The amount of pain you experience does not necessarily relate to the amount of tissue damage you may be suffering from. The pain experience is constructed in the brain based from many sensory cues from the environment. Thus, the intensity of pain does not necessarily correlate with the severity of the injury.
1 in 4 of the chronic pain cases in the United States defy normal tissue healing time.
So, why after someone’s tissue has healed are they still in pain?
The traditional western medicine model is a bio-medical linear model that sees the mind and body as being separate; quite a limiting model and way of thinking. To begin to understand why people experience chronic pain long after their tissue has healed, we need to bring in a new model of thinking that brings in the whole of a person; a bio-psycho-social model. This model recognizes that the mind and body cannot be separated. It recognizes the importance of alarm sensitivity, fears, attitudes, and beliefs in a chronic pain state. The ‘bio’ is the biology, anatomy, and physiology of a person’s physical and mental condition. The ‘psycho’ recognizes the psychological factors in function. And the ‘social’ takes into account the importance of a person’s societal and environmental context.
Let me give you a tangible example of how the amount of pain you are experiencing, may not directly correlate with the amount of tissue damage present. Here are 2 scenarios:
Scenario 1: You are out on a walk with your child, enjoying a warm, sunny day. As you cross the street, you sprain your ankle.
Scenario 2: You are at work and you don’t like your job very much. As you walk to the break room, you trip over something and sprain your ankle.
More likely than not, your body is going to elicit a MUCH stronger pain response from scenario 2 versus scenario 1. The reasoning being that in scenario 1, you were in a happier, more positive mood. In scenario 2, where you were not happy at your job and already in a more negative state and then you sprain your ankle. This scenario will have an amplified pain response.
The top 2 predictors in chronic pain are:
1) Satisfaction at Work
2) Satisfaction at Home
So, what is pain? And what do our mental and social part of ourselves have to do with it?
The answer is a bit complex, but I will do my best to break it up into tangible pieces.
Pain is a multi-system emergent output constructed by individual neurosignatures (what lights up as representation of said event).
Our systems are continually scrutinizing. All pain responses are a normal response to what our brain thinks is a threat.
Let me break it up a little:
Tissue is affected/changed/damaged.
This input is received by nerves, travels up through the spinal cord to the brain. Danger signals are produced here, not pain.
Processing then begins in the brain. The input is scrutinized based on the individual’s experiences, beliefs, knowledge, body image, cultural, motor patterns, etc. Depending on their life events, environment, etc. an output response is created.
The output links up with all the beliefs & stories and is generated. The brain weighs all information with the signal to determine the output response.
There is a then an action/response. The body responds in a way that it believes will help bring the body back to homeostasis (balance). The brain does this, protects, heals, and brings about balance, in a variety of possibilities, which could show up as a change in:
The message is processed throughout the brain and if the brain concludes that you are in danger and you need to take action, it will produce pain. The brain activates many systems that work together to get you out of danger.
How you understand and cope with pain affects your pain as well as your life.
Tissue damage creates inflammation which directly activates danger sensors and makes neurons more sensitive. Short term inflammation promotes healing. When pain persists, the danger alarm system becomes more and more sensitive. The danger messenger neuron becomes more excitable and manufactures more sensors for excitatory chemicals.
Response systems then become more involved and start contributing to the problem. Thoughts and beliefs become more involved and start contributing to the problem. The brain adapts and becomes better, and easier, at producing the neurotag for pain. Danger sensors contribute less and less to the danger message arriving at the brain. The ‘pain loop’ has been created and gets ‘stuck’ in the brain. At this point, the pain response is coming more from this loop than from the original site of injury.
MOVEMENT must be an integral part to any pain management program. It gives the nervous system what it needs, increases blood flow and space, and decreases inflammation.
Just because something hurts, does not automatically equal harm. Education and understanding are critical for you to overcome pain and return to life.
A key is to understand why your hurts won’t harm you and that your nervous system now uses pain to protect at all costs, not to inform you about damage. It’s a habit!
By being patient and persistent, you can use smart activities to gradually increase your participation and involvement in life. Purposefully seek out activities that produce danger-reducing chemicals, such as movement, particularly walking outside on a sunny day.
You can quickly learn to exercise the virtual body as well as the actual body. Thoughts are also nerve impulses. But you are not your thoughts. Thoughts are inflammations in the brain. Similar to getting stuck in the threads of negative thinking, you can get stuck in the ‘thought virus’ of pain. By educating yourself to dampen down thoughts that are creating pain, you can empower yourself.
The brain weighs the world and constructs our output response. By beginning to have a better understanding of how pain works and how the chronic pain loop is created, you are that much closer to allowing yourself to escape the pain.
(Information in the above blog post was gathered from my notes from an Explain Pain conference I attended in 2015.)