The problem (if I'm going to pick just one) with the conventional way of treating chronic pain is that we only focus on the area of pain. If you have chronic shoulder pain then all focus is put on the shoulder. Imaging is directed at the shoulder and treatments such as steroids and physical therapy are all focused on the shoulder. If that pain were to move, we would chase it. Claiming success for abolishing your shoulder pain and assuming the same will work for your newly developed neck pain.
But what if the area of your pain is not where your pain is coming from? What if there's nothing wrong with your shoulder after all?
When it comes to chronic pain, physical abnormalities and tissue damage tend to be the least contributing factors. Chronic pain is a physical, biochemical, and mental/emotional process with emphasis on the biochemical and mental/emotional. After all, your body is really good at healing itself. You can break your femur in half and without doing anything other than stabilizing the area, your body will heal it in 6 weeks. Any physical pain lasting outside of 3 months (the threshold for chronic pain) is likely not being driven by physical factors, such as tissue damage, anymore.
Biochemical insults are always present, such as inflammation and poor mitochondrial production. Conventional medicine at least respects inflammation, but their therapies to reduce inflammation are poor. Which leaves the mental/emotional component which conventional medicine either doesn't understand and respect, or they just don't want to touch it because you can't throw a drug at the problem.
Could your chronic pain be driven by your brain and central nervous system?
Chronic pain centralization is just this. It is the process by which your central nervous system (your brain and spinal cord) take over the distribution of your chronic pain. It doesn't matter how you got into chronic pain, once you have been living with pain for more than 3 months it has engrained itself into your subconscious and eventually unconscious mind. This is where chronic pain lives; the subconscious and unconscious minds.
Which is a problem because we, as a human species, are not known for our abilities to tap into these areas of our brains. We prefer to repress emotions and forget about them. Except we really don't. These emotions just get relocated to the subconscious and then eventually the unconscious if we ignore them long enough.
Just as much as you don't want to deal with that negative, inconvenient emotion, neither does your brain. So your brain does everything it can to make you deal with that emotion, including causing you physical pain.
Any emotion that you are not dealing with will deal with you.
This is called the somatization of mental illness when mental pain becomes physical. Your brain has figured out over a long period of trial and error that you will ignore mental pain but you are less likely to ignore physical pain. If you can feel it then you are more likely to respect it. Physical pain, in our minds, means tissue damage and we are more inclined to do something about that so it doesn't get worse. But that isn't what pain means. Pain only has one message. That something is wrong and we need to put some attention on the matter. Pain can't always tell you what is wrong or even where. That is for you to figure out. Pain is just the alert system that something is wrong.
But as previously mentioned, we don't view pain this way. We assume that pain that feels physical must be from physical tissue damage, at the source of the pain. So many unnecessary therapies are administered because of this view on pain. Manual therapy, injections, and operations that cause time, recovery time, and money are thrown at a problem that doesn't even exist.
If you ignore pain long enough, either because you are intentionally ignoring the pain, or because you aren't treating the source of the pain, your brain and spinal cord will make the pain worse to let you know that what you are doing isn't working. It's time to try something else that addresses the root causes of your chronic pain. Your central nervous system has a few tricks up its sleeve to make this happen.
Physiological changes occur in your brain and spinal cord
Your brain and spinal cord can actually change physically to intensify pain. It will decrease the amount of inhibitory interneurons that stop pain from reaching your brain. Not all pain reaches your brain to be processed. Most of it is actually stopped by your spinal cord in belief that your brain shouldn't be bothered with this "pain" right now. But when you are living with chronic pain and your pain becomes centralized, your central nervous system physically changes to make you more hypersensitive to pain in hopes you will ignore it less.
Changes in your DNA
The expression of your DNA changes to produce more pain receptors throughout your body and to reduce the amount of opioid receptors in your body. This increases the amount of pain you experience through physical and biochemical insults as well as makes pain medications like opioids less effective. Do you feel the pain now?
Changing pains
If you injured your low back it makes sense that your pain should be residing mainly around your low back. But if the source of your pain is not any one physical location then your brain has to decide where to put the pain. To really get your attention it can make the pain spread and move because that is something worth paying attention to!
So how do you know if your pain has become centralized? Do you have fear, stress, anxiety, etc. around your pain? If so I just proved that there is a mental/emotional component to your pain and the problem is likely much larger than you realize. But here are other way to tell if your pain is being driven by your central nervous system.
Do you respond better to things like anti-epileptics and ant-depressants than anti-inflammatories and pain medications?
Local nerve blocks don't work
Your pain is increased by stress and things that shouldn't cause you pain
Your pain is increased just by thinking about your pain
Your pain originated during a time of stress
Your pain originated without injury
Symptoms are inconsistent
You have a large number of symptoms
Your symptoms and pain spread or move
You have triggers that have nothing to do with your body
Your symptoms are symmetrical
You experienced adverse childhood events or trauma
You describe your pain in unusual ways. instead of normal descriptors like "sharp," "dull," "pins and needles," you say "it feels like someone is building a wall of firecrackers in my back"
You have a lack of a physical diagnosis
This may feel daunting, because by now I hope you are realizing that conventional treatment routes will have no effect of centralized pain. You still can't ignore any contributing physical tissue damage and biochemical issues, but these things are not driving your pain anymore. In order to effectively get out of chronic pain, you have to treat the mental/emotional component of your pain through mind-body counseling. This pain reprocessing therapy helps to retrain your central nervous system to not view pain as dangerous. It gets down to the root causes of your pain, unearths those repressed emotions and helps you resolve them. In doing so puts you on the path to healing your chronic pain long term.
Mind-body counseling HAS to be a part of your chronic pain treatment program. If it is not, it doesn't matter how many world class treatments and operations you undergo, you will remain in pain.