Pre-Pain: At Risk

Pre-disposition- genetic and high levels of body inflammation (usually due to poor diet) results in fewer pain killer neurotransmitters in the brain to resist the development of chronic pain in susceptible individuals.

The Spark

Trauma- macro or micro, initiates pain. This can be a motor vehicle accident (even minor), a work injury or as simple as poor posture or poor ergonomics at the computer.

The Cycle is Born: Homeostatic Brain Mal-adaptation

After 8 weeks of pain, the brain is tricked into believing pain is the normal state for that person. Since the brain prefers to maintain homeostasis, it turns down production and release of the neurotransmitter pain killer endorphins, serotonin, GABA while increasing Substance P production and inflammatory prostaglandins production. In one clinical study, chronic pain sufferers were missing on average up to 65% of endorphins compared to people without pain.

Here are the Scans of Normal Brain vs. Brain on Chronic Pain

The Red Hot Pain Zones are the result of inadequate neurotransmitter pain killer production and/or release in a chronic pain sufferer. Notice the thalamus, which directs the pain traffic from the body, is red hot.

Sleep Disruption: Lack of stages 3 and 4

As the serotonin levels fall and the release is reduced the deep stages of sleep are lost. The deep stages of sleep are where most of the natural pain killer production (particularly the endorphins) takes place. This sets-up a vicious cycle of poor neurotransmitter pain killer production with sleep disturbance.
Since serotonin is one of the major mood elevators, depression is quite common among pain patients.

Numerous sleep studies have documented anywhere from 80-90% loss of stages 3 and 4. In our patient population, the average is much higher ~ 95.6%.
This is probably due to the tertiary nature of our centers attracting patients with much longer histories of pain.

Rebound
Up to 50% of chronic pain can be secondary to rebound from narcotics, prescription meds and caffeine.