According to the Canadian Pain Task Force (2019), one in five Canadians lives with chronic pain. Two thirds of them have moderate (52%) to severe (14%) pain, and 50% have lived with chronic pain for over ten years.

In the United States, treatments for chronic pain cost almost as much as heart disease, cancer and diabetes combined.

Even if many people live with chronic pain, traditional medical treatments don't always work for these people.

What is Chronic Pain?

It is usually defined as pain which persists for more than 3 months. Two main situations can lead to chronic pain:

1. An injury develops into chronic pain even though the injury is healed.
   Imagine that you just hurt yourself. For example, you tweaked your back, so you feel pain every time you bend down. With chronic pain, your body can become conditioned to "bending down = pain". As a result, your brain, which is a control operating system that tries to protect your body from danger, misinterprets normal sensation from your back as pain. Even when the injury has healed.
   

2. Pain without tissue damage.
   You can feel pain because of a negative past experience or because of emotions or fear. For example, imagine a toddler falling on the ground. At first, the toddler often won't cry. But seeing the fear in their parents' face might trigger crying.
   
   Phantom limb pain is another good example. A person who has had their leg amputated can still occasionally feel pain in their leg, even a few years after losing it. A situation that triggers fear or stress can also create or amplify pain sensations.

Hold on! If it's not tissue damage, what causes pain then?

A simple answer is "misinterpretation of the brain". I'm not saying that “pain is just in your head”.

All pain is real because pain is an output from the brain to protect our body.

However, pain is not always an accurate measure of tissue health!

Instead, pain means your brain is trying to protect you from something.

Basically, we feel pain when the brain perceives a sensation that might be dangerous for the body.

For example, here is a case presented in the Pain Reprocessing Therapy course that Kaz participated in...

[A builder aged 29 came to emergency department after having jumped down on to a 15 cm nail which went through his boot. As the smallest movement of the nail was painful, he was sedated with fentanyl and midazolam. The nail was then pulled out from below. When his boot was removed a miraculous cure appeared to have taken place. Despite entering proximal to the steel toecap, the nail had penetrated between the toes: the foot was entirely uninjured.]

This builder had so much pain because his brain perceived the whole situation as danger even if his foot wasn’t really injured.

At the other end of the spectrum, some athletes continue to play their sports even after sustaining a fracture during the game. In fact, there is a case of a female ultra trail runner who sustained a pelvic fracture during a race (171km, 10,000m elevation), completing the entire race with the 2nd place for women.

Feeling pain does not always equal damage, and vice versa. This infographic created by The Running Clinic shows that medical imaging often identifies “injuries” in people who don’t even have pain.