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  • Writer's pictureDr. Strat Poulson

What Actually Matters for Chronic Pain?


There’s a lot of conflicting information out there about what matters for chronic pain. Perhaps you’ve heard that a “weak core” is responsible for low back pain? Although someone may have a weak core, that doesn’t necessarily mean that they will have low back pain and some of the strongest core muscles in the world wont keep professional athletes and weightlifters from having occasional bouts of low back pain either!

Research has even shown that people who have low back pain often have higher levels of muscle activity in core muscles in the low back and abdominal region when compared to healthy individuals with no pain.

What about “degeneration” ?

Degeneration in the vertebral discs, and the joints of the body is a normal part of aging.

No one would assume that grey hair and wrinkles are a life sentence for pain and disability, yet these findings of degeneration on X-rays and other scans are found frequently in people with no pain at all.

As a matter of fact, in this study the incidence of disc degeneration in individuals with no pain who were 20 years old was 37%, this climbs to as high as 96% of 80 year old’s who also have no pain! (

So if we see degeneration in nearly half or more of people with no pain how can we assume that the degeneration that was seen on our scans is causing our pain? We simply can’t.

What about rotator cuff tears and tendonitis?

The story is essentially the same.

In this study they found that MRI imaging of the shoulder in patients who have no pain, found 37% of these healthy people had rotator cuff tears or some other identifiable problem on their images. (

So once again, the results of diagnostic imaging may not be as useful for determining the cause of your pain as your doctor may think.

So what actually matters for chronic pain?

As it turns out, there are a variety of factors that can affect our levels of pain.

Have you ever responded to someone harshly because you had too little sleep and were stressed out?

You probably regretted it afterword, maybe you even apologized. If you had been feeling better, you may not have been so short or rude.

Your pain system works the same way. When your body is running low on sleep, is stressed out, or is unsatisfied with your work or home life it becomes more sensitive to pain signals and overreacts.

Imagine a bucket that you’re filling up with stressors, and when that bucket overflows you feel pain.

You can add many things to the bucket.

Lack of sleep, poor diet, work stress, a lack of emotional support or creative outlets, and a lack of close meaningful relationships can all bring this bucket near to the edge.

Now you add a few drops of sleeping on the couch, or a workout that you weren’t used to or ready for and bam!

Your bucket overflows and you feel pain.

So what do I do about my overflowing bucket?

Well, you have a few options, first you can start taking things out of your bucket.

You can work on getting better, more restful sleep. You can work on cleaning up a bad diet. You can work on ways to reduce your work stress, or find more beneficial emotional and creative outlets.

You could also, try to build a bigger bucket. Gradually increasing your movement and working up to more physical activity and strength, practicing mindfulness and finding meaningful activities that you enjoy will help to create a larger bucket where your stressors are less likely to overflow into pain.

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