Understanding Plan

Experiencing pain is normal. Everyone experiences pain now and then.1 Pain is supposed to be protective to make you stop doing things that may be dangerous.2 But chronic pain that has persisted for more than 3 months is no longer protective, nor informative.3 So, what is chronic pain and what can you do about it if you suffer from it?

All pain is created by your brain because your brain has decided that you are threatened and in danger and need protecting.4-9 The interesting thing is that you don’t actually have to have any actual tissue damage to feel pain.10 And if your brain is not aware of tissue damage, you may not feel any pain at all, even if you’ve injured yourself.4 6

Sometimes pain persists long after tissue damage has actually healed.11 When  pain  persists  for  more  than  3 months we call this chronic pain.  Chronic  pain  is the second-most common reason people see a doctor and miss work.11 More than one-third of people with chronic pain become disabled by their pain to some degree.12 13 Chronic pain can be mild or excruciating, episodic or continuous, merely inconvenient or totally incapacitating. The pain can be from headaches, joint pain, neck pain, back pain or pain from an injury. Other kinds of chronic pain include tendinitis, sinus pain, carpal tunnel syndrome, and pain affecting specific parts of your body. The common thing with all these types of pain is that the actual feeling of pain is always, 100% of the time, created in your brain.5 8 14 15 This does not mean it’s not real – but understanding that the pain itself is created in your brain is really important for how you can get rid of it. And because pain depends so much on what you think and feel about the pain,2 it’s very important you understand pain properly.

Your pain experience depends on why your brain has decided you need to be protected – why it’s creating the feeling of pain for you in the first place.5 It can, therefore, be very useful for you  to try to figure out why your brain may be creating pain for you. What was happening at or around the time your pain started. What makes it worse? What makes it better?

Why is that important? Because we know that the brain can be retrained,16 so you need to use all the tools available to you to retrain your  brain  to be out of pain.16 Some of the keys to retraining your brain are staying active,17-19 staying positive,20 eating well,21 22 and sleeping well.23

Stay Active

One important way that you can help yourself if you are in chronic pain is to stay active.17-19 Your posture and how you move plays an important role in how you feel and how you experience pain.18 19 Even as little as a short walk every day can help.19 If there are movements you cannot do because of your pain you can still help by imagining these movements.24  We  know from neuroscience research that imagining a movement influences the brain in    a very similar way to actually doing the movement.24 25 This can help retrain your brain to understand that the movement is not dangerous – because imagining doing the movement will not hurt. You can basically trick your brain into giving you back pain-free movement.24 Play with these sorts of things. Make movement fun. Move in different emotional states, like when you are happy or grateful. Move outside – in the sun, in a park with beautiful plants and flowers. Move in the water.

The movement of your spine is also very important.26  Yoga  or simple spinal exercises can be great for this     and chiropractic care may be really important to help you move too.27-29  The main focus of chiropractic care      is to improve  the movement and function of your spine.30-32  This is so important because proper movement     of your spine helps your brain know more accurately what is going on, not only just in your spine, but also elsewhere in your body.33 34 And research tells us that chiropractic care can help people who suffer from back pain,38 39 and headaches.40 This is most likely because chiropractic care helps your brain know more accurately what is going on in your spine and body33 41 and may help your brain to switch off feelings of pain, when they are no longer needed.

So if you suffer from chronic pain do your best to stay positive,20 move often,18 19 eat well,21 22 sleep well,23 and go see your family chiropractor to help retrain your brain to be out of pain.38 39


Katz WA. The needs of a patient in pain. The American journal of medicine 1998;105(1, Supplement 2):2S-7S. 2. Seymour B. Pain: A Precision Signal for Reinforcement Learning and Control. Neuron 2019;101(6):1029-41. 3. Holt K, Russell D, Cooperstein R, et al. Interexaminer reliability of a multidimensional battery of tests used to assess for vertebral subluxations. Chiropr J Aust 2018;46(1):101-17. 4. Fenton BW, Shih E, Zolton J. The neurobiology of pain perception in normal and persistent pain. Pain management 2015;5(4):297-317. 5. Koyama T, McHaffie JG, Laurienti PJ, et al. The subjective experience of pain: Where expectations become reality. Proceedings of the National Academy of Sciences 2005;102(36):12950-55. 6. Mitsi V, Zachariou V. Modulation of pain, nociception, and analgesia by the brain reward center. Neuroscience 2016;338:81-92. 7. Ploghaus

  1. Dissociating Pain from Its Anticipation in the Human Brain. Science 1999;284(5422):1979-81. 8. Wager TD. Placebo-Induced Changes in fMRI in the Anticipation and Experience of Pain. Science 2004;303(5661):1162-67. 9. Wiech K. Deconstructing the sensation of pain: The influence of cognitive processes on pain perception. Science 2016;354(6312):584-87. 10. Costigan M, Scholz J, Woolf CJ. Neuropathic Pain: A Maladaptive Response of the Nervous System to Damage. Annual Review of Neuroscience 2009;32(1):1-32. 11. St Sauver JL, Warner DO, Yawn BP, et al. Why patients visit their doctors: assessing the most prevalent conditions in a defined American popu- lation. Mayo Clinic proceedings 2013;88(1):56-67. 12. Webb R, Brammah T, Lunt M, et al. Prevalence and Predictors of Intense, Chronic, and Disabling Neck and Back Pain in the UK General Population. Spine 2003;28(11):1195-
  2. 13. Mallen C, Peat G, Thomas E, et al. Severely disabling chronic pain in young adults: prevalence from a population-based postal survey in North Staffordshire. BMC Musculoskeletal Disorders 2005;6(1):42. 14. Apkarian AV, Hashmi JA, Baliki MN. Pain and the brain: specificity and plasticity of the brain in clinical chronic pain. Pain 2011;152(3 Suppl):S49. 15. Atlas LY, Bolger N, Lindquist MA, et al. Brain Mediators of Predictive Cue Effects on Per- ceived Pain. 2010;30(39):12964-77. 16. deCharms RC, Maeda F, Glover GH, et al. Control over brain activation and pain learned by using real-time functional MRI. Proceedings of the National Academy of Sciences of the United States of America 2005;102(51):18626-31. 17. Geneen LJ, Moore RA, Clarke C, et al. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database Syst Rev 2017;4:Cd011279.
  3. Booth J, Moseley GL, Schiltenwolf M, et al. Exercise for chronic musculoskeletal pain: A biopsychosocial approach. Musculoskeletal care 2017;15(4):413-21. 19. O’Connor SR, Tully MA, Ryan B, et al. Walking exercise for chronic musculoskeletal pain: systematic review and meta-analysis. Arch Phys Med Rehabil 2015;96(4):724-34.e3. 20. Schutze R, Rees C, Slater H, et al. ‘I call it stinkin’ thinkin’’: A qualitative analysis of metacognition in people with chronic low back pain and elevated catastrophizing. British journal of health psychology 2017;22(3):463-80. 21. Masino SA, Ruskin DN. Ketogenic diets and pain. Journal of child neurology 2013;28(8):993-1001.
  4. Silva AR, Bernardo A, Costa J, et al. Dietary interventions in Fibromyalgia: a systematic review. Annals of medicine 2019:1-29. 23. Burgess HJ, Burns JW, Buvanendran A, et al. Associations Between Sleep Disturbance and Chronic Pain Intensity and Function: A Test of Direct and Indirect Pathways. The Clinical journal of pain 2019. 24. Bowering KJ, O’Connell NE, Tabor A, et al. The effects of graded motor imagery and its components on chronic pain: a systematic review and meta-analysis. The journal of pain : official journal of the American Pain Society 2013;14(1):3-13. 25. Mulder T. Motor imagery and action observation: cognitive tools for rehabilitation. Journal of neural transmission (Vienna, Austria : 1996) 2007;114(10):1265-78. 26. Laird RA, Keating JL, Ussing K, et al. Does movement matter in people with back pain? Investigating ‘atypical’ lumbo-pelvic kinematics in people with and without back pain using wireless movement sensors. BMC Musculoskelet Disord 2019;20(1):28. 27. Eliks M, Zgorzalewicz-Stachowiak M, Zenczak-Praga K. Application of Pilates-based exercises in the treatment of chronic non-specific low back pain: state of the art. Postgraduate medical journal 2019;95(1119):41-45. 28. Li Y, Li S, Jiang J, et al. Effects of yoga on patients with chronic nonspecific neck pain: A PRISMA systematic review and meta-analysis. Medicine 2019;98(8):e14649. 29. Galindez-Ibarbengoetxea X, Setuain I, Andersen LL, et al. Effects of Cervical High-Velocity Low-Amplitude Techniques on Range of Motion, Strength Performance, and Car- diovascular Outcomes: A Review. J Altern Complement Med 2017;23(9):667-75. 30. Brown RA. Spinal Health: The Backbone of Chiropractic’s Identity. Journal of Chiropractic Humanities 2016;23(1):22-28. 31. Hart J. Analysis and Adjustment of Vertebral Subluxation as a Separate and Distinct Identity for the Chiropractic Profession: A Commentary. J Chiropr Humanit 2016;23(1):46-52. 32. The Rubicon Group. Definition and Position Statement on the Chiropractic Subluxation. [Online] Available at: http://www.therubicongroup.org/#/policies/: The Rubicon Group, 2017:4. 33. Haavik H, Murphy B. Subclinical neck pain and the effects of cervical manipulation on elbow joint position sense. J Manipulative Physiol Ther 2011;34(2):88-97. 34. Korakakis V, Giakas G, Sideris V, et al. Repeated end range spinal movement while seated abolishes the proprioceptive deficit induced by prolonged flexed sitting posture. A study assessing the statistical and clinical significance of spinal position sense. Musculoskeletal science & practice 2017;31:9-20. 35. Gross A, Langevin P, Burnie SJ, et al. Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment. Cochrane Database Syst Rev 2015(9):Cd004249. 36. Gross A, Miller J, D’Sylva J, et al. Manipulation or mobilisation for neck pain: a Cochrane Review. Man Ther 2010;15(4):315-33. 37. Bryans R, Decina P, Descarreaux M, et al. Evidence-based guidelines for the chiropractic treatment of adults with neck pain. J Manipulative Physiol Ther 2014;37(1):42-63.
  5. Goertz CM, Pohlman KA, Vining RD, et al. Patient-centered outcomes of high-velocity, low-amplitude spinal manipulation for low back pain: a systematic review. J Electromyogr Kinesiol 2012;22(5):670-91. 39. Ruddock JK, Sallis H, Ness A, et al. Spinal Manipulation Vs Sham Manipulation for Nonspecific Low Back Pain: A Systematic Review and Meta-analysis. J Chiropr Med 2016;15(3):165-83. 40. Bryans R, Descarreaux M, Duranleau M, et al. Evidence-based guidelines for the chiropractic treatment of adults with headache. J Manipulative Physiol Ther 2011;34(5):274-89. 41. Holt KR, Haavik H, Lee AC, et al. Effectiveness of Chiropractic Care to Improve Sensorimotor Function Associated With Falls Risk in Older People: A Randomized Controlled Trial. J Manipulative Physiol Ther 2016.