Before you click on the “close” button because you think this is just one more well meaning health professional who has never had to endure anything like the pain you go through every day, telling you that you can think your way out of pain.You’re right. But I’ll tell you why.
We used to think that Nociceptors (nerve receptors that sense when tissue may become damaged or is becoming damaged) sent signals to the “Pain Centre” of the Brain (thalamus) and then this projected to the part of the brain that normally gets signals from that part of your body – and thats it, you have pain in that body part. Simple 1-to-1 input, response. This should make treating pain simple, because if you block that signal, you have no pain.
Alas, it’s not that simple. In fact, it is so gloriously COMPLEX that it take me the rest of this blog to explain why that’s not true. And then you’ll disbelieve it, because you’re certain that your pain doesn’t work that way, and then maybe if I’ve done my job well enough you’ll start to question your own conviction over the next few weeks and months and start to really absorb this modern pain research and help educate others about it, as you continue your own road to recovery.
The problem that we started having with this simple, linear pain model – is that it doesn’t explain large chunks of what happens in real life. Like the fact that blocking this pathway doesn’t get rid of pain in most cases (in some experiments, surgeons have literally cut the nerve connections from injured body parts to the brain, and often the pain still persists). It is well established that limbs that no longer exist can cause pain and sensation to be experienced.
So scientists (and I’ll be upfront, this stuff is largely taken from the works of G.Lorimer Mosely et al) started doing some very clever experiments to work out the question “So what really is Pain then?”. The journey involved doing experiments that subjected normal people to different painful stimuli, in different conditions and inferring results from this. Some really interesting findings include;
- An person in an empty white room with no other stimuli, subjected to a laser which is gradually turned up until they experience pain will record different results on any given day by up to 30% power output on the laser. This means even in an individual that Pain threshold is wildly variable in even the most clinical and restricted settings. Imagine how much this changes in the real world with its barrage of sensory inputs, experiences etc.
- When a person is subjected to a painful stimulus, and at the same time is shown a Blue light, they will report lower pain levels than if subjected to red light. The same is true with smell, and offensive smell will cause higher pain levels to be experienced than pleasant smells.
- Many clinical stories report situations where a patient has a serious trauma, but is so worried about another person or situation (say, their baby in the back seat) that they don’t notice their leg is folded or crushed until they look at it. In this situation the danger nerves(Nociceptors) are screaming about the tissue damage, but the brain hasn’t registered a pain experience.
- In contrast, a patient who had an injury years before and has healed as much as they are going to heal can experience significant increase in pain just by visiting the scene of their accident. In this scenario, there can be NO increase in nociceptor firing, but their pain becomes significantly worse.
- The list of these experiments goes on, and on, and would bore you other than to wonder why these researchers get off causing innocent people pain all the time . . . . . .
- Suffice to say that “Nociception (danger sensation from nerve endings) can sometimes cause no pain at all, can cause more pain than it should, and actually isn’t required for a pain experience at all”
So what is going on? Why does the brain not pay attention to danger messages sometimes, and other times it produces pain without danger messages?
The truth is, Pain is the master of all protection systems. It is amazing, complex, and we’d be in serious trouble without it. However, like all protection systems, it can become ramped up, hypersensitive and at times go totally Commando.
What really happens in your brain is that there is constant ebb and flow between different nerve networks (we’ll call them neurotags) which are the entire spaghetti of connected neurons that are responsible for an individual thought, concept, memory, emotion, input, output, or other brain functions. You have a neurotag for Love, and you have a neurotag for Pain. You have a neurotag for the waft of cigarette smoke scent that reminds you of that time that Grandma laughed so hard that milk came our of her nose. You have a neurotag for every function that your brain can perform, because that’s the way it works. Single nerve cells don’t do anything by themselves, and your brain lights up like a Christmas tree when you’re doing nothing at all.
Some of these networks will increase the effect of others, and some decrease. For instance if you are looking at a photo of your Grandma while you smell a waft of cigarette smoke, you’ll have a much stronger reminiscence than if you just smelled the smoke by itself. If you’re worried about a disc slipping in your back when you bend forward (FYI, they can’t slip) then you’ll have MUCH more pain when bending to pick up your socks than if you never heard about discs slipping or saw an MRI of your spine. However, if you’re out with a group of friends having fun, and stop to pick up a stray $100 note on the ground, then that same back bend will cause much less pain.
So the addition of more nerve networks in our brain that feed in to the pain experience make out brain better at protecting us from what it thinks might cause tissue damage.
Unfortunately for us, it can very quickly start to give us a protective experience (to cause us to act, move, react) from levels of activity or stimulus that cannot possible cause tissue damage. The longer our Pain system protects us from tissue damage, the better it gets at doing it.
That’s enough neurobiology for today. The complexity of the rest of it could take up numerous text books (in fact, it already does). Hopefully you can take on board, at the least, that pain does not mean tissue damage. Pinch your nose firmly until your eyes water. You just had pain, did you actually damage yourself? That’s a personal example of how pain is a warning of potential damage, and it can be wrong just like any protection system (think of our immune system that damages our joints in rheumatoid arthritis because it mistakes the tissues as not from our body, or our endocrine system that increases heart rate, breathing and blood pressure when we’re under stress at work)
So how does this help us as therapists? Doesn’t that mean that treating someone’s body is just a clever trick to convince their brain they don’t have pain?
Firstly, we need to realise when we’re no longer helping you. If you have sprained your ankle, and there is a large amount of bruising and swelling, your brain has very credible evidence of tissue damage, and it rightly causes you to have pain so that you stop running on it (although if you sprained it running from a swarm of zombies I’m sure it’d hurt less than if you sprained it in front of the hottest girl in school). In this case, it is perfectly appropriate to see a physiotherapist, get treatment, get advice, and we can genuinely help you get well faster and be in less pain. But if that ankle is still swollen and sore 9 months later? It’s already healed, treating the tissues is not going to help. In this case we need to work out what other factors are causing your brain to decide that any movement of your ankle may cause further damage. Similarly, if you’ve never had back pain, bend in the garden and then can’t stand up – go and see someone to get checked out, to make sure nothing really serious is going on (Cancer of the spine, Disc prolapse) and get it seen to if it does. But when that back stops you from standing 6 months later, we need to dig deeper into the other things in your life that are Danger messages for your brain, and tell it to keep producing a protective pain experience.
By working with you to identify all of the “changeable” aspects of your pain experience, we can significantly reduce how much pain you experience in day to day life. Coupled with special exercises to strengthen weak tissues, this means you can become more active, get out, make plans, and get back to life.
It works, we have the science to prove it. What makes your pain different from anyone else’s?
If you would like help with a Persistent Pain issue, something that is not responding to medication or treatment and keeps you trapped at home, unable to get out and enjoy life – inquire about the Outer Eastern Persistent Pain Group on 13009HILLS. This is a five week intensive course which couples Group Psychology to manage the mental health issues associated with pain disorders as well as teaching mindfulness for pain control, with Group Physiotherapy to educate patients about pain neuroimmune biology and teach movements and exercises to strengthen and relieve pain.