Imagine you’re injured in a traumatic accident. You take the appropriate steps: you undergo surgery, you are prescribed medication by your practitioner and you follow the appropriate steps for recovery.
But what if, despite these steps, you’re still feeling pain? And worse, the pain impacting your daily life? You thought this was all behind you but then your doctor diagnoses you with a chronic pain condition.
Now you’re worried that you may face a lifetime of unpredictable pain as you try and treat something that seems so elusive. It strikes you at work, affecting your professional life and job performance. It’s present in your home, interfering with your personal life. It might even interfere with your ability to sleep and affect you during the day. And that’s not to mention the stress you and your loved ones will face.
You may feel that your old life is over, but don’t give up so soon.
Neither you nor your practitioner are helpless in trying to treat this condition. Being informed about your condition and sharing what you know with your practitioner will help you learn more and will give you the confidence to face this condition. It’s also something you can share with your friends and loved ones to ease any anxiety they’re feeling.
New studies on what turns short-term, acute pain into the long-term burden of chronic pain are creating advances in medical science. One study focused on back pain in particular has shed new light on the process our brains go through when short-term pain transforms into long-term, chronic pain (1).
Having a better understanding of how pain becomes chronic and what parts of our brain are involved will not only change how we, as a society, think about pain but also how your practitioners treat pain, as well as the mindset you and your loved ones will have as you face it.
You might be more interested in treating or even curing yourself of chronic pain. But never underestimate the power of knowledge.
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By better understanding what chronic pain is and how it affects you, you can start to gain power over your condition. It will also help your practitioner better target treatments for your pain, creating a treatment plan that is personalized and will lead to your recovery.

Why has it been so hard to study chronic pain?

Why has it been so hard to study it up till now?
Well, the simple answer is that up until recently we didn’t know enough about it. It seemed to be just the nebulous side effect of traumatic accidents, physical injury or simply caused by aging.
All relatively false by the way…
Some conditions like fibromyalgia were even brushed off as a “woman’s disease” since most of those affected are women. Many people were told these conditions were just a part of getting older or were common in many women.
Research has shown that changes in the brain’s function and structure occur with chronic pain. Mapping the brain through high-tech imagery has revealed that different chronic pain conditions have different effects on the brain (3).
This is another reason why studying, and especially treating chronic pain, was so difficult in the past. Chronic pain affecting your back may have an entirely different effect on your brain than chronic pain affecting your legs. Also, you’re not guaranteed to develop chronic pain from a short-term, acute pain condition. You could experience short-term pain from a broken foot and heal normally without ever developing chronic pain. Likewise, you could be healthy for all your life and still develop a chronic condition later in life.
There are no definitive factors that your practitioner can analyze to try and accurately predict whether your pain will turn chronic. A few have turned up, but as a whole, there are no symptoms for your practitioner to look out for.
A very common type of chronic pain is chronic back pain, which is defined as any back pain experienced for more than 6 months. A recent study targeting chronic pain patients found that chronic back pain only affected their prefrontal cortex. This is the part of your brain that relates to differentiating conflicting thoughts, future goals as well as consequences. (4)
But the study found that short-term, acute pain consistently targeted multiple parts of your brain and entirely missed the prefrontal lobe.
What this means is that there’s a huge difference between how your brain is affected by acute pain and how your brain is affected by chronic pain. It also means that your brain’s perception of pain transforms as the pain develops from acute to chronic. Knowing this is a key step to accurately researching how the brain is reorganized by pain, and how we can track its development.

How do we study chronic pain?

Given the different effects acute and chronic pain have on your brain, researchers can now develop a solid framework for analyzing when and how pain transforms in your brain.
To directly study this, researchers can use brain-imaging scans to create a brain map. A brain map is an image of your brain that shows what parts are being directly affected depending on the amount of pain and what type of pain you feel.
Researchers have to look at the brains of those with acute pain as well as those with chronic pain. You might think that the only difference between you and someone with acute pain is that your pain is continuing, while theirs has ended. But our brains are highly complex organs that are responsible for processing and perceiving pain. Understanding the role of the brain is important because that is where we perceive our pain.

What did we find?

Tests done on people with chronic back pain found two main findings that will change the way you think about your pain.

1. The Brain Processes Chronic Back Pain Differently

When comparing the brains of someone with acute, short-term pain and those with chronic back pain, it was found that acute pain was registered in the parts of the brain that typically deal with pain. But chronic pain was registered in the parts of the brain that handles emotion (5).
This is important to understand when you think about treating your own chronic pain. Thoughts, emotions, beliefs and expectations matter.
Thoughts, emotions, beliefs and expectations matter. Share on X
This is a transformative insight that opens up many new possibilities for effective treatment. Chronic pain linked to emotions (anxiety, depression) could inspire you to look into options like pain psychology. While you shouldn’t take this to mean that your pain isn’t real or is somehow all in your head – your pain is real and there is a medical reason why you’re experiencing it – it does mean that you’re not entirely helpless.  
You can learn more about pain psychology and how it could help you in my interview with Dr. Beth Darnall on Episode #11 of the Healing Pain Podcast.
Through understanding exactly where chronic pain strikes, you’ll find your options for much more effective treatment and recovery opening up. It’s incredibly helpful for you to be just as informed as your practitioner since you two need to work together.

2. We Can Now Track Pain:

Based on the first finding above, we now know that pain starts in the brain’s traditional pain sensors and shifts to the emotional sensors (6).
You can learn more about maladaptive chronic pain mechanisms in my interview with Dr. Melissa Farmer on episode #34 of the Healing Pain Podcast.
What this also means is that through periodic scans, your practitioner can now chart the progress of chronic pain in your brain. You two will be able to see you the changes in your brain as it develops. While you might not be able to find an exact date and time that it finally becomes chronic, you will, however, be able to see its journey and develop active strategies that lessen its impact.
Suddenly chronic pain doesn’t seem like such an elusive condition. Now you and your practitioner can establish a timeline of appropriate treatment. It’s important to remember that while recent studies have shown that opioid painkillers are ineffective in treating chronic pain, they do still play a part in certain cases (7).
Having a timeline of this transformation, what experts call the chronification of pain, is important in knowing at what stages of your treatment, medication, or surgery is appropriate and when it’s not (8). That means you avoid the side effects of opioids and you don’t run the risk of a potentially devastating opioid dependency.
And even more importantly it could possibly affect those in the future, by giving practitioners a window of time to effectively target and treat pain before it becomes chronic.
Although these results are only for chronic back pain, they shed an enormous amount of light on the true nature of chronic pain’s effect on the brain. You might not suffer from chronic back pain, but the repercussions of these findings apply to you regardless of what type of chronic pain you have.
This research proves that chronic pain is not such an elusive illness, not simply a side effect of a bad accident or aging. Hopefully, this gives you some peace of mind knowing that this isn’t so scary after all.

What does all this mean?

On a broad level, these findings affect the very definition of your chronic pain. It was once thought to be a side effect of short-term, acute pain that struck certain people but not others. But you might have been diagnosed with a chronic pain condition that seemingly appeared out of the blue. In this case, your practitioner probably said it was caused by your age or your exercise.
You might have felt just as confused as your practitioner is about chronic pain and perhaps a little helpless as your entire life seemed to change before your eye. You were sure that you’d be dealing with this mysterious burden for your entire life.
But the results of these findings give us all a better understanding of chronic pain. It is something you’ll have to deal with, but it’s not a lifetime of unconquerable pain because understanding how pain affects your emotional centers is key in treating your chronic pain.
You were probably confused and a little upset when your practitioner diagnosed you with a chronic condition. So naturally, you were relieved when you were given a prescription for painkillers.
But research has shown that they’re ineffective in properly treating pain, a claim backed up by the knowledge that chronic pain affects the emotional centers of your brain rather than the parts dedicated to pain. This is why chronic pain may have affected your mood. You might have also been diagnosed with depression after your chronic pain diagnosis.
Treating the brain and your emotions require a somewhat different approach than treating physical pain. You should discuss with your practitioner alternative treatment methods such as pain psychology. This develops active coping strategies to target some of the negative thoughts and emotions that you might not know are affecting your pain.
Another approach might be working with a physical therapist to outline appropriate exercises to help your body and get you moving and back into the real world.
Chronic pain isn’t as mysterious as it was once thought to be.
And it’s important to remember that you’re not alone in dealing with your chronic pain and you’re not helpless either. Understanding how chronic pain affects your brain is the first step to handling it. And once you start treating it properly, you’ll be surprised at how little of a problem in your life it becomes.