When pain returns, why does it seem worse?

While very difficult to study, I have a theory. After an individual has pain improve for a period of time, and then it returns, patients more often than not report that it seems worse than before. Why is that? It is possible that the pathology has progressed, that is to say, there are more nociceptive or painful signals being sent to the brain. However, I think the answer more likely lies in the emotional nature of pain.

As previously defined, pain is a negative emotional experience. When we chronic pain sufferers experience relief, a burden has been lifted. When a treatment works, people frequently say, “I feel like I got my life back.” When pain returns and that relief is taken away, I think pain can just feel worse. One’s life, or aspects of one’s life, is taken away. Again. Speaking from an individual who is in and out of a wheelchair depending on pain “flares,” it is demoralizing to lose something like the ability to walk after it has been restored.

For healthcare providers, when the pain returns, we need to understand and be empathetic to how the recrudescence of pain affects a patient. Not only has the symptom returned, but some semblance of normalcy has been taken away. Even in the absence of worsening tissue pathology, the experience may very well be worse for the patient. As patients, we need to take a step back, take many deep breaths, and realize that most likely, there is nothing physically worse with our bodies. The pathology is most likely the same. We need to recognize that it likely seems worse because of the emotion involved with going through a flare. This thought process can help with coping.