Your mind and body are not designed to withstand being in pain for a prolonged period. Therefore, chronic pain, which lasts for 3 months or more, can take its toll on the mind and body. Let’s get to the specific effects.
Low Mood, Anxiety, And Depression
One of the biggest impacts chronic pain has on our brains is how it affects our mood. Being in pain on its own can be taxing emotionally, but when you pair that with the effects chronic pain can have on our lives, things can get tough.
Being diagnosed with chronic pain and knowing that this pain is not going to go anywhere quickly, can be a really difficult concept to come to terms with. Stigma and lack of education often mean that medical professionals and society imbed beliefs within us that ‘chronic’ means forever, and that you are always going to be in pain. This is an understandably terrifying concept.
Chronic pain can feel as though it has sapped all of the joy out of your life. When it’s left untreated, functioning can be reduced. Many people aren’t able to work or keep up with the hobbies and activities they used to engage in before they were chronically ill. This can be detrimental to an individual’s mood.
On top of that, not being able to work means that financial worries come into play. Concern about pain worsening can induce anxiety and yet more stress. Social isolation can result in people feeling that they are alone in their struggles which contributes to a drop in mood.
Chronic pain doesn’t only affect the individual, but also the patient’s loved ones. Connections can become tense, and often family takes on a caring role. Having to ask for help and loss of independence can result in the person in pain feeling embarrassed, guilty, or like a ‘burden’.
Hypervigilance is common with chronic pain, which means that patients are overly focused on their pain. This often leads to catastrophizing, which means that patients are worrying excessively about their pain to the point that it is interfering with their lives. Often the worry that they are going to worsen their pain or reinjure themselves, means that patients will start to fear their pain and even avoid activity in reaction to this fear: this is called fear avoidance.
All of these factors can increase stress levels and anxiety, lower mood, and often result in comorbid mental illnesses alongside chronic pain. Depression and anxiety are extremely common in pain patients, with up to 85% of chronic pain patients being affected. Mood disorders are often comorbid with chronic pain. These mental illnesses can contribute to worsening pain and other symptoms. The emotional impact of chronic pain is so severe that pain patients are at a higher risk of suicide. Chronic pain patients are at least twice as likely to have suicidal thoughts or behaviors than the general population as this study states.
Changes In Brain Structure
Being in long-term pain changes the structure of our brains. Chronic pain reduces the volume of gray matter in our brains. Grey matter is the area of the brain which controls learning, attention, memory, thought processes, motor control, and coordination. This means that chronic pain patients can have problems with memory processing, learning new things, keeping their attention focused on one task, thinking through problems, and finding solutions.
Motor control can also be impacted as this study explains. This means that chronic pain patients can struggle to control their motor functions (including day-to-day activities and movements and more precise movements and coordination).
This study found that chronic pain patients had up to 11% less grey matter than those without chronic pain. This is the same amount of grey matter that would be lost in 10 to 20 years of aging! The study discovered that the longer a person is in chronic pain, the greyer matter they lose, explaining that, “The decreased volume was related to pain duration, indicating a 1.3 cm3 loss of gray matter for every year of chronic pain.”
This can sound scary but don’t worry. This doesn’t mean your brain is permanently damaged. This study from the Journal of Neuroscience went into depth to discover whether this impact chronic pain has on the brain’s structures is reversible, and concluded that “we suggest that the gray matter abnormalities found in chronic pain do not reflect brain damage but rather are a reversible consequence of chronic nociceptive transmission, which normalizes when the pain is adequately treated.”
This means that when you get effective treatment for your chronic pain, you can reverse the effects and regain the brain’s normal functioning. However, the key here is that the longer you are in untreated chronic pain, the grayer matter is lost. Therefore, the longer without treatment, the longer it will take to recover.
This study concluded that “Neuroplastic brain changes that may have developed over several years (as a consequence of constant nociceptive input) need probably more time to reverse completely.” So, the sooner you seek treatment, the quicker you can get back to a normal level of functioning both physically and cognitively.
Altered Central Nervous System Processing
Our brains are neuroplastic, which means they change as they learn from what is happening in our environment and what we go through in our lives. When our brains are in chronic pain, the neural pathways in our brains and central nervous system change. They become sensitized and over-reactive.
As pain patients become more sensitized to pain, they can experience more pain than they should in reaction to acute pain; this is known as hyperalgesia. Patients often experience pain in reaction to external stimuli when they shouldn’t, for example when they scratch their skin or take a shower; this is called allodynia. This is common in fibromyalgia and from personal experience, I know it can be one of the most difficult symptoms to live with.
The neurochemistry within chronic pain patients is altered in comparison to those without chronic pain. Neurochemistry simply means the messages that are received and sent out throughout the body through chemicals and nerves. This means that the sensitivity of other seasons, such as sound and smell, can be increased.
Effects On Brain Equilibrium
The various areas or regions within the brain of a healthy person have something known as a state of equilibrium. This essentially means that they work in balance with one another. In a healthy brain, when one region is more active, the others are less active. Scientists have discovered that in chronic pain patients, the region of their brain with regulates emotions is constantly active, even when other regions are more active. This can wear out this area of the brain and mean that it is not functioning optimally, because it’s not getting the rest it needs. This article explains that this area of the patient’s brain is, “stuck on full throttle, wearing out neurons and altering their connections to each other.”
Usually when you’re trying to focus on a certain task or figure out the solution to a problem, the area of your brain needed for that task will become more active, while the others will quiet down so that you can concentrate. Within chronic pain patients, their brain is always ‘noisy’. This can result in a reduced attention span along with problems thinking clearly and solving problems.
Due to the reduced levels of functioning and movement we mentioned earlier, chronic pain patients can also experience deconditioning. This means that their muscles weaken because they are not being used. Their bodies become less fit because they are not getting the exercise, they need to stay healthy and strong. This can increase pain, decrease mobility and have a serious negative impact on quality of life.
Being in near-constant pain can take its toll on muscles, nerves, and joints. This can lead to atrophy (meaning weakening), neuropathies (meaning malfunctions of the nerves), and contractures (meaning the muscles, tendons, ligaments, or skin are in a state of permanent tightening), as this article explains. In turn, this can make it hard to move, reduce flexibility, and in time contributes to increased pain and disability.
When areas of the body experience deconditioning, other areas of the body will try to compensate. This often results in uneven gait when moving, incorrect postures, and other unconscious compensating behaviors. This puts more strain on the areas of the body which are trying to compensate, which in turn can lead to overuse, degeneration, and other associated problems. It can even make the secondary sight of compensation more painful that the original problem!
When you’re in chronic pain it can be really difficult to sleep. This study explains that impaired sleep is highly common in those with chronic pain, explaining that it affects, “50–89% of the chronic pain population”
Sleep is vital to maintain general physical and mental health. When we sleep, we give our body the time to recuperate and re-energize, in turn allowing our bodies and minds to function in the best way possible during our waking hours. Sleep has an effect on every process within our bodies and brains. When we don’t get the sleep, we need due to chronic pain, it can have serious consequences on our health.
This study on the impact of impaired sleep patterns explains how seriously this can affect the lives of even healthy people without chronic pain: “Long-term consequences of sleep disruption in otherwise healthy individuals include hypertension, dyslipidemia, cardiovascular disease, weight-related issues, metabolic syndrome, type 2 diabetes mellitus, and colorectal cancer.”
Chronic pain patients are more likely to struggle with hypertension, which essentially means high blood pressure. This is “due in part to altered processes in pain pathways and cardiovascular function that normally overlap”, as this study states. The study also explains that the mechanism known as the ‘baroreflex’, which controls changes in our blood pressure, is also involved in normal pain processes. It’s involved in the same process that inhibits pain in people without chronic pain.
When chronic pain comes into play the baroreflex’s processes are interrupted and aren’t doing their job properly, so hypertension follows. Hypertension means that the body is overworked and the blood flow is functioning over time. It can lead to many health problems when it’s left untreated including heart attack, stroke, heart failure, and angina among other problems.
Hormonal And Chemical Effects
Chronic pain has an impact on our endocrine system, which is the system within our bodies that controls the hormones being sent throughout our bloodstream. Hormones regulate a lot of vital things within our bodies including metabolism, sexual function, growth, development, how we sleep, our mood, how the function of our tissues, and more! When our endocrine system is unbalanced, it can have some worrying effects on our minds and body.
The way our bodies produce and regulate insulin and metabolize lipids are affected by chronic pain as explained here. This means that the way our body is breaking down fats and processing the food we eat is affected. This can lead to weight gain, diabetes, malnutrition, and the buildup of fat within the arteries which can contribute to the cardiovascular issues we discussed earlier.
For many reasons, living with chronic pain is highly stressful. Stress causes pain and pain cause stress, otherwise known as the pain and stress cycle. This cycle is a vicious one. It can have very detrimental effects on the body. Glucocorticoids are hormones that control many systems within our body and are released more so when stressed. When cortisol (a glucocorticoid known as the stress hormone) is released excessively, it does the opposite of its intended purpose. Excess cortisol increases inflammation. This study explains the impact of long-term inflammation: “Inflammation induces oxidative and nitrosative stress, free radical damage, cellular death, aging, and systemic tissue degeneration.”
Excess cortisol also increases fear which perpetuates this stress and pain cycle. Adrenaline is sent out in response to these high levels of stress. If you think about it, when you’re in that ‘fight or flight state, your body needs to prioritize certain resources to get you ready to jump into action. When these hormones are sent out for a prolonged period, your body thinks you are constantly in this emergency and so always has you ready for action in response. Adrenaline increases your blood pressure, increases your respiratory rate, dilates your eyes, and sends increased blood flow to the areas of your body that are going to help you to react to an outside threat.
In the long term, this can cause problems with increased blood pressure, breathing, vision, and more. The systems within your body which are deemed ‘less important during an emergency are given fewer resources in response to these hormones being sent out. This means that in the long term, they are not given the blood flow or other resources they need. This can result in digestive problems, reduced bone density, and even a lowered immune system!
Low levels of serotonin have been found in chronic pain patients, as well as problems with how the body processes serotonin as this study discusses. Serotonin is a chemical that helps to keep your mood stable and gives you a general sense of well-being, as well as playing a major part in other bodily processes. Low levels of serotonin can result in mental health problems, digestive issues, problems sleeping, reduced bone health, reduced sexual function, and even problems with blood clotting.
Testosterone deficiency is also common in chronic pain patients. Testosterone is a hormone produced in both females and males to help our bodies grow and function. Of course, the most well-heard job of testosterone is to keep the reproductive system healthy and to maintain sex drive. When we lack testosterone it can cause reduced sexual function, hot flashes, weight gain, loss of muscle mass and more as this article from Harvard Medical School describes.
Reduced Sexual Function
Up to 63% of patients with chronic pain report reduced sexual function. Hypertension can contribute to sexual dysfunction, often causing lower libido in women and erectile dysfunction in men. The hormonal definitizes we discussed can of course lower sex drive.
Reduced sexual function can also come from being in pain, fear of avoidance of movement, and even deconditioning. Often social withdrawal, changes in dynamics within relationships, and problems maintaining connection, which we mentioned earlier, can increase the likelihood of reduced sexual function. The mood is often a contributor to a lack of sexual desire, along with a lack of confidence.
As well as the hormonal effects which can be a factor in weight gain, deconditioning, and lack of functioning can often contribute to obesity. When the body isn’t getting the exercise, it needs to burn calories, which can result in weight being gained. Being overweight adds extra pressure to the joints which can increase pain and reduce mobility. Obesity also overworks your heart, lungs, and other bodily systems, because your body isn’t designed to be providing for and controlling an overweight body.
There IS Hope
All of these negative effects chronic pain can have on the body sound worrying. Try not to panic though. The effects of the vast majority of these issues can be reversed. Weight can be lost. Your body can be reconditioned and regain general fitness. Stress and its effects can be reduced to a more manageable level. The cognitive effects on the brain can be reversed. Mental illness can be treated. Perhaps most importantly of all, chronic pain can be treated! You can get your life back!
There are many treatments available to help you regain your quality of life. Medications can be useful and psychological treatments such as Cognitive Behavioral Therapy (CBT), Graded Exposure Therapy and more can help you to overcome your symptoms! You can seek help from your doctor. The sooner you get treatment, the sooner you can get a handle on your symptoms and stop the effects of chronic pain in their tracks!
Precision Pain Care and Rehabilitation has two convenient locations in Richmond Hill – Queens and New Hyde Park – Long Island. Call the Queens office at (718) 215-1888, or (516) 419-4480 for the Long Island office, to arrange an appointment with our Interventional Pain Management Specialist, Dr. Jeffrey Chacko.