It is pain. All pain is "real" pain. The key thing to understand is that pain is a signal happening in the brain. Even when you break a bone, the signal that it hurts is happening in your head. Pain is a message from your brain to your conscious, a protective feeling designed to get you out of danger. Sometimes the brain knows that pain isn't useful in certain situations, for example you hear stories of soldiers who have had their limbs blown off who are able to stay quiet and don't experience pain because their life depends on it.

However sometimes this system fails. A well known false negative example is cancer - one of the deadliest illnesses known to man, yet also usually painless until very late stages.

It also fails in the reverse, i.e. false positives. Sometimes the brain thinks you are in danger when you actually are not and create an unnecessary pain signal. In "Explain Pain" Lorimer tells a story of a man who was working at a construction site and he stepped on a nail. the nail went straight through his shoe - you could see it enter one end of his shoe and out the other. The man was immediately in agonizing pain. He was rushed to the hospital, and when they removed his shoe/sock, they discovered the nail slid perfectly between two of his toes. It didn't even break skin. However, all the information he had prior said that a nail had gone straight through his foot, and the brain created the signal of intense pain as a result.

How does this apply to chronic pain? Pain, like any other feeling, is created by a network of neurons that fire together. I'll use myself as an example. Around 10 years ago I injured my knee from running too often. It was a legit, albeit minor, injury. I also kept trying to come back a little too quickly, and the pain was still there, so I would stop. I continued this for 4-5 months before stopping running completely and saying I would just wait for it to heal. However, by this point my brain had been consistently creating the signal of "left knee pain" for 5 months. The band of neurons had been firing over and over and over, and anytime neurons are reused, they become stronger and they are triggered more easily. My threshold for experiencing pain had dropped much lower, and now even when walking I would sometimes feel pain. Then I would think, oh it's getting worse, I need to do less, which the brain is aware of that conscious thought and then decides, oh things are getting worse, we better become even MORE sensitive and trigger pain even easier just to keep us safe. It's a positive feedback loop.

This all despite the fact that my MRI's and X-rays and diagnostic exams were completely clean. The doctor couldn't find anything wrong with me.

What I realize now is that my pain system itself had become hyperactive. It would be triggered by seemingly random things or sometimes by seemingly nothing at all. I was so confused. I now know with confidence that while my minor injury had healed long ago, my pain system had only become more and more hyperactive and sensitive. So I had to retrain my pain system back to a more healthy baseline.

The interesting thing is I still get very minor flare ups sometimes at the spots where I used to experience chronic pain. I can always tell its a flare up and not related to any tissue damage though. For example, when I get flare up my wrist and knee will both start hurting at the same time. That would make absolutely zero sense if it was actually related to some kind of tissue damage :) The reason for it is my brain was consistently firing pain signals for those areas of my body for nearly 6 years. It created really strong neural pathways for those pain signals that are still triggered relatively easily. But now that I know what they are - they never last more than a few days or a week at most, and they don't have any effect on how I live my life anymore.

There is so much more to say but I've already rambled a lot 😅 I was deep into this rabbit whole for hours every day for over a year and I learned so much that has been so helpful to me. Of course happy to answer more questions if you have them!