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Dr. Jason Winkelmann

Serotonin and Chronic Pain

Updated: Nov 16, 2023

Serotonin is well known as the "happy neurotransmitter" but it does so much more than just boost our mood. It can actually help you get out of chronic pain!

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You see, when your nerves fire a pain signal to your brain, they do so at 100% all the time, whether you stubbed your toe on the coffee table or you gently bumped your elbow on the door frame. The pain signal from your toe and elbow to your brain are exactly the same. Yet these two very different experiences are perceived by your brain differently. Why is that?


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You have your spinal cord to thank for that. Nerves only know how to send a pain signal, they don't know how to change the intensity. So your spinal cord acts as the pain gatekeeper. When you do something, like stub your toe, that warrants a strong pain sensation, your spinal cord allows most of the pain signal from the nerves in your toe to reach your brain. You then perceive this experience as very painful.











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But when you gently bump your elbow, your spinal cord disagrees with the intensity of the pain signal stemming from the nerves in your elbow and actually dampens it. Diminishing the amount of pain signal that reaches your brain and this is why you don’t experience as much pain.



Cool, right?!


We call the process of your spinal cord dampening the pain signal traveling to your brain descending inhibition. Descending inhibition is facilitated by inhibitory interneurons and this is a really big deal! The chronic pain sufferer has fewer inhibitory interneurons than the average person, which is a reason they experience pain at a greater intensity and duration.


 

So where does Serotonin play into all of this?


Well, studies have shown that the neurotransmitters serotonin, and, the lesser talked about, norepinephrine positively affect those inhibitory interneurons. They help your spinal cord dampen the pain signal traveling to your brain so that you interpret, and feel, pain more appropriately! For various reasons, the chronic pain sufferer may be deficient in these neurotransmitters.


This is why antidepressant medications in the TCA and SNRI (not SSRI) classes have been effective in reducing chronic pain. But they still have their problems. These medications are riddled with side effects, only temporarily prevent the degradation of these neurotransmitters, not increase them, and meta analyses have proven that they are not effective for treating depression! Yikes!


 

So what can we learn from this?


For starters, depression is not due to a serotonin deficiency, but if we suffer from chronic pain we should be doing whatever else we can to increase the amounts of these neurotransmitters in our bodies. These neurotransmitters are created by the amino acids phenylalanine, tyrosine, and tryptophan. Eating a whole foods diet will supply you with these important nutrients, and the nutrients your body needs to convert these amino acids into serotonin and norepinephrine.


You can also supplement these amino acids or the supplement 5-HTP to increase serotonin levels. Other ways to naturally raise serotonin levels include consuming more probiotics, getting more sunlight, exercise, fostering relationships, and laughing!


This is tackling the root causes of chronic pain which produces long lasting benefits. Not just slapping a bandaid on the problem that will eventually cause more problems down the road.


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