What is pain? What happens when pain does not go away?
Pain is one of many responses from the brain when it has received enough danger messages from one part of the body.
Let’s take a common injury:
You just cut your finger. So what’s happening?
1. Danger receptors in your finger send danger (or ‘fire’) messages up towards your spinal cord and then onto your brain. These messages travel through your nerves.
2. The brain (aka the big boss/computer) analyses, processes all the information received from the finger area as well as going through your memory of similar past events (that happened to you or to someone you know).
3. At the same time, it analyses information from outside your body, receiving messages from your vision and hearing, to know whether you are in a safe environment.
Why does it do that? Because in the unlikely event a tiger just happened to be behind you when you cut your finger, you would obviously need to escape first, and only once you’re safe would it make sense to start worrying about the finger. So the brain would release some adrenaline to help decrease the danger messages or even stop them for long enough for you to get to a safe place.
4. If your life is not in any immediate danger and there are enough danger (‘fire’) messages going to the brain, one of the response will be that you feel pain in your finger.
There will also be other responses, such as your immune system kicking in to start the healing process, muscles reactions, etc..
5. As the wound heals with time, there will be less and less danger (‘fire’) messages going to the brain. Therefore the pain decreases until it’s fully gone.
*However, sometimes pain levels are not proportional to the tissue damage (think about a paper cut, ouch!) but also it does not always equal damage*
How is that possible?
That’s because pain is there as a PROTECTOR, it can be a response to BOTH ACTUAL threat and PERCEIVED threat. It will feel the same either way, pain is pain. It is there so you can get out of a situation your brain perceives as dangerous or threatening to its wellbeing, whether it really is or not.
So, this is what happens with what we call “Acute Pain” or pain that has been present for less than 3 months.
The medical body considers that most injuries will be healed to their best ability within 3 to 6 months. For example, it ‘only’ takes about 6 weeks for a fractured bone to heal.
But what happens when my pain persists beyond this timeframe?
We don’t always know why some people’s pain persists once all the tissues have been healed, but we do know that it happens in around 20% of cases.
Going back to our finger analogy, the danger (‘fire’) messages from the finger always travel up the same road (the nerves).
Before the injury, you could say that the road wasn’t used a lot, it was a single lane
dirt road, with danger messages travelling through from time to time. For example when the finger was slightly touching a hot surface.
However, when pain stays for a while, there are sustained danger (‘fire’) messages travelling through that same road, meaning the road gets busier and busier.
So the old single lane dirt road has to be upgraded to a 2 lanes dirt road, then later on to a 2 lanes sealed road to then upgrade to a fancy 4 lanes sealed road and