Chronic Pain and the Nervous System - January 2026 Newsletter
Chronic Pain and the Nervous System
Hello, this is Dr. Ellen. In this month’s newsletter, I want to talk about a subject that most people are aware of but may not know much about. The phrase ‘chronic pain’ is known by most and unfortunately experienced by many. I want to write about the causes of chronic musculoskeletal pain and focus on the nervous system’s role in maintaining ongoing pain. I will also touch on some of the interventions that have been used to mitigate and, in some, eliminate the suffering resulting from chronic pain.
By the way, if you haven’t had a chance to see my previous newsletters, you can find them on my website, www.drellencutler.com under ‘Free Resources’.
Pain and the nervous system
We usually think of pain as a normal response to tissue damage of the body. There are nerve endings throughout the periphery of the body that let specific neurons within the central nervous system (i.e., the brain and spinal cord) know there is a noxious stimulus occurring to a specific part of the body. These neurons are called ‘nociceptive’ neurons. This is the most cause of acute pain and is termed ‘nociceptive’ pain.(1) Unless and until the local cause in the peripheral tissue is resolved, the nociceptive pain will continue to be experienced. Sometimes, the pain experienced originates from dysfunctional tissues in another part of the body. Examples of this are tender points that are experienced as headache, or sacroiliac dysfunction felt as knee pain. These are termed ‘referred’ pains, which are often dull or achy in nature.
Pain can also arise from damage to peripheral nerves outside of the central nervous system. This has been termed peripheral ‘neuropathic’ pain.(1) If unresolved, this too may become a chronic pain. This most commonly occurs when there is prolonged pressure on a peripheral nerve and is often accompanied by impairment of sensation and muscle function that is served by the compressed nerve. An all-too-common example of this is pressure placed upon and resulting inflammation of the nerve roots that form the sciatic nerve causing leg pain (i.e., sciatica).(2) There can also be central neuropathic pain, where there is dysfunction of the nociceptive neurons of the central nervous system themselves.(1)
Yet another type of chronic pain can arise in an area where there originally was a nociceptive pain. This involves one of the involuntary parts of the peripheral nervous system, namely the sympathetic nervous system. This is termed ‘complex regional pain syndrome’ (CRPS). The quality of the pain can be burning in nature, and the severity can worsen over time, even with resolution of the original tissue damage that initiated the pain. Often, even light touch of the area can provoke increased pain.[3]
Chronic pain without tissue damage
The International Association for the Study of Pain (IASP) defines pain as "An unpleasant sensory and emotional experience associated with, or resembling [my emphasis] that associated with, actual or potential tissue damage".(4) This describes the subjective nature of pain and explains that chronic pain can be sustained without ongoing tissue damage, including of the nerves themselves. This has been referred to as ‘nociplastic’ pain.[1] This is one of the most common types of chronic pain I have seen in my patients, occurring because of increased sensitization of areas of the nervous system that are related to the area of the pain. Interestingly, this often seems to have been initiated by a nociceptive pain.
There are psychological approaches that address ongoing pain conditions. Cognitive Behavioral Therapy (CBT) is the largest evidence-based psychological approach that can help with ongoing pain conditions.(5) Over the past several decades, a number of other approaches have been created to specifically address ‘nociplastic’ pain. John Sarno described what he called tension myositis syndrome (TMS), in which chronic musculoskeletal pain that was unexplained by physical examination, imaging, or other studies was a response to repressed emotions, especially anger. The brain created physical pain as a distraction. Treatment centers around educating patients that their pain is emotionally driven, not structurally dangerous, and encourages resumption of normal physical activity. Quite a few of Sarno’s patients experienced significant relief using his approach.(6)
Subsequently, Howard Schubiner developed Pain Reprocessing Therapy (PRT). Because nociplastic pain is learned, he felt it could be unlearned, and PRT used specific techniques to retrain the brain to stop signaling that there is pain.(7) A 2022 study supported the idea that changing fear and avoidance beliefs about the causes and threat of pain can provide substantial, sustainable pain relief for people with chronic back pain of unknown cause.(8) Another approach is Emotional Awareness and Expression Therapy (EAET), which also teaches patients to process trauma and emotional conflicts, recognize the nervous system's role in generating pain, and address suppressed feelings to reduce pain and improve function.(9)
Another general approach is the treatment of ‘myofascial’ pain, which emphasizes the importance of ‘trigger points’ in areas experiencing or adjacent to musculoskeletal pain. Psychological distress seems to play a central role in the development and exacerbation of myofascial pain.(10) Interventions are used to release these points and thus break the feedback loop between the peripheral receptors and the central nervous system that perpetuates the experience of pain. The release of these trigger points has been approached in a number of ways. Various types of needling have been used, ranging from ‘dry’ needling to injections of local anesthetic with or without a corticosteroid. Chiropractic adjustments and other spinal and local manipulation as well as various types of local pressure/massage have also seen successes in relieving chronic musculoskeletal pains.
Ellen Cutler Method (ECM)
Over my years of practice, I have seen many individuals with chronic pain complaints. I have repeatedly found ECM energetic testing and clearing methods to be quite effective in mitigating and often ending many of my patients’ persistent problems. Through ECM testing I first determine the nature of their pain problem, and then find if there are specific reactivities related to this or to the reactivities themselves. Once uncovered, I use ECM clearing methods to desensitize any identified reactivities as well as to identify optimal lifestyle choices and complementary treatments such as chiropractic adjustments or mind-body approaches. Typically, moving toward a whole food plant-based diet and avoiding pro-inflammatory foods leads to improvement in their complaints. This is done in conjunction with having a full spectrum digestive enzyme at the beginning of each meal (such as Dr. Ellen’s Way ‘Digest Supreme’)(11). I have seen great successes using this methodology.
Please be well, be healthy, but remember…
“The longer you have pain, the better your spinal cord gets at producing danger messages to the brain, even if there is no danger in the tissue.”
― Lorimer Moseley (i.e., the brain and nervous system can learn to keep producing pain, but can also learn to stop producing pain.)
Dr. Ellen
References:
“Terminology” at https://www.iasp-pain.org/resources/terminology/
“Complex Regional Pain Syndrome” at https://www.ninds.nih.gov/health-information/disorders/complex-regional-pain-syndrome
“IASP Announces Revised Definition of Pain” at https://www.iasp-pain.org/publications/iasp-news/iasp-announces-revised-definition-of-pain/#:~:text=Although%20pain%20usually%20serves%20an,Posted%20in%20Uncategorized
“Opportunities for chronic pain self-management: core psychological principles and neurobiological underpinnings” at https://bookcafe.yuntsg.com/ueditor/jsp/upload/file/20250623/1750644256854056332.pdf
“Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients with Chronic Back Pain” at https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2784694
“Emotional Awareness and Expression Therapy (EAET)” at https://painguide.com/pain-care/professional-care/therapies/eaet/
“Myofascial Pain Syndrome: An Update on Clinical Characteristics, Etiopathogenesis, Diagnosis, and Treatment” at https://onlinelibrary.wiley.com/doi/full/10.1002/mus.28377
“ECM Digest Supreme” at https://drellencutler.com/digest-supreme
* These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, mitigate, or prevent any disease.
