The Chronic Pain Experience Podcast

Part 2 – Why Is My Pain Getting Worse?

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Living with chronic pain can feel overwhelming and isolating, especially when despite your best efforts, your pain seems to be getting worse instead of better. If you’ve ever asked yourself, “Why is my pain getting worse?” you’re not alone. There are many factors at play that can keep you stuck in a cycle of pain, and understanding these is the first step to reclaiming control over your life.

In this article, inspired by insights from pain recovery coach Deana Tsiapalis of Pain 2 Possibilities, we’ll explore why chronic pain can persist and worsen, the gaps in our current healthcare system, the biological changes in your nervous system, and the often overlooked concept of sensitization. Most importantly, we’ll shed light on how you can begin to navigate your path to recovery with clarity and hope.

Why Am I Not Getting Better? The Gaps in Chronic Pain Care

One of the biggest reasons chronic pain lingers is due to significant gaps in the way chronic pain is currently understood and treated. Often, the healthcare system focuses heavily on structural or mechanical issues—injuries, tissue damage, or anatomical abnormalities. While these are important, they only represent a fraction of what chronic pain is.

Many people with chronic pain find themselves overwhelmed by numerous appointments, feeling unheard by providers, and frustrated by a lack of clear answers or support. This can lead to a sense that something must be terribly wrong if recovery isn’t happening, or even fear that pain will be a lifelong sentence.

Unfortunately, pain education among healthcare providers is minimal—physicians typically receive only 5 to 10 hours of training on pain management during their entire education. This lack of comprehensive training leads to a medical model that often treats symptoms rather than addressing the root causes of chronic pain. Insurance policies and healthcare systems are also slow to adapt, frequently covering treatments suited for acute pain but not those targeting complex, chronic pain conditions.

The Limitations of a Reductionist Model

The traditional medical approach is reductionist, meaning it treats symptoms as isolated issues. While this can be effective for acute injuries or clear physical problems, chronic pain is often the result of more complex, overlapping systems. When pain becomes chronic, it may no longer be tied to a single injury but rather involve changes in the nervous system, emotional health, and social environment.

Changes in the Nervous System: What Happens with Chronic Pain?

When pain persists over time, profound changes occur in your nervous system that can make recovery feel impossible. These changes include:

  1. Impaired Sensory Processing: Your nervous system may struggle to accurately sense pressure, temperature, or touch. This disconnect between brain and body can cause confusion and heightened pain responses.
  2. Overactivation of the Brain: Chronic pain lights up multiple areas of the brain simultaneously, leading to increased energy use and symptoms like fatigue, brain fog, anxiety, and depression.
  3. Difficulty Controlling Pain Signals: Instead of blocking or reducing pain signals from the spinal cord, the brain may amplify them, making pain feel more intense.
  4. Hardwired Pain Pathways: Similar to how practicing a skill strengthens neural pathways, chronic pain can create reinforced “pain pathways” in the nervous system that become hard to break.

    5. These changes affect multiple body systems including muscular, endocrine, immune, sympathetic, and parasympathetic systems, which all contribute to the chronic pain experience.

    Obstacles That Sabotage Your Recovery

    Beyond biological changes, several external and internal obstacles can keep you trapped in pain:

    • Unsafe Environments: Living or working in emotionally or physically unsafe settings can prevent progress.
    • Lack of Support: Feeling unheard by healthcare providers, family, or community can erode motivation and hope.
    • Narrow Treatment Focus: Addressing only biological or only psychological factors limits recovery. Chronic pain requires a holistic approach.
    • Lack of Information: Without clear guidance and understanding, recovery can feel like guessing or “throwing spaghetti at the wall.”
    • Medical System Barriers: Long wait times for specialists and an overemphasis on symptom treatment rather than root causes.
    • Deconditioned Body and Fear of Movement: Pain makes movement difficult, but inactivity worsens pain. Fear around movement can create a vicious cycle.
    • Boom and Bust Cycle: Pushing through pain on good days followed by days of incapacitation creates setbacks.
    • Belief That Only Doctors Can Help: Recovery often requires addressing psychological and social factors alongside biological ones.
    • Financial and Capacity Challenges: Pain reduces mental and physical capacity, making it hard to engage consistently in recovery.
      • Understanding Sensitization: The Underlying Cause of Many Chronic Conditions

      Sensitization is a key concept in chronic pain that explains why pain worsens and spreads beyond the original injury. It refers to changes in the central and peripheral nervous systems that cause the brain to overreact to normally harmless stimuli, producing intense and widespread pain.

      Think of sensitization as the nervous system “learning” to be overly protective. Just as learning a new skill involves creating strong neural pathways, chronic pain creates reinforced pathways that amplify pain signals. This process is not your fault—it is a natural but maladaptive response of the nervous system.

      Examples of Sensitization in Action
      • Watching someone else move in a way that causes you pain can trigger your own pain.
      • Pain that moves around your body rather than staying localized.
      • Feeling pain when thinking about it or anticipating it.
      • Experiencing multiple diagnoses without clear physical causes.
      • Temporary relief from treatments without lasting improvement.
        • Symptoms Associated with Sensitization
        • Digestive issues
        • Sleep disturbances
        • Depressed mood, anxiety, irritability
        • Fatigue and decreased exercise tolerance
        • Memory and concentration difficulties
        • Changes in reproductive health

          • Sensitization plays a role in many chronic pain conditions such as fibromyalgia, osteoarthritis, rheumatoid arthritis, chronic regional pain syndrome (CRPS), migraines, chronic fatigue syndrome, and more.

          The Biopsychosocial Model: Treating the Whole Pain Experience

          Chronic pain is not just a biological issue—it is the product of complex interactions between biological, psychological, and social factors. This is known as the biopsychosocial model of pain:

          • Biological: Structural, mechanical, and nervous system changes.
          • Psychological: Thoughts, beliefs, emotions, memories, trauma, and coping behaviors.
          • Social: Access to care, culture, work environment, family, and societal stressors.

            • Effective chronic pain recovery addresses all three dimensions. Focusing solely on biological treatments misses key drivers of pain and limits your chances of long-term healing.

            Key Takeaways: Moving Forward with Hope and Clarity

            Understanding why your pain is not improving is empowering. Here are the most important points to remember:

            1. There are significant gaps in our current chronic pain care system, especially around education and treatment approaches.
            2. Chronic pain causes changes in your nervous system that amplify pain signals and make recovery more complex.
            3. Obstacles such as lack of support, unsafe environments, and misinformation can sabotage your progress.
            4. Sensitization is a common underlying cause of many chronic pain conditions and involves an overactive nervous system.
            5. The biopsychosocial model highlights the importance of treating biological, psychological, and social aspects of pain together.
            6. You are highly adaptable and bioplastic—your nervous system can change for the better with the right strategies.

              7. Remember, chronic pain is a complex experience but not a life sentence. With understanding, support, and a comprehensive approach, you can begin to reclaim your life and reduce your pain.

              If you suspect that sensitization or nervous system changes are contributing to your chronic pain, seeking guidance from knowledgeable professionals and educating yourself about pain science can make all the difference on your recovery journey.

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              The Chronic Pain Experience PodcastBy Deana Tsiapalis
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