What if pain was our Friend?
Research has shown that there are no pain receptors in the body only receptors/nociceptors that detect unpleasant stimuli. The unpleasant impulses get sent to the brain areas for processing and it is the brain that determines if you will feel pain or if you do not. The amount of pain we feel is always real to us – I am NOT suggesting it is imagined in any way – but the intensity of pain experienced is NOT dependent upon the amount of damage or problems in the body’s structures. There are countless stories of people who have had no pain when they have suffered a severe injury or conversely people who have experienced horrendous pain with no known cause. There is the famous story of the man who shot a nail through his foot and was brought to hospital in agony only for the hospital staff to remove his boot to discover the nail had gone between his toes. Lorimer Moseley a leading pain researcher has written an interesting book about it called, ‘Painful Yarns: Metaphors & Stories to Help Understand the Biology of Pain.’
Pain has also shown to be influenced by the context it is viewed in, i.e. if we are doing something we love or very important we tend to feel pain less and if we are doing something unpleasant we tend to feel it worse. Pain is experienced as more intense if we have suffered previous painful episodes whether it is physical/emotional/mental/social/spiritual/emotional pain- the brain cannot tell the difference between any of these. Many patients with past issues other than physical have difficulty comprehending that their social/mental/emotional/other physical past pains may be influencing their current physical symptoms. Even current emotional/social/mental /environmental issues can be impacting your perception of your pain. If a dysfunction or pain is not resolving then often other factors are influencing it especially if there is no physical reason for the delay in healing. Most injuries are on their way to full resolution within 6 weeks but if symptoms are worsening or not improving by 12 weeks there are more factors involved than just physical and to keep just treating the physical injury without respect to the other areas may not get you anywhere. These can be difficult and strange ideas to get your mind around…..
What is chronic pain then? Pain is a warning system that is detecting danger – yes a physical injury will often be painful and pain is warning for you to be careful, as something needs your attention. In chronic pain the danger sensors have been hypersensitized so they come on sounding their warnings much earlier than needed. Kind of like light motion sensors at your front door coming on early if someone merely passes by at the end of the street, instead of when they are at your front door. This creates hypervigilance within you that ramps up your neurochemicals like adrenaline & cortisol and if they are on for too long and out of balance this creates increased risk of further illness and injury as you immune system is compromised thus healing is compromised and your digestive system and sleep may also be suffering. The longer you experience the pain the harder it is to decrease, as it creates deep pathways in your neural circuits – the nerves that fire together wire together and so become a subconscious pattern that is the ‘go to ‘ reaction for a particular stimulus or trigger.
As it is natural for us to run away from or avoid painful situations/stimuli/sensations etc we often choose coping methods that are not helpful and end up prolonging or worsening the painful symptoms perceptions. The longer we run away from the sensations the harder it is to finally stop and face it and apply a new way of dealing with it. Usually after 12 weeks of pain, medications are less and less effective. So medication often is not the only answer.
If you have severe chronic pain it is slow process back to health. The first step is realising the pain is your friend and is trying to help you. You just have to learn the language it is speaking in and that is not easy. Sometimes the pain may not resolve completely but you can become able to be more active despite the pain, especially if you understand how pain works.
Physical exercise must be gradually increased to avoid flaring up the pain too much and scaring you back into avoiding it. Learning about how pain works is very helpful, as instead of feeling you are at its unpredictable mercy, you can start seeing how there is a pattern and then you have to learn to follow that pattern back to a more pain free life.
Setbacks are normal and to be expected. Compassion for yourself on your journey is highly recommended, as any time you resist or get cranky with yourself, you are more likely to set off the pain alarm response and thus increase your pain perception. There are very few conditions that require complete rest, and virtually none that require rest indefinitely. The body has to move. Every part of the body needs movement and needs to slide and glide. So learning gentle exercises and progressing slowly is a must. “Motion is lotion”. Otherwise you decondition and slowly get weaker and sorer.
Learning to find what brings you joy and happiness is vital, as these things cause your body to stop producing the chemicals that trigger pain responses and further increase injury/illness risk. Doing things you enjoy, turn on the ‘feel good’ neurochemicals’ like endorphins & the healing part of your nervous system- mainly the Ventral Vagus Nerve/ the parasympathetic nervous system. The more you can stimulate the happy healing chemicals like endorphins, dopamine/serotonin etc the less responsive your pain danger warning system will be. Doing the things you love with the people you love, is a great way to stimulate the chemicals in your brain that are stronger than the pain meds. They are ‘your own medicine cabinet in the brain’ and we all have access to it and it is not addictive.
Of course pain treatment is often harder than what I am writing about but hopefully this can start you in the right direction. Sometimes something small like reframing how you look at pain can change how you choose to treat it…remember pain is a danger detector or warning system not the truth about the extent of damage to your tissues. The body usually heals within a certain time frame and if it has not and there is no other physical reason then you may need to look at other areas which may be impacting on the experience of the painful sensations and address these environmental/social/emotional/mental or other areas as well….after all we are not just our body. We are a collection of trillions of cells working in community who are also connected to everyone and everything else in our universe – quantum science has revealed a lot already…
Jo Hadley
Integrative Physiotherapy
