Stopped in Your Tracks: Enduring Persistent Physical Pain and the Link to Cognition

Originally published by A Voice For Choice Advocacy on March 14, 2024.

EDITOR’S SUMMARY: The pain you feel in your wrist, tooth, back, or anywhere else in your body has implications beyond its area of impact. If you’ve put your work life on pause, and can barely focus on other important areas, it’s likely due to the influence pain has on your mental capacity as well. Feeling completely consumed is not uncommon, and deciding which path(s) to take for immediate and long-term relief is undoubtedly a top priority.

Written by Jennifer Wolff-Gillispie HWP, LC

Edited by Nicki Steinberger, Ph.D.

Pain is almost synonymous with living. It is something nearly everyone will experience in their lifetimes. From your first “boo boo” as a toddler, to the misery of a headache, and the intense agony of a broken bone, physical pain is something you can not escape. What’s more, your most painful experiences may be etched into your memory, coupled with the emotions you experienced at that time.?

Wired to remember, previously experienced high-intensity pain can lead to fear and anxiety, related to experiencing that pain again. While the anticipation of pain may be conscious or subconscious, the results are the same. In an article from National Library of Medicine (NIH), “Subliminal (latent) processing of pain and its evolution to conscious awareness,” this is reinforced:?

“The emergence of chronic pain is usually not abrupt in onset. Subtle ongoing conscious or subconscious processes contribute to a brain state that defines the ‘chronic pain phenotype’, usually associated with a complex phenotype involving sensory, emotional, cognitive, endocrine and other processes.”

While minor aches and pains may come and go with little to lament about, excruciating pain may be long-lasting and unbearable to live with. Julius Caesar was quoted saying, “It is easier to find men who will volunteer to die, than to find those who are willing to endure pain with patience.”?

Experiencing pain, however long it lasts, can be distracting to put it mildly. You might not be able to “think straight,” and your ability to focus may be nil. Pounding, pulsing, and throbbing pain has a way of taking over your mental capacity, leaving you unable to do much of anything. If you find yourself incapable of completing tasks, even the basic daily ones, know this is a common phenomenon. From “Cognitive dysfunction and pain: considerations for future research”:

“For many people with chronic [or otherwise persistent] pain the experience of pain is constant or nearly constant. For those with consistent pain, pain may act as a constant interruption, the effects of which may be compounded by the addition of other internal (e.g., fatigue) and external interruptions on activity.”

Pain negatively affects cognitive ability, and can shift the way you do things. Your levels of activity and types of activity may look very different than they did prior to pain setting in. From the University of Arizona, “Four Questions: Chronic Pain and How It Affects the Brain”:?

“If you’re suffering from chronic [or persistent] pain, your ability to make good decisions or adapt to new information might be compromised. You might not realize it, but your friends and others might notice that you’re sticking to what you know. You’re not venturing out, you’re not trying new things, you’re not learning new information. You’re kind of on autopilot.”

Whether your pain is chronic (lasting more than 3 months) or acute (severe/sudden), living with ongoing pain is undeniably a miserable state of existence. Without doubt, having to endure this can affect your mind in addition to your physical body. According to Daniel K. Hall-Flavin, M.D.:?

“Pain and depression are closely related. Depression can cause pain — and pain can cause depression. Sometimes pain and depression create a vicious cycle in which pain worsens symptoms of depression, and then the resulting depression worsens feelings of pain.”

While pain and depression can be intimately linked (explored later in the article), and gnaw at you over time, how might you mitigate the intensity of the pain you are experiencing now? To gain a better understanding, here’s a look at the science of the pain experience.

Acute and Chronic Pain: Typical Allopathic Treatments

Acute pain is typically a protective response to immediate tissue damage or injury. Nociceptors, specialized nerve endings detect dangerous stimuli (such as heat, pressure, or chemicals) and send pain “alert” signals to the spinal cord. The spinal cord then processes these signals, which ascend to the brain through the nervous system. The brain interprets these signals as pain, generating a rapid, conscious perception of the injury along with an appropriate physical response.?

This is an accurate and vital process that allows your body to receive the pain message and respond with a near immediate correction from the external assault—dropping the hot pan or pulling your foot away from stepping on a sharp piece of glass. Once the threat and damage from the injury is no longer detected by your body, the pain signals stop, and your body can return to its normal pain-free state. Sometimes this is immediate, and other times this can take days, weeks, or months as the injury heals. Unfortunately in some cases, acute pain from accidents or injury can lead to ongoing, long-term chronic pain.

