In order to help you better understand pain, the following article provides a story with highlights, a video on understanding pain and a transcript of the video. I trust these will help make it clear.
Highlights:
Video:
Transcript:
Let me start by saying that in order to understand pain, we need to know that pain is a very individual and personal experience. No 2 people will feel exactly the same type, intensity or frequency of pain even if they have exactly the same diagnosis.
Why do we experience pain?
Pain is our body’s alarm system to protect us from harm. It is there to protect us. Pain is a driver of behaviour to protect the tissues of the body. What does this mean? Let us look at a simple analogy in order to understand this statement. If you step into a thorn while a bear is chasing you, you don’t feel pain because it is more important to run for protection. Lack of pain drives you to be able to run. The converse is also true, if the environment is safe but you step on something sharp, you will experience pain which will drive you to stand still and take the weight off the foot.
A functioning alarm system is vital for life, otherwise we would never know when we have a serious injury. For instance, a broken bone and probably shouldn’t walk on it or your appendix has burst and you need to seek medical help to save your life.
Does pain = damage?
Contrary to past belief, pain and tissue damage aren’t mutually exclusive. It takes 6-8 weeks for tissue damage to heal yet in some cases, pain persists long after this period.
Two thoughts. If pain was purely dependent on tissue damage or changes like joint degeneration, why do some people experience pain in the absence of any physical damage such as phantom pain in an amputation? The second question to ponder, is why do some people experience relief of their pain when a placebo is administered?
In the medical world, we see severe joint degeneration on x-rays but a person that doesn’t experience pain. Yet others have mild joint damage from age and experience intolerable levels of pain. It can be very confusing.
Are we missing some information?
Clearly pain is complex and depends on more than the biological aspect of tissue damage. It is in fact dependent on multiple factors – biological (tissue health, damage, age, sleep), psychological (emotions, coping skills, beliefs, past experiences) and social (culture, peers, finances). Hence the term the Bio-psycho-social model of pain.
Pain is 100% an output of the brain. I’m not saying your pain is in your head, it is in fact very real. Pain is, however, created by your brain after receiving signals from the body that it interprets as a threat. Even if the threat is not real, the brain will create pain to get you to behave in a way that creates safety as mentioned earlier. It is constantly looking for a state of equilibrium between safety and threat, move or stay put, after processing the signals.
These signals are multifactorial. They can be temperature, pressure, physiological chemicals, hormones, emotions such as fear, joy or anger and lastly what meaning or belief we have attached to an experience. The brain will process these signals, weigh them up in columns of safety versus threat and the one that dominates will determine the brain output (pain, muscle spasm, movement). The more factors that point to a threat, the more intense the pain experience will be.
Try as much as you may, you cannot consciously “think the pain away”. The brain has thousands of these bits of information coming at it every second of every day and needs to be able to process it without disrupting normal function, therefore it all happens in the subconscious mind. The subconscious mind is pretty lazy and will follow the path of least resistance, the path mostly or previously used. If you have a subconscious memory of a response (pain) to a range of stimulus that had a favourable outcome (safety) according to the brain, it will choose that path again. This reinforces the pathway between the set of stimuli and resulting pain. The more often you experience pain, the better your brain will get at producing it. A vicious cycle.
That is, until the perception of threat is challenged by different stimulus and it has to adjust its output to maintain equilibrium.
Balancing threat versus safety
This is where the magic of rehab happens. We are going to challenge the brain’s interpretation of threat by managing the stimuli in a way that it begins to feel safe again. One of the methods used is graded exposure to the painful movement or starting with an easy exercise and progressively making it more challenging. Another method is learning to manage stress and/or the psychosocial factors that weigh in on determining threat and finding ways of dialling them down.
By understanding that pain is not an indicator of how much damage or healing has happened but that it is an output of the brain, we have already begun the process of unravelling your pain.
Would you like some more information?
Here are a few links to get you started.
First off is a book by Lorimer Moseley and David Butler, explaining pain neuroscience. It is widely used by both clinicians and pain sufferers. (Please note that this is an affiliate link and I will earn from the sale of this book, however, it is at no extra cost to you).
Next is a TEDx video where Lorimer Moseley explains why things hurt.
Lastly, a video about rethinking persistent pain and trying to understand it better.
Medical disclaimer:
This content is for information purposes and is not intended to replace professional medical advice, diagnosis or treatment. If you have any health concerns or pain, please contact your healthcare provider directly.