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Unravelling the Pain Conundrum

photo of head bust print artwork

How It All Works

The stim-u-lus wakes up the noci-ceptor, the nociceptor signals to the dor-sal horn, the dorsal horn relays to the thal-amus, and then the cortex steps innnn! Hey!

Feeling pain is normal. If a sensation triggers special organs called “nociceptors” to fire, that signal gets bounced all the way up to our brain to alert us that we may be sustaining an injury if we don’t do something about it. In that normal scenario, if we avoided injury or the injury we sustained heals, that pain pathway is silent and we do not feel pain.

As it turns out, while the signals that can trigger painful sensation travel a predictable route into the brain, it doesn’t mean that those signals are guaranteed to make you actually feel pain. This is because our central nervous system (brain and spinal cord) has many different mechanisms that modulate or control how those basic nerve signals are interpreted and acted upon. Things get even more complex and fuzzy when we take into account how higher brain functions like attention, experience, emotion, and behavior further affect how pain is perceived. We won’t deep dive into the exact workings of the nervous system (there are plenty of textbooks out there for that), but we will talk about how pain disorders affect our quality of life. To do this, we’ll begin with the bad news.

Beware the Dark Side, Luke.

Fear leads to anger. 
Anger leads to hate.
Hate leads to suffering.”

– Yoda B. Hermit

Pain is a huge problem in society. It leads to people feeling miserable. It contributes to thousands of lives ending by suicide every year. It is a leading cause for disability and lost work. Its challenges sustain a pharmaceutical industry worth billions of dollars, which is expected to rise significantly as life expectancy increases and more people accumulate chronic disease.

All of these negative issues stem from situations where our brains become inundated and overwhelmed by the feeling of pain. It could be from instances where pain signals do not successfully shut off after a stimulus disappears or brain pathways become overly responsive to those sensations. It could also occur from how we think and feel about pain. For example, being ultra-aware of sensation can increase painful feelings that don’t reflect physical harm (like scenarios where moderate pressure can trigger feelings of agony). Moreover, imagining that damage is being done, even when it is not, has been associated with amplified pain intensity. Feelings of sadness, anger, or fear that are not successfully managed can also increase pain perception and actually contribute to real, chemical inflammation within our various tissues; further increasing pain perception. Acquired attitudes and behaviors like pain avoidance, helplessness, and catastrophizing are also predictors of chronic pain disorders and disability.

The takeaway point here is that excessive rumination on painful sensation, potential triggers, and negative emotions all contribute to problems with causing and prolonging severe pain that is easily brought on, does not resolve with addictive drugs, and destroys quality of life.

The Good News

Pain is controllable without medications. It can be defeated and WE ALL have the power to make it happen. It all starts and ends in our brain and, more importantly, in our minds.

When we are young and healthy, it’s important to be active. In that activity, we need exposure to different stressors, challenges, and growing pains, if you will, that teach our developing brains how to positively succeed. It helps to be supported and nurtured through that process by the people around us. Not everybody is so lucky to be born into that kind of support system, but finding positive people and embracing positive habits can be developed through adversity by leveraging appropriate resources. Our early experiences with challenge and pain can help shape our self identity into one that is strong, positive, and resourceful.

It also helps to orient ourselves to the positive side of pain. While pain can have an inhibitory effect where it pushes us to stop what we’re doing and suffer, it can also have a facilitative power when associated with positive experience and perception. One example is the painful discomfort that comes with maximal physical exertion in sport. When you are pushing your limits, your muscles are burning, and you feel like vomiting, you are doing your best effort. Chances are high that you will set your best athletic result. External feedback from peers and spectators as well as personal pride in your performance makes the pain take the backseat. Win or lose, you accomplished something and are better prepared mentally to keep pushing the envelope in training so you can keep improving. Our brain is able to downturn the intensity of pain signals and avoid the paralyzing effect it can have on our behavior when we are focused on something other than the sensation itself. Pain can be interpreted as beneficial and even reinterpreted as harmless in the case of an existing pain syndrome.

As we age and live longer, there is ample opportunity to develop and, in turn, manage chronic health issues; many of them associated with feelings of pain. Here are some strategies that can help empower you to manage chronic pain without relying on medications:

1. Stay busy. Stay physically and mentally active every day. Being deeply focused on tasks and their outcomes that you enjoy, will reduce your pain.

2. Recognize how often you spend actively thinking about the pain you feel and work to curb the habit. The less you ponder and evaluate your pain, its triggers, and your perceived limitations, the less it will affect you.

3. Embrace the fact that your brain has the innate and complete power to help you feel better simply by knowing painful sensations do not mean physical harm is happening.

4. Seek to experience beneficial discomfort of exercise because it will not harm but help you and it will progressively help the more you do it.

5. It’s good to show and share your struggles with the people who care for you or those who relate to you how you feel. Being socially supported not only heals the soul, but also corrects faulty pain mechanisms.

You can defeat chronic pain. It is not magic. It is not fluffy rah-rah. It is science. And it starts with you taking your first step.

Our Challenge To You:

Pick 1 of the 5 strategies above and put it into action beginning tomorrow.

Next week, pick another strategy that resonates with you and practice it while keeping up the routine you had the previous week.

Continue to add a strategy of your choice for each week until you’ve completed Week 5.

Give it a try and leave us a comment below about how you feel. Did it help? What did you find to be the hardest part about making change?
We want to hear from you!

References:
Garland EL. Pain processing in the human nervous system: a selective review of nociceptive and biobehavioral pathways. Prim Care. 2012;39(3):561-571. doi:10.1016/j.pop.2012.06.013

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