The ABCs of Chronic Pain: Understanding a Complex Condition

Chronic pain is a complex and often debilitating condition that affects millions of people worldwide. Unlike acute pain, which is a normal sensation that alerts us to injury or illness, chronic pain persists for weeks, months, or even years. It can significantly impact a person's quality of life, affecting their physical and mental well-being, relationships, and ability to work. I know this all too well. At the time of my fall, I was a 911 operator for the RCMP in my hometown, and although I tried to continue working, it got to a point that I was not ok to work. The pain was just too much. Simply put, it’s affected every aspect of my life and impacted my family.

To better understand this complex condition, let's break it down using the ABCs of chronic pain I created for this post:

A is for Acute Pain:

• Relation to Chronic Pain: Anxiety and chronic pain are often experienced together. The emotional distress and fear of the unknown associated with chronic pain can contribute to anxiety. Similarly, anxiety can worsen the perception of pain and can make it more difficult to manage. It is scary to think that your pain could get worse, or that it’s going to cause one more thing to have to deal with. Anxiety about the person you are and your capabilities, anxiety about your condition getting worse, anxiety about finances as often Pain Warriors cannot work, and anxiety about the future, what it looks like and overall how it’s impacted others. When you have chronic pain you have lots to worry about. It’s something I’m working on.

B is for Brain:

• Relation to Chronic Pain: In chronic pain, the brain's pain processing pathways can become altered, leading to increased sensitivity and persistent pain perception. This phenomenon, known as central sensitization, can cause the brain to interpret even non-painful stimuli as painful. For example, a person with fibromyalgia may experience pain from a light touch that would not normally be painful. My condition, Complex Regional Pain Syndrome (CRPS), formerly known as Reflex Sympathetic Dystrophy (RSD), is a disease of the Central Nervous System that is constantly firing pain signals to my brain. I too feel pain with light touch, as well as temperature sensitivities. It really makes doing anything so much harder as my brain is always so busy with receiving chronic pain signals, that it doesn’t have the capacity for regular, everyday things that an able-bodied person’s brain has the bandwidth for. My brain is constantly telling me I’m in pain, and in distress, and it is draining to be honest. I have to think that much harder, and try to block the pain signals for as long as I need my brain to do something.

C is for Central Sensitization:

• Relation to Chronic Pain: Central sensitization plays a crucial role in many chronic pain conditions, including fibromyalgia, CRPS, irritable bowel syndrome, and chronic fatigue syndrome. It can explain why people with these conditions often experience widespread pain and hypersensitivity to touch, light, and sound. This definitely played a role in my chronic pain setting up shop in my body and spreading it from the initial injury site. Within a month of injuring my ankle, the pain had spread to both of my legs in their entirety, feet included.

D is for Depression:

• Relation to Chronic Pain: Chronic pain and depression often co-occur, creating a vicious cycle where pain exacerbates depression and depression worsens pain perception. The emotional distress and social isolation associated with chronic pain can contribute to depression, while depression can amplify pain signals and reduce motivation for self-care. This is one area I’ve always struggled with. Being in pain all the time is sad. What it’s stolen from you is sad. When you are in pain, it’s hard to find the motivation to do things, even if they are fun, and slowly your social circle shrinks. You judge yourself and wonder if you are a good person, because you can’t do what you used to be able to, so feelings of low self worth and self doubt start to settle in. I have to work really hard at managing my depression, and it takes time to find what works, but I’ve got a good routine going that helps with managing the mental issues I have due to my chronic pain.

E is for Exercise:

• Relation to Chronic Pain: While it may seem counterintuitive, regular exercise is often recommended for managing chronic pain. Exercise can help strengthen muscles, improve flexibility, release endorphins (natural pain relievers), and reduce stress, all of which can contribute to pain relief. However, it's crucial to choose appropriate exercises and gradually increase intensity to avoid exacerbating pain. I never thought that I would ever be able to have an exercise routine, except for going for small walks. That all changed in January, 2024, when I got Apple Fitness+ for the extensive meditation section and not long after I began a small fitness routine doing a few of the videos in the “Workouts For Older Adults” section twice a week. I’ve now expanded my meditation and fitness routines to include daily morning and afternoon “Mindful Cooldown” stretching videos that combine both stretching and mindfulness.

F is for Fatigue:

• Relation to Chronic Pain: Fatigue is a common symptom of chronic pain, as the body expends significant energy managing persistent pain signals. Additionally, pain can disrupt sleep, further contributing to fatigue. This fatigue can make it challenging to engage in daily activities and self-care, potentially worsening pain and overall quality of life. This is a real struggle for Pain Warriors and Spoonies. It is incredible how tired, like full body and brain exhaustion, you feel when your brain is being peppered with pain signals, even if you are not doing anything strenuous or active. I often say that even calm and quiet activities, like reading or drawing, are exhausting, because the pain causes extreme fatigue. It does no matter what you are doing. To explain this level of fatigue is hard because unless you’ve lived it, you can’t understand it.

