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Explaining Chronic Pain

Pain Explained

Chronic pain involves changes in the peripheral nervous system (PNS) which conveys nociceptive information to the central nervous system (CNS).  Over time, changes occur in the CNS that can cause continuation of the nociceptive information – even if the original stimulus has been removed!  For instance, say someone has a very painful ulcer on their calf.  The doctor sees the infection is spreading and must amputate the leg to save the person’s life.  After the amputation, the patient continues to report pain in the calf from the ulcer.  This is called phantom limb pain.  Let’s work through the process of how phantom limb pain (and chronic pain) occurs.

A-delta and C fibers are nociceptor unencapsulated receptors (free nerve endings) that respond to noxious stimuli.  Noxious stimuli is an actual or potential tissue injury that is likely to cause pain.  Nociceptors convert mechanical, thermal, and chemical energy into electrical signals and carry this information to the CNS.  Mechanical energy can include compression or tension.  Thermal energy includes heat which is caused by inflammation.  While chemical energy is a response to the chemicals in the body.  The nociceptors are found in/around most tissue including skin, muscle, tendons, joint structures, periosteum, intervertebral disks, and within peripheral nerves.

Nociceptors can begin to have increased responsiveness, which is termed peripheral sensitization.  Sensitization of a neuron is characterized by increased spontaneous activity, a decrease in threshold of response to noxious stimuli, an increase in responsiveness to the same noxious stimuli, and/or an increase in receptive field size.  So, what a normal nerve might perceive as slightly painful a sensitized nerve may perceive as excruciatingly painful.

Nociceptors then send their information up to the CNS:

  • Creating a reflexive response that is coordinated within the spinal cord to withdraw the body from the painful stimulus (i.e. pulling your hand away from a hot stove)
  • Ascending nociceptive pathways which take the information up to the brain to be further processed and may trigger
  • Descending facilitatory pathways which increase the nociceptive response and can cause referred pain, secondary hyperalgesia, and contralateral hyperalgesia or
  • Descending inhibitory pathways which decrease the nociceptive response

More recently, researchers have found glial cells in the CNS which also play a critical role in the processing of nociceptive information.  Research indicates that glial cells can release anti-inflammatory factors that help to restore normal nociceptive processing.  However, they also release a variety of substances that facilitate nociceptive information.  Therefore, glial cells play an important role in both the facilitation and inhibition of nociceptive information in the CNS.

Are you completely confused with all of this and questioning how it applies to your chronic pain?  Hold tight – the next blog posts discuss this in further detail regarding specific diagnosis.  Or, if you would like to understand more about the pathways involved in chronic pain, please feel free to contact Amy at Physical Therapy for everyBODY at (425)658-4944 or amykonvalinpt@gmail.com.  I am passionate about education and would be happy to have a phone conversation with you!

Dr. Amy Konvalin

Dr. Amy Konvalin

Struggling with pain and dysfunction can impact every part of our lives — it drains our energy, distracts us from our goals, and keeps us from the people and activities we love. As an Orthopedic Clinical Specialist, Dr. Amy Konvalin understands how frustrating those limitations can be — and she knows how to help get you back to the life you want to live! Beginning with a focused evaluation, Dr. Amy works to determine the root causes of your pain, as well as understanding how it affects the way you move through your world. Dysfunctional patterns of movement often grow worse with time and cause further damage if left untreated — so it’s important to address these issues as soon as possible. Dr. Amy knows there is no one-size-fits-all plan for success, and she partners with patients to identify their unique treatment goals and personal values. Using these goals as a guide, Amy uses her doctorate training in manual (hands-on) therapy and exercise prescription to treat patients with a wide variety of medical challenges and histories throughout the Maple Valley, Black Diamond and Covington areas. Dr. Amy is also a wife to a Boeing superstar/former C-130 navigator. While they lived in Germany, Dr. Amy was able to volunteer with the US Army to treat military personnel and civilians on base. She has two beautiful teenage ballerinas who keep her on her toes and educate her on all things ballet! Bailey, the princess pup, is her running partner and her napping partner. In the spare moments in between, Amy enjoys reading, yoga, wine with friends, Pilates, and walking on the beach.
Dr. Amy Konvalin

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