4 Principles About Pain That You Need To Understand
Time For A Change
The year 2020 is remembered pretty negatively by pretty much everybody who went through it, but for the world of pain science a major step forwards was taken. The IASP (International Association for the Study of Pain) updated its definition of pain from
“An unpleasant sensory and emotional experience associated with actual or potential tissue damage.”
to
“An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.”
Wild stuff I know, and you may have had to read it a few times to even understand how the second one is even different, but when it comes to improving the treatment of pain, those 5 extra words go a long way to explaining some of the more unusual ways that the mind and body link together when it comes to the experience of pain.
Since the 1600s, we have assumed that pain comes from the body, and that the experience is one of a problem to be solved. For the most part, this served us well, as pain does indeed tend to show up when we have a physical problem that requires our attention. But over the centuries it has also become clear that this is not the whole story. There are many cases where the body experiences pain yet no professional can find the root cause, could it be that the root cause may be more psychological than physical? Or is it possible that our understanding of pain is just a little off?
This update to the definition of pain is the first time that pain is a huge step towards shifting our views on pain as something happening in the body towards something that originates in the brain, and today I would like to share 4 principles about pain that you may not be aware of, and might just change your relationship with both pain, and your brain.
Pain is an alarm, not a sensor.
Imagine a large building with a fire detection system. In each room is a sensor that detects smoke, as well as an alarm consisting of a bell and flashing light. These sensors and alarms are not linked together as a unit, but instead all sensors and alarms are connected together via a central computer. When the sensor detects smoke, the computer triggers the alarms in order to get the occupants attention and evacuate the building. So the sensor and alarm both depend on each other, but they both have different functions. If a sensor is broken, the computer will not get the correct data about smoke, but the alarm can still be triggered manually if the building manager can get this information in another way, or even if the building needs evacuated for a different reason.
The philosopher Rene Descartes was the first person to suggest a scientific theory of pain, linking pain in the body to processing in the brain. The idea was that signal for pain was passed from the site of injury up to the brain, which was where we would ‘feel’ the experience. This theory treats pain like the sensor detecting smoke, but in reality pain looks more like the fire alarm. When the sensors, or nerves, in the body detect a problem, they send this information to the brain. The brain takes this information and combines it with all the other information it has received, and then makes a decision on whether or not the alarm, or pain, is the best response.
This might sound like overkill, but when it comes to survival there is a good reason why the alarm should be separate from the sensor. Imagine you were to injure yourself crossing a busy street, it is better if your brain can choose not to send pain if pain might lead you to further danger. Similarly, if you are about to do something likely to cause danger, your brain may choose to send pain in advance, in order to prevent the bad thing from happening at all.
So what does this teach us about pain overall? Pain is the alarm, not the sensor, and like an alarm, pain is the signal to get our attention, not the details of the problem to be solved.
2. Pain is both a sensation, AND an emotion.
Hot and cold? Which one is good and which one is bad? If you’re from Ireland you might have a pretty clear answer on this, but most people will tell you it depends on the context. An ice cold bucket of water poured over your head in the summer might feel pretty refreshing, but in the winter would not be welcome at all. The temperature of the water is the same both times, but how we feel about it is different. On the inside of the body, the brain divides temperature up in the same way. There is a sensory component that focuses on the details, and an emotional component that focuses on the context of the situation. Temperature is therefore both a sensation and an emotion at the same time, and when we realise this we can greatly improve our tolerance for extreme temperatures by focusing on the sensation and reframing the emotion.
Pain turns out to be really similar to temperature. So much so that pain can sometimes be blended with temperature in the body. And the emotional component is no exception. When we are experiencing pain we are experiencing a sensation at a certain point in our body, but also at the same time we have an emotional response. And when it comes to intensity, the emotional side of pain is usually the one to crank things up.
When you think about it this makes sense. If you eat something spicy on purpose you will probably enjoy the experience much more compared to if you ate something spicy when you didn’t expect it. The brain’s emotional centres go into overdrive when they are caught off guard, and this means they will try much harder to change your behaviour by giving you negative emotions. Similarly, you may find your pain experience of your broken arm is much different when you think about how you can’t play guitar versus thinking about how much time you’re getting off work.
We might not be able to do a whole lot about the sensory part of pain, but we can absolutely work on reframing our emotions. Slowly but surely, this can change the overall quality of the pain experience.
3. Pain is unique to everybody.
Did you ever hurt yourself so badly as a kid you started to panic that you had broken a bone? But then you took it to your parents who informed you that it couldn’t be broken, because it would hurt more if it was. There is a pretty common idea that bigger injuries hurt more, and that pain is something that can be measured on a universal scale. Both of these ideas are completely incorrect.
We’ve already looked at the idea that the brain can switch pain on and off when it feels the circumstances are appropriate, and that our emotions can distort our perception of pain. So it should be starting to make sense, that since everybody is dealing with different circumstances, and everybody is in a different place when it comes to emotional and psychological profiles, that everybody is going to experience pain differently based on their life experience up to that point.
As well as circumstance & emotion, there are several other factors that will influence how we experience pain. Our genetics will determine factors like the size and spread of the nerves around our body. Our stress levels will determine how intense a stimulus must be before it sends a signal to the brain, and our past experiences shape our neural pathways, making some sensations more or less familiar than others. All of these things influence the exact experience we go through when it comes to pain, and as such it is impossible to say that something that is 5/10 on the pain scale for me, will be the same for you. Not only that, our experience changes day to day, so we can’t even say that a 5/10 for me now will still be a 5/10 later on.
It takes quite a while for research to turn into practice, and some of you will have had the experience only recently of a medical professional proclaiming that you could not possibly be in the amount of pain you claim to be in, based on their years of experience. While this thinking may take time to shift, it is absolutely on the way out, and the science no longer supports the idea that the sensation of pain can be measured by anyone other than the one experiencing it.
4. Pain is a decision, decisions waste energy.
What’s the best way to become more efficient? If you believe the self help books, the answer is automation. Every time we need to make a decision on how to act, we waste valuable time, and even worse, we use up valuable stores of willpower. If we can automate this process so the decision happens automatically, we free up resources to focus on other things. From CEOs kitting their wardrobe with sets of the same outfit, to the tech industry churning out AI bots for every task imaginable, we seem to value automation over everything, even if making a decision would lead to a better result.
The desire for automation is not a new concept, in fact it is completely hardwired into our brains. Our brain is constantly trying to automate every aspect of living, and when it does this successfully we call it a habit. Habit forming is crucial for our unconscious mind, as it the best way to save energy, and thus improve our chance of long term survival. Any time the brain finds itself making the same decision several times over, it turns the process into a habit, regardless of whether the outcome is good or bad.
That’s where pain comes in. If you lift your arm overhead and it hurts every time, the brain eventually realises it can just automate the pain response. Instead of weighing up the circumstances, like tissue damage and potential danger, the brain switches on a pain auto response to fire every single time the arm gets ready to lift. Over time, the physical issues may have resolved themselves, but since you survived the ordeal, the brain sees no issue with continuing to fire the pain response automatically. It is saving energy after all, and it makes you much less likely to repeat the action that injured your shoulder in the first place.
When we are dealing with a chronic pain complaint, the problem is usually less about fixing or strengthening the joint, and more about relearning to move without these habitual pain responses.
What Now?
One of the more interesting things about research into pain is that just understanding the process better can go a long way to reducing pain symptoms and making movement more manageable overall. If you would like to explore these concepts in a practical way, get yourself booked in for a consultation, to explore the possibilities of pain free movement.