G is for Gate Control Theory:

• Relation to Chronic Pain: This theory helps explain why certain interventions, such as massage, heat therapy, and transcutaneous electrical nerve stimulation (TENS), can provide pain relief. These therapies are thought to "close the gate" by activating non-painful sensory fibers, thereby reducing the transmission of pain signals to the brain. I have wanted to investigate getting a Spinal Cord Stimulator for my CRPS pain and go through the motions to see if it would work for me, for a long time, and this year I’m going to get serious about it and start the process. No more letting anxiety and fear dictate certain things in my pain management. I’ve been reading about them in my chronic pain Facebook groups, and am hoping with the technological advances, that one would work for me.

H is for Holistic Approach:

• Relation to Chronic Pain: Chronic pain management often requires a holistic approach that addresses not only the physical aspects of pain but also the psychological, social, and emotional impact. This may involve a combination of medication, physical therapy, psychological counselling, and lifestyle modifications. I have found managing chronic pain to be a full time job, at least mine is. My doctors and specialists have always treated my complex pain with a multitude of treatments. There is no one fix-all miracle cure. It takes work and to look at things from multiple angles and treat it in multiple ways.

I is for Inflammation:

• Relation to Chronic Pain: While acute inflammation is a normal part of healing, chronic inflammation can contribute to persistent pain in conditions like arthritis, inflammatory bowel disease, and nerve damage. Managing inflammation through medication, diet, and lifestyle changes can be an important part of chronic pain management. I’ve got so much pain though, that this is hard for me to identify any pain as being inflammation.

J is for Joint Pain:

• Relation to Chronic Pain: Joint pain is a common symptom of many chronic pain conditions, including osteoarthritis, rheumatoid arthritis, and fibromyalgia. It can result from joint inflammation, damage to cartilage, or nerve irritation. Managing joint pain often involves a combination of medication, physical therapy, and lifestyle modifications to protect the joints and reduce inflammation. I noticed a big difference with this after I’d been doing my exercise routine for a while. Being more active helped me build back a small amount of my legs’ atrophied muscles and that made a difference in my knees.

K is for Kinesiophobia:

• Relation to Chronic Pain: Kinesiophobia is common in people with chronic pain, as they may associate movement with increased pain. However, avoiding movement can lead to muscle weakness, decreased flexibility, and further pain. Overcoming kinesiophobia through gradual exercise and education is often crucial for improving function and reducing pain. This is something that is so important to manage at the onset of Kinesiophobia, even if you don’t think it will help. I’ve seen a huge improvement in both my pain and mental health since I began my fitness routine.

L is for Lifestyle Modifications:

• Relation to Chronic Pain: Lifestyle modifications play a significant role in managing chronic pain. This may include regular exercise, stress management techniques, healthy eating habits, adequate sleep, and pacing activities to avoid overexertion. I think what’s saved me is creating a regular, daily routine that is based on healthy habits and routines that benefit me. In 2024 my goal was to recover from my nervous breakdown in 2023, and in my recovery I’ve made a number of healthy changes, and it led me to creating my new business.

M is for Mindfulness:

• Relation to Chronic Pain: Mindfulness-based interventions, such as meditation and mindful breathing, can help people with chronic pain manage their symptoms by increasing awareness of their thoughts, feelings, and bodily sensations. Mindfulness can also help reduce stress, improve coping skills, and enhance overall well-being. I thrive on mindfulness, and doing meditation every day has been rewarding for me personally. I use 2 apps for mediation, Apple Fitness+ and Balance, and I love them both.

N is for Neuropathic Pain:

• Relation to Chronic Pain: Neuropathic pain is a common type of chronic pain, often associated with conditions like diabetes, multiple sclerosis, CRPS and shingles. It can be challenging to treat, often requiring specialized medications and therapies. I unfortunately have a very aggressive and resistant form of CRPS and it is hard to treat it’s symptoms with medications, and I have to use a multi-disciplinary approach of medications, creams, and healthy habits and routines.

O is for Opioids:

• Relation to Chronic Pain: While opioids can be effective for acute pain and some types of chronic pain, their long-term use for chronic pain is controversial due to the risk of addiction, overdose, and other side effects. Opioid prescriptions for chronic pain have declined in recent years, with a greater emphasis on alternative pain management strategies. I have lots to say on this topic. For more on opiates and people’s perceptions of people with chronic pain, see my December 15, 2024 blog post on how TV portrays people with chronic pain.

P is for Pain Management:

• Relation to Chronic Pain: Effective pain management often involves a combination of medication, physical therapy, psychological therapies, and lifestyle modifications. The goal is not always to eliminate pain entirely but to reduce pain intensity, improve function, and enhance overall well-being. I have become an expert of sorts at pain management. Having to manage the level and intensity of pain I’m in takes up hours each day. It’s a lot of work managing medications, routines, exercise, things like therapy and education about your chronic pain, as well as making sure you are including enough self care for yourself.

Q is for Quality of Life:

• Relation to Chronic Pain: Chronic pain can significantly impact quality of life, affecting a person's ability to work, engage in social activities, and enjoy hobbies. Effective pain management aims to improve quality of life by reducing pain intensity, improving function, and addressing the emotional and social impact of chronic pain. It definitely affects my quality of life and I have to work hard at making sure I don’t get swallowed up by the intense and overwhelming pain that I live with.

R is for Rehabilitation:

• Relation to Chronic Pain: Rehabilitation plays a crucial role in chronic pain management, helping individuals improve their physical function, strength, flexibility, and endurance. This may involve physical therapy, occupational therapy, and other specialized therapies. It pays off when you can attend to those things, but again is a lot of work, when we are already working hard at managing our pain. The amount of appointments and tasks one can have related to their chronic pain can be overwhelming and if I’m being honest, I got “Appointmented Out” and just couldn’t handle any more appointments.

S is for Sleep:

• Relation to Chronic Pain: Sleep is essential for overall health and well-being, and it plays a crucial role in pain management. Chronic pain can disrupt sleep, leading to fatigue, increased pain sensitivity, and mood disturbances. Improving sleep quality through good sleep hygiene, relaxation techniques, and pain management strategies is essential for managing chronic pain. I use an app for sleep called Rise, and it helps me maintain a fairly healthy sleep routine.

T is for Triggers:

• Relation to Chronic Pain: Identifying and managing triggers is an important part of chronic pain management. Triggers can vary from person to person and may include stress, certain foods, weather changes, or specific activities. By recognizing and avoiding or modifying triggers, individuals can reduce the frequency and intensity of their pain. This brings us to the importance of tracking your chronic pain with a journal or diary so that you can see visually what triggers you, what helps, what doesn’t, etc. and identify patterns so that you do things to manage them.

U is for Understanding:

• Relation to Chronic Pain: Understanding chronic pain – its causes, mechanisms, and potential treatments – is crucial for both patients and healthcare providers. Education and open communication between patients and healthcare providers can empower individuals to actively participate in their pain management and make informed decisions about their care. It’s taken me years to understand chronic pain as much as I do, and my life led me to this point in my life where I can educate and help others understand their chronic pain or that of a loved one.

V is for Validation:

• Relation to Chronic Pain: People with chronic pain often face disbelief or minimization of their pain from others, which can lead to feelings of isolation and frustration. Validation from healthcare providers, family, and friends is crucial for emotional well-being and can help individuals cope with the challenges of living with chronic pain. This is really important. I often operate as if I’m not in pain, but that’s just because I’ve learned to cope and manage with the high levels, which makes it hard for people to truly know or see how much pain and distress I’m in.

W is for Well-being:

• Relation to Chronic Pain: Chronic pain can significantly impact overall well-being, affecting physical function, emotional health, and social relationships. Effective pain management aims to improve well-being by reducing pain, improving function, and addressing the emotional and social impact of chronic pain.

X is for X-ray:

• Relation to Chronic Pain: X-rays can be used to identify structural abnormalities or injuries that may be contributing to chronic pain, such as arthritis, fractures, or spinal abnormalities. However, X-rays may not always reveal the underlying cause of chronic pain, especially in conditions like fibromyalgia or neuropathic pain.

Y is for Yoga:

• Relation to Chronic Pain: Yoga can be a beneficial complementary therapy for chronic pain management. Gentle yoga postures can help improve flexibility, strength, and balance, while breathing exercises and meditation can promote relaxation and reduce stress. I do the yoga videos in Apple Fitness+ in the Workouts For Older Adults section sometimes and it’s something I want to work towards regularly doing this year.

Z is for Zest for Life:

• Relation to Chronic Pain: Chronic pain can make it challenging to maintain a zest for life, as pain can limit activities, disrupt sleep, and affect mood. However, effective pain management, along with psychological support and lifestyle modifications, can help individuals regain a sense of control, rediscover joy in life, and live fulfilling lives despite chronic pain. After 2023 I didn’t think I’d ever get that zest back, but last year I found it, and thrived on it, and 2025 is also looking promising in the zest department.

Chronic pain is a complex and multifaceted condition that requires a comprehensive and individualized approach to management. By understanding the various aspects of chronic pain, from the underlying mechanisms to the psychological and social impact, individuals and healthcare providers can work together to develop effective strategies for managing pain, improving function, and enhancing overall quality of life.

Remember, you are not alone in this.

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