How To Manage Pain With The Latest Therapies And Pain Science
“Pain is at a very fundamental level all about your brain’s assessment of safety: unsafe things hurt. If your brain thinks you’re safe, pain goes down.” Paul Ingraham
IF YOU’RE CURRENTLY EXPERIENCING PAIN, OR YOU KNOW SOMEONE WHO IS IN PAIN, THEN YOU WILL BE EXCITED TO KNOW THAT THERE’S A REVOLUTION HAPPENING IN HOW WE UNDERSTAND PAIN.
By Rita McAlonan – Child and Adult Therapies
HOW DOES PAIN WORK?
Our body contains specialised nerves that detect potentially dangerous changes in temperature, chemical balance or pressure. These “danger detectors” (or “nociceptors”) send alerts to the brain, but they cannot send pain to the brain because all pain is made by the brain.
When you’re injured, the brain makes an educated guess which part of the body is in danger and produces the pain there. Pain is not actually coming from the wrist you broke, or the ankle you sprained. Pain is the result of the brain evaluating information, including danger data from the danger detection system, cognitive data such as expectations, previous exposure, cultural and social norms and beliefs, and other sensory data such as what you see, hear and otherwise sense. The brain produces pain. Where in the body the brain produces the pain is a “best guess scenario”, based on all the incoming data and stored information. Usually the brain gets it right, but sometimes it doesn’t.
These “danger detectors” are distributed across almost all of our body tissues and act as the eyes of the brain. When there is a sudden change in tissue environment – for example, it heats up, gets acidic (cyclists, imagine the lactic acid burn at the end of a sprint), is squashed, squeezed, pulled or pinched – these danger detectors are our first line of defence. They alert the brain and mobilise inflammatory mechanisms that increase blood flow and cause the release of healing molecules from nearby tissue, thus triggering the repair process. Local anaesthetic renders these danger detectors useless, so danger messages are not triggered. As such, we can be pain-free despite major tissue trauma, such as being cut into for an operation. Inflammation, on the other hand, renders these danger detectors more sensitive, so they respond to situations that are not actually dangerous.
WHAT IS CHRONIC PAIN?
“Pain depends on how much danger your brain thinks your in, not how much you are really in.”
Lorimer Moseley, Pain Researcher
Chronic pain is nearly always a habit in the nervous system. Different to acute pain which is associated with tissue damage. Acute pain is essential and it protects the area from being harmed further whilst it heals. Most tissues in a human body will heal in 3 – 6 months. So ongoing pain more than 6 months is often labelled as chronic pain. The bodies ‘pain alarm system’ hasn’t switched off after the tissues have healed.
Pain becomes a bad habit and a fixed pattern in the nervous system. Once the volume gets turned up signalling danger, it’s hard to get it turned down.
THERE IS NO PAIN CENTRE IN THE BRAIN
Pain involves the nervous, endocrine and immune systems.
THE MYSTERY OF CHRONIC PAIN
“We think of pain as a symptom, but there are cases where the nervous system develops feedback loops and pain becomes a terrifying disease in itself. Starting with the story of a girl whose sprained wrist turned into a nightmare, Elliot Krane talks about the complex mystery of chronic pain, and reviews the facts we’re just learning about how it works and how to treat it”.
Let’s have a look at the BIOPSYCHOSOCIAL MODEL in relation to pain
To understand pain, we must look at the whole person in their world, which is where the BIOPSYCHOSOCIAL helps us. This model is championed by pain researchers Butler and Moseley. Look at how each of these overlap and much needs to be considered when you seek help for pain
Pain is Psychological, Social and Biological which is why it is so complex!
As a trauma informed therapist and body worker, I consider each and everyone of these when taking your history, listening to your story and developing your treatment plan.
Why things Hurt? Lorimer Moseley on how the body and brain interpret pain and how pain is an illusion!
THE NEW PARADIGM OF PAIN MANAGEMENT
The new paradigm of Pain Science teaches us that all pain as a purpose, that pain is at a very fundamental level all about your brain’s assessment of safety. Our brains are over-protective for too many things. Did you know 90% of clinical pain is protective pain? So, in essence our pain protection system is acting like an alarm system in an effort to keep us safe!
A short-term goal of pain is to protect you from damage or potential tissue damage. Your brain has learned this and may generate a pain event and stop you from doing anything to make the pain worse and as our brains are much too over protective, we need to get ‘under the alarm system.’ Anything we can do to feel safe will facilitate this process. If your brain thinks you’re safe, the pain goes down.
