Approximately 30 percent of adults over 18 are experiencing chronic pain with a slightly higher prevalence (34 percent) among females.1 Pain can significantly influence an individual’s recovery and functional ability.
Patients with chronic pain may frequently say “I have had this pain for such a long time that I have just grown used to it.” A patient may be trying to convey that their pain is a very familiar symptom and they are used to it being present, but when a patient is experiencing chronic pain, do they actually build a tolerance to it? Do patients with chronic pain just eventually grow used to it? This is an important topic as it can influence treatment and help healthcare providers move toward improved outcomes in the management of chronic pain.
Throughout our body we have specialized nerves called nociceptors that detect pain. When these nerves are activated by painful stimuli, they send a signal to the spinal cord, then up to the brain, where the signal is interpreted as pain. The brain can then send a signal out to the body for an appropriate response – such as moving your hand off of a hot stove. This process works well for pain that can be reduced by simply taking away the painful stimuli. Some pain, such as pain experienced after surgery, can’t be relieved by removing the painful stimuli. This type of pain, felt for a longer duration, can be regulated not only with medications, but also the body’s own internal mechanisms. It is the body’s ability to regulate these longer duration pain signals that is important in chronic pain.
So, does a person who experiences chronic pain build a tolerance it? A review of the literature indicates that people who are experiencing chronic pain have a reduced ability to internally regulate pain experienced for a longer duration compared to individuals with non-chronic pain.2 This was reported to be particularly true for the elderly population and more prevalent among females than males.2 This indicates that those experiencing chronic pain are not as effective at internally regulating their long duration pain and are therefore more sensitive to pain over time.
Studies have also shown that people with chronic low back pain can have lower tolerance to pressure applied to painful areas when compared to a control group.2 This hypersensitivity to touch was also noted in areas away from the primary area of injury. Because of a person’s decreased ability to internally regulate this type of pain, they don’t build a tolerance to it, but actually become more sensitive! In fact, we can see patients with chronic pain and their decreased internal response to it, by a process called conditioned pain modulation (CPM). With CPM, painful stimuli can be used at a remote site to decrease pain at the primary site. As an example, a patient could put their non-injured foot into cold water, and through the body’s internal pain regulation, decrease pain at the primary area of injury. For patients with chronic pain, this CPM response is reduced.2 This, again supports that patients with chronic pain are not building a tolerance to pain, but becoming more sensitive to it.
Understanding how your pain works can be extremely helpful for managing and treating it. Knowing what to expect when performing activities and being prepared for how your body may react can allow you to engage with activity successfully. Physical Therapy can employ various manual therapy techniques, education on proper movement, and exercise to improve the CPM response and address hypersensitivity to pain. Your physical therapist can be an effective part of your health care team treating your chronic pain.
If you are currently experiencing chronic pain, contact your nearest Athletico location to schedule a free assessment. Free assessments are available in-clinic and virtually through our telehealth services.
The Athletico blog is an educational resource written by Athletico employees. Athletico bloggers are licensed professionals who abide by the code of ethics outlined by their respective professional associations. The content published in blog posts represents the opinion of the individual author based on their expertise and experience. The content provided in this blog is for informational purposes only, does not constitute medical advice and should not be relied on for making personal health decisions.
Johannes CB, Le TK, Zhou X, Johnston JA, Dworkin R. The prevalence of Chronic Pain in the United Sates Adults: Results of an Internet-Based Survey. The Journal Of Pain. 2010, 11(11): 1230-1239.
Central sensitization and changes in condition pain modulation in people with chronic nonspecific low back pain: A case-control study.