Without an understanding of why chronic pain persists, doctors often prescribe “everything but the kitchen sink” for treatment; often without success. Over the counter pain relievers, including NSAIDs/non-steroidal anti-inflammatories (aspirin, naproxen: Aleve, ibuprofen: Advil and Motrin), acetaminophens (Tylenol), corticosteroid injections (including epidurals for pain management), opioids (oxycodone, hydrocodone, tramadol), and surgeries are resorted to in search of relief. These drugs and interventions all come with their own inherent risks, and in the case of the medications, are not intended or recommended for long-term use.

Two of the most commonly used types of pain relievers, acetaminophen and NSAIDs, are easily accessed and inexpensive, but can be dangerous. Acetaminophen, sourced from any drug store, “is now the reason behind at least 42% of ALF (acute liver failure) cases seen at tertiary-care centers (hospitals and specialized treatment locations) in the United States, and 1 in 3 deaths,” according to “Acetaminophen Sets Records in the United States: Number 1 Analgesic and Number 1 Cause of Acute Liver Failure.” Even taking “appropriate doses for an extended time can put you at higher risk for liver damage.”? In regards to aspirin, Aleve, Motrin, and Advil (NSAIDs):?

“Studies of older adults show that chronic NSAID use increases the risk of peptic ulcer disease, acute renal failure, and stroke/myocardial infarction.”

Opioids are a whole other story: When you take opiates for pain, the drug allows for the release of endorphins in your brain, elevating your mood. Over a period of time, your body adjusts to the continued use of the drug by producing less endorphins. In order to get the same amount of pain relief and feelings of contentment, you need to increase your dosage. In severe instances of chronic long-term use, you can become physically dependent on the medication, and experience withdrawal symptoms without it.?

Now, you may be thinking, I know plenty of people that have taken opioids that did not become addicted. While in many cases this is true, according to the Mayo Clinic:

“Researchers have found that taking opioid medications for more than a few days increases your risk of long-term use, which increases your risk of addiction. The odds you’ll still be on opioids a year after starting a short course increase after only five days on opioids.”

Surgery is an option you may decide on to tend to the problem that is causing you pain. While in some cases surgery is hard to avoid, and may be an immediate matter of life or death, it’s important to note that even the most routine and seemingly innocuous surgeries have inherent risks. Bleeding problems and blood clots, infections, nerve damage, scarring, injury, paralysis, poor results, and death can occur.?

A bit of physiology: Understanding the peripheral and central mechanisms involved in acute and chronic pain is beneficial for developing a targeted treatment plan that addresses the underlying cause. While acute pain serves a protective function, chronic pain reflects a more complex interplay of biological, psychological, and social factors. In chronic pain scenarios, persistent stimuli, such as inflammation in near-by tissues, can lead to sensitization of nociceptors. This makes them more responsive and lowers the threshold for activation, amplifying pain signals. Living with prolonged pain can actually cause changes to your central nervous system.

The spinal cord and brain undergo alterations, leading to increased excitability of neurons. This heightened sensitivity can result in the perception of pain even in the absence of ongoing tissue damage. The Cleveland Clinics Journal of Medicine goes on to emphasize this fact:??

“When patients have chronic pain or other symptoms that seem out of proportion to anything we can tell is physically wrong with them, we should not assume they are faking it. The central nervous system can undergo changes—structural, functional, and chemical—that make it more sensitive to stimuli, a process called central sensitization.”

Chronic pain often involves neuroplasticity—rewiring of the neurons in the brain—where the structure and function of the nervous system adapt over time to its newly acquired situation. Emotional factors can amplify and modulate the perception of both chronic and acute pain. High-stress levels and anxiety may heighten the perception of pain by affecting neural pathways causing the release of neurotransmitters. For instance, stress activates the body’s “fight or flight” response, releasing stress hormones such as cortisol and adrenaline. These hormones can sensitize pain receptors. Anticipating pain or fearing its consequences can also intensify the emotional response to pain, and contribute to the overall distress associated with it.

Persistent pain and depression coexist in a bidirectional relationship. Chronic pain can influence the development of depressive symptoms, and conversely, depression can exacerbate the perception of pain. Shared neurotransmitter pathways in the brain are involved in both mood regulation and pain processing. Imbalances in neurotransmitters like serotonin and norepinephrine may contribute to emotional suffering and heightened pain sensitivity.

A study out of the University of Arizona Health Sciences, “Study shows millions of people live with co-occurring chronic pain and mental health symptoms” found:?

“Adults with chronic pain were approximately five times more likely to report anxiety or depression symptoms compared with those without chronic pain. And, among all U.S. adults living today with unremitted anxiety or depression, the majority (55.6%) are people who also have chronic pain.”

Emotional Influence on the Sensation of Pain

Positive emotions and activities that induce pleasure, such as laughter and physical activity, can trigger the release of endorphins and serotonin. These neurotransmitters act as natural painkillers and mood enhancers, influencing the overall experience of pain and lack thereof.

Recognizing and addressing the emotional component of pain is integral to comprehensive pain management. Approaches that encompass both physical and psychological aspects (mind-body), including cognitive-behavioral therapy, psychotherapy, mindfulness (being fully present), and relaxation techniques, are often employed to treat pain more effectively.

The mind-body connection is the intricate relationship between mental, psychological, and emotional factors, and their impact on your physical health, including the perception of pain. Understanding this connection is essential for a holistic approach to decreasing pain, as several factors (physical, mental and emotional) could be responsible for the enduring pain. Addressing only one of the aspects and overlooking the others could leave you missing the mark in resolving your problem completely.?

Emotional well-being also directly influences your immune system function. A compromised immune system can prolong chronic inflammation, affecting muscle, joint, and nerve pain. By boosting your mental/emotional health, you can reduce inflammation, thereby regulating pain. Consider stress for example; well-researched to show the immense burden it can have on your immunity. Chronic stress, also known as “distress,” can throw your biological system out of whack, and create associated health complications. These include but are not limited to seizures, asthma, and arthritis.

With emotional health in mind, one of the most powerful tools you can access to navigate chronic or acute pain is hope. Although this might seem trivial, being hopeful has a positive physical effect on your body, and a positive psychological effect on your mind. Having hope can lower levels of depression and anxiety, increase your overall satisfaction with life, improve health conditions, increase your desire to create life-affirming habits, and lead to increased success in your endeavors. From “The Importance of Hope”:?

“People who are hopeless tend to shut down in the midst of a challenging situation; however, those who are hopeful believe differently. For example, hopeful people believe that the future can be better than the present and that they have the power to reach a desired outcome. They also take appropriate actions toward a desired outcome.”

Believing your current struggle with pain is temporary, and will improve over time (regardless of what others tell you; doctors included), is a powerful mental position to take. Even the language you use when referring to your “condition” has power of its own. Research affirms this:

“Research shows that physicians, nurses, and other providers’ terminology actually influences health outcomes — either by demonstrating respect that improves the provider-patient relationship and leads to positive behavioral changes, or by stoking stigma and shame that can worsen inequities in healthcare access.

Your body has the ability to “listen,” respond, and adapt to any situation presented. From Society in Participatory Medicine, “The Power of Words in Healthcare: A Patient-Friendly Lexicon. Top 10 List #WordsDoMatter Project,” it is stated:

“Language has a magical influence on the lives we lead, with an impact on our thoughts, emotions, and/or actions. The words we use are one of the most potent ingredients in the science of language. Words have the power to heal, guide and motivate.”?

Remember to breathe. Creating spaciousness in the body, and in your mind between thoughts and responses to pain, can help decrease the severity of symptoms. From “How can you focus when you are struggling with pain?”:

“Distractions are inevitable, but if you’re struggling to focus on the task at hand, explore different ways to consciously shift your attention. Practice slow, deep breathing to reduce the intensity of pain and help you maintain focus. Since your breath is the link between your body and mind, you can consciously control and regulate your breath to soften the intensity of pain and calm your thoughts. If you feel a build-up of intense emotions, find outlets for expressing frustration and anxiety with movement and expression: go for a walk, dance to your favorite song, or try some form of mindful movement.??

Don’t underestimate the effectiveness of herbs to soothe your pain. Experimentation is called for, as the correct dosages and varieties will affect you uniquely from others. There are no “magic bullets,” nor one-size-fits-all remedies. For over 5000 years, plant medicine has been used for healing a multitude of ailments; perhaps it may be wise to lean into this traditional medicine. In collaboration with your integrative practitioner, especially if you are taking pharmaceuticals, consider the following herbs to reduce pain and inflammation: Boswellia, ginger, lavender, turmeric, cloves, bromelain, peppermint, and white willow bark.

Finding the right solution to relieve your pain may take some time and a little detective work on your part, so be patient. When addressing the physical aspect of pain, treatments such as chiropractic, acupuncture, physical therapy, yoga, dietary modification, cold water therapy, and red light therapy can be helpful. More importantly, working on your mental and emotional states, and curating a hopeful attitude in regards to your situation may be the keys to releasing you from the persistence of the intolerable.

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