A Body Long Ill Recovers Long

A patient who told me it had been three years asked, a moment later, whether it would then take three years to heal.

Asking whether it will take three years is counting in days. Saying it has hurt for a long time also means the same thing has passed through that many times. Recovery takes time not because the days that have passed need to be filled again, but because the same thing has to be done, many times, in the opposite direction.

Long Pain Teaches the Nerve That Path

Pain is, by nature, a signal meant to inform. It means: there is an injury, so be careful.

But when the same signal passes through for a long time, the very connection that carries it changes. The point where one nerve meets another is called a synapse. When the same signal passes through it again and again, that connection actually strengthens. Then a small stimulus produces a large amount of pain, stimuli that should not hurt at all begin to hurt, and the signal remains even after the original injury has fully healed.

This is why those who treat pain group together pain that has lasted longer than three months or that recurs, and consider it separately. Those three months are not a clock inside the body but a line drawn to decide where to start looking at it differently — a line drawn by time, and nothing else. This means how long it has lasted is that large a part of the pain itself. I discussed this line in detail in How Long It Takes for Pain to Become Chronic.

A Strengthened Connection Can Also Weaken

The property of a connection strengthening comes paired with its opposite. Passing through frequently strengthens it — this is called long-term potentiation. There is also a weakening counterpart, called long-term depression, which does not happen automatically just because a signal becomes infrequent — it occurs when weak stimuli continue at a low frequency. In studies that look closely at nerves, these two are always found together as a pair. There is no body that has only the strengthening side on its own.

This is where the arithmetic of time comes in. A strengthened connection can weaken again. But it does not happen from passing through once. It requires passing through many times, and that takes time. How many times it takes cannot be counted in advance.

This is the arithmetic behind why a body that has been in pain for a long time takes a long time to recover. It is not a pleasant thing to hear. But the fact that what it costs, and how much, can be reckoned at all also means there is a direction to it.

Recovery Happens Only When the Body Actually Does the Work

Resting reduces the load. Using the painful spot less, not overexerting it, leaving it alone. In an acute situation, this is the right thing to do.

But leaving it alone does not repair it on its own. Recovery only happens when the body actually does the work. Blood has to reach the injured site, what has accumulated there has to drain away, and the body has to have the capacity to do all of this. If the conditions are not met, only time passes. I discussed these conditions in They Say Rest Heals It, But What If Rest Does Not Help?.

So not all the time that has passed is time spent recovering. Among people who have suffered for a long time, some have gone years with that process barely running at all. Those years are time that passed, not work the body did. Saying it takes long because it hurt long is not the same as saying leaving it alone for long enough is enough.

The Bad Days Reveal the Direction

Chronic pain can still rise and fall in severity even while it is improving. It repeats a cycle of getting better and getting worse. Many people grow discouraged at this point, because when a bad day comes, they assume that everything done so far has been undone.

But comparing bad days against each other reveals something different. Bad days still come, but they are not as bad as before. If that low point is gradually getting shallower, that is the direction things are moving in.

I pay attention to how much less bad the bad days have become, more than to the good days. A single good day can happen just from sleeping well that night or the weather being nice. The floor of a bad day only becomes shallower once a longer stretch of time has accumulated.

Somewhere Else First

There are times, though, when it does not rise and fall this way. In that case, checking comes first.

When it does not alternate between bad and good but only keeps getting worse. When this month is worse than last month, and this week is worse than last week.

When it does not ease even while resting, and it wakes you at night. This is a different shape from hurting while moving during the day and easing when you lie down.

When something else runs alongside the pain. For instance, weight loss you never intended.

These three are not things to wait and watch over time.

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Saying recovery takes a long time means it will not be over quickly. It also means that the body is doing something the whole time it is coming back.

And not everything that has become chronic returns entirely to how it was. Even after all that time, some part remains different. It is better not to put off that conversation until later. Knowing in advance how far things will return makes it easier to gauge the road still ahead.

Which way it will go, though, is not something the years that have passed can tell you. What tells you is today's bad day.

Written by Dr. Heo Ji-young (PhD in Korean Medicine Pathology, Kyung Hee University · former Research Professor of Herbology, Kyung Hee University)