Chronic Pain Management

An excerpt from Master Your Chronic Pain: A Practical Guide by Dr Nicola Sherlock

Master Chronic Pain Book
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Turning Up and Down the Pain Volume Dial 

Scientists can be heard saying that ‘our nervous system is plastic’, by which they mean that it can adapt and change. This ‘neuroplasticity’ is illustrated when a person is recovering from a stroke. After a stroke, brain cells can regenerate, re-establish, and rearrange neural connections in response to the damage caused by the stroke. This is what happens when people who have suffered a stroke recover quite well, even after they initially lose the ability to move certain body parts or speak. The nervous system can adapt and change.

With regard to chronic pain (also known as persistent pain), it has been shown that the more you understand your pain, and practise the skills that help in its management, the more your nervous system can adapt and change – in a good way. Now that we know that pain signals are released by our bodies to respond to what it believes to be a ‘threat’, reassuring our brains that the level of threat is minimal should help to manage the pain.

There are several other ways in which we can turn down the pain volume

  • Very gradual increases in activity and exercise levels can turn the volume down on your pain. When you exercise, your body releases chemicals called endorphins. These endorphins trigger a positive feeling in the body, similar to morphine. The endorphins also interact with the receptors in your brain and reduce your perception of pain. If we can release more of the chemicals that feel good, we are giving our brain information that there is less threat. This reduction in threat can turn down the volume of your pain. I fully appreciate that when you live with persistent pain, it is not easy to become more active or increase your exercise level, so I have dedicated another chapter (Chapter 4) of this book to this.
  • Understanding and education about pain are very helpful to turn the volume down on your pain.
  • A large body of research evidence has shown that mindfulness meditation can turn the volume down (I have written more about that in Chapter 6).
  • The appropriate pacing of activity can turn down the volume (and Chapter 5 is all about that).
  • Relaxation can ‘wind down’ the nervous system and dampen pain messages.
  • Engaging in hobbies can distract and turn the volume down.
  • Socialising and having fun with family and friends can dampen down pain messages.

On the other hand, there are also things that can turn the volume up on your pain:

  • Stress can turn the volume up on your pain.
  • Anxiety about your pain can make your pain worse.
  • Anxiety about life in general (for example, how you are going to pay your mortgage), can turn up the volume on your pain.
  • Low mood and depression have been shown to turn the volume up.
  • Lack of sleep makes pain worse.
  • Feeling angry and frustrated can amplify pain messages.
  • This is just a flavour of some of the things we have learned about pain management in recent years. These topics will be explored in more detail throughout this book.

Pain Management – Things to Remember

  • Persistent pain is different from acute pain.
  • Persistent pain is real pain.
  • When you live with persistent pain, it does not mean that you have harmed or injured yourself further. The persistent nature of your pain is due to a more sensitive alarm system.
  • Scans and x-rays may not help you or your doctor to understand why you have persistent pain.

Finally, the most important thing to remember, and the reason I felt compelled to write this book, is:

There are many things that you can do to turn the volume down on your pain and improve your life.


Master Chronic Pain Book