12 Aug How Pain Works (a quick summary of a massive topic!)
When you are looking for a solution to persistent or recurrent pain it really helps to understand what you are dealing with.
We tend to think of pain as being something caused in our bodies. If we think about how it works at all, we maybe think of “pain receptors” sending a signal of pain down the nerves, to our brains.
This idea fits best with an acute injury e.g. a broken leg
BROKEN BONE > PAIN SIGNAL> BRAIN
Brain says: DON’T MOVE YOUR LEG!
This all seems straight forward until you have a situation where the broken leg has fully healed, the cast has been off some weeks, and there is still pain. In this case, if pain is supposed to equal damage to the bone, and the damage is all healed, why would there still be pain?
When you look into this you start to realise it’s a bit more complicated…..
Pain is your brain’s interpretation of all the information it has about the situation.
Sounds odd? Bear with me….
Information comes in to the brain all the time via the nervous system, and it has to filter and interpret all of this. You can’t be aware of, or concentrate on everything all at the same time, so the brain works to present us with the most relevant, useful stuff. This works visually, e.g. you might not notice what’s going on in your peripheral vision if you are concentrating on your computer screen.
Your brain will filter out background conversations when speaking to a friend in a noisy pub, but if someone mentioned your name in one of those conversations your attention would likely be tuned in!
Information from the body is one of those things competing for our attention. You may have noticed this with, for example, getting a dead leg because you have been sitting in a position for too long. Your body has sensors in the tissues – these are nerve endings that report on things like pressure, temperature or chemical changes and send information to the brain all the time. The brain then filters and interprets this information in the same way as it does for sight, sound and other bodily sensations.
In the case of the dead leg, chemical changes due to the restricted blood supply occur, and this will cause the chemical sensors to send information. At what point you pay attention to it will vary though. If you are bored, any slight discomfort might register, and you will fidget to get comfortable. If your brain is busy with other things it might wait until the signal seems very urgent before it tells you that you really need to move.
Pain is what we experience when the brain decides there is something worry about.
It is an unpleasant sensation, so it acts like an alarm signal to get your attention, so that you protect yourself. You remember painful events very clearly, so you will avoid getting hurt again (in general – sports like skiing seem to be an exception!)
It is a danger signal that your life, or something very important is at stake, so you must respond. Pain was useful in our evolution, but also still today, to prevent us hurting ourselves or to let injuries heal.
Unfortunately, because it has this important job as a danger signal it errs on the side of being oversensitive.
In the case of that broken leg that has healed, but is still painful, the information from the body sensors is now at a very low level because healing has occurred.
So why is the brain still producing an alarm signal : pain?
These are just some examples of why pain might persist:
The area of the nervous system dealing with the leg has been very “busy” for many weeks and has become “sensitised”. Any little bit of information from the sensors is then paid attention to out of proportion to the rest of the body. This can make normal light touch of an area seem painful, for instance, because any slight pressure is overinterpreted as pain.
It can also mean that muscles in the painful area “guard”, tightening around the injury to prevent movement. Gentle mobilisation can help prevent this, but it can remain an unconscious pattern even after the area has healed.
The brain perceives danger so “flight or fight” hormones and systems are activated. If the pain is ongoing this activation is also ongoing. This has many affects e.g. it can make it more difficult to rest. Being sleep deprived makes everything seem harder, and pain is often worse when you don’t have quality rest.
All experiences involve thoughts and emotions, and pain is no exception.
If you have been worried about getting back to work, or maybe the leg was injured in a traumatic accident, then the brain will register this injury as of more of a threat. You might compare it with an injury as a child, when recovery was at home, being looked after by your parents and you had no real worries. Then, your brain decided that, although unpleasant, there isn’t too much threat to your whole existence, you felt cared for and worry free. So, the brain decided that, once the bone and other tissues stop signalling a problem, that the threat was gone, and no more pain was felt.
But, if you had had a horrific injury in past, you may relive that experience a little with this new injury, and that old worry and sensitivity of those parts of your nervous system will be added onto the information on how much the brain should pay attention to the leg. This means that the brain will generate a bigger alarm signal about this area.
So, you can see there could be many factors that could affect why the same injury could be more, or less, painful for the different people, and more or less likely to turn into persistent pain.
These factors come into play to a greater or lesser extent whatever the source of pain.
If you have an ongoing condition, such as arthritis, where there will be signals from sensors in the body, you are likely to experience some pain. However, that doesn’t mean you cannot influence your pain. There are lots of powerful ways the nervous system can dampen pain and learn to pay less attention to the signals from the body sensors, when they aren’t useful to your wellbeing. You can also learn to undo some of the less helpful responses we often have unconsciously to pain such as tensing up, or avoiding certain movements.
If you have read this far, please don’t misunderstand: pain might be from the brain, but that DOESN’T mean its just in your head. I know that’s not true from personal experience, and it is not what this all means. You can’t just think yourself out of pain. Be positive, and it will all go away. Not true. You also are not responsible for causing your pain to persist. Many of the factors in why persistent pain develops are unconscious or out of your control eg genetics.
But knowing pain in all its complexity gives you access to all sorts of tools to help it.
If you just treat the body without ever considering the mind, and how the nervous system works, you might get better, but it’s less likely because you are missing major bits of the pain puzzle. Why not use all opportunities to help your pain and to improve your wellbeing in a more general way too?
Alexander Technique doesn’t separate mind and body, so has lots to offer to help you out of pain.