Pain is complex so we need to approach this from a whole human being perspective.
Pain is not just ‘issues in our tissues’, in fact it’s not an accurate measure of tissue health.
Pain is biological, psychological and social and we need to address all of this, which is why I work with you as a whole person.
The good news is that we can unlearn the pain habit. We can train our nervous system to respond differently to the information that’s coming in. Working creatively, we can find ways to manage and significantly reduce pain.
Bringing in as much safety to the nervous system will help. If the brain is detecting danger in its internal and external environment and automatically goes into a fight/flight or freeze response then it may instigate a pain response.
BACK PAIN – SEPARATING FACT FROM FICTION
So many people suffer back pain and it can really affect how they live and work.
The language used around back pain is very interesting and can play a large part in how we few our backs and how we think about our backs. We can become very protective of using our backs but our backs are strong.
Have you ever been told or said any of the following:-
- ‘My back has gone out’
- ‘You have a ruptured disc’
- ‘You have the back of a 70 year old’ (but you’re not 70)
- ‘I have a slipped disc’
- ‘Your back is damaged’
- It’s wear and tear’
- ‘You have bulging discs’
- ‘You have arthritis’
- ‘I wouldn’t be surprised if you ended up in a wheelchair’
- ‘You have to avoid bending/lifting’
- ‘Your back wears out as you get older’
and so on…
This video from Professor Peter O’ Sullivan is worth a watch. Listen to how these people describe their back pain.
MOTION IS LOTION
One of the best solutions for pain (Professor Mossley) is movement. Before introducing physical movement if you have found movement challenging, it can be helpful to visualise moving first. Imagine doing something that is low impact and fun e.g. playing catch with your dog. Visualise this over and over before approaching physical movement and exercise.
For example, if a person has been cautious about moving then their muscles in their back and other areas of the body may be tense. Movement and exercise will help loosen these muscles and strengthen the muscles also. Remember backs are strong but to start off, less will be more! Slowly at first, so we stay under the alarm system. Evaluate how that goes and do a little more. This will build some confidence and safety around movement and the nervous system shouldn’t be triggered. We do not want to over assess either because we are unlearning our current pain protection mechanisms. If you haven’t been moving much and the muscles were tensed and are now looser, then setting expectations that some of the pain may be new pain from the body reorganising itself and having a conscious awareness of this will help you.
TAME THE BEAST
Here’s a great resource, website and youtube video from pain scientists Watch the video to learn about new approaches to reducing your pain. How you think about your pain, changes the way it feels.
A LITTLE OF MY OWN STORY WITH CHRONIC PAIN
After decades of living in CHRONIC PAIN which was destroying my life, I was given a diagnosis of Arthritis and Fibromyalgia. The pain was so debilitating I couldn’t sleep, wearing clothes hurt, my children couldn’t touch me, let alone hug me without me screaming out in agony ☹. Many MRI scans and consultant appointments later I was stuck in a continuous cycle of pain and no real answers, I had had enough!
I searched for answers and for me medication wasn’t the answer. The drugs I was prescribed came with greater side effects and they didn’t even take the edge off, they just made me feel more unwell and drugged. I know this is not the case for everyone, this is not medical advice, it is personal experience. I finally found a consultant who told me there are no drugs for fibromyalgia and to find another way to support myself. I set off on a journey to find a way back to health and this started with looking at my diet.
When we learn that everything we eat and drink is information, it really helps you make healthy more informed choices. I thought I ate well and I didn’t drink much alcohol, so I thought I was doing ok but there were lots of improvements I could make to help myself. I cut back drastically on sugar, additives, processed foods, bread products and any foods which contain wheat and gluten. My system had become so sensitive that eating these foods increased inflammation in my body and kicked off another pain cycle.
Training as Biodynamic Craniosacral Therapist was a turning point in understanding pain and within this, I had the opportunity to learn the new paradigm of Pain Management and Pain Science. The essence of cranial work is that you touch people and they change. After years of being in pain it can be hopeful to feel something different and this is life changing, especially if we have been in pain so long, we’ve forgotten what it’s like not to be in pain! Craniosacral therapy is gentle touch and after years of painful physiotherapy which left me in worse pain than before, this was a welcome experience. When we are in pain, we do not want feel the pain, so we tend to disassociate from the pain and try not to be ‘in our body’. This is the opposite to what we need to do in order to feel better and heal. We need to feel our bodies and learn to understand the pain in order to heal it.
Want to work with me to understand your pain and experience something different?
Article by Rita McAlonan. Child Adult Therapies