpful neuroplastic changes cause a non-painful stimulus, like movement or pressure, to be felt as pain’, he tells me. ‘It can also cause things that shouldn’t hurt much, to hurt a lot, and for pain to spread, insidiously, to a wider area around the bit that was first injured.’
What struck Paul was that he and most people, including health professionals, were poorly informed about central sensitisation. Many of the people he spoke to relay similar experiences with this. And for them, learning about it has also been truly transformative. One such example is a woman called Lauren, who was hit by a truck while riding her bike, which resulted in chronic pain in multiple areas of her body. In search for a treatment that would work, she stumbled upon ‘central sensitisation’ while listening to a podcast.
‘It was such a relief for her because she could give up chasing pointless treatments and focus on the real cause of her pain,’ says Paul.
Identifying this as the true source of ongoing pain was key to Paul’s own healing and he believes it will be for others.
Short-term pain is the body’s healthy protective response – it stops you moving an injured part to help it get better. Drugs, injections or surgery often make sense as treatments for short-term pain. But when pain becomes chronic, those things are less likely to help. If central sensitisation is identified, which it can be through questionnaires and something called ‘quantitative sensory testing’, the treatment pathway should be different. Keeping central sensitisation front of mind simply ensures that people get treatment aimed at the right cause.
‘Chronic pain is not “all in your head”. It’s 100 per cent real. But it is fostered by a belief that the painful bit is catastrophically damaged, and by the negative emotions that naturally flow from that belief.’
According to Paul, Professor Vania Apkarian, who is largely behind this discovery, established that ‘negative emotions act as a filter that biases the brain to think any sensation from a painful part is threatening, dangerous and indicative of ongoing damage. When the brain senses threat, it’s more likely to make pain.’
Therapies such as pain education, psychotherapy, hypnosis, and gaining an understanding of central sensitisation can help people redefine their meaning of their pain, allowing them to shift their perception of their pain from being a threat to something that can occur even when the injury has healed.
‘That understanding, in and of itself, can lead to brain changes that “close the gate” in the spinal cord on ascending pain signals, reducing pain,’ says Paul.
Why Does It Still Hurt is an optimistic book for people struggling with chronic pain.
‘What I’ve learnt from my own journey, and those of the remarkable people I interviewed for the book, is that recovery is more than just possible. It can even happen for people who’ve been crippled with pain for a lifetime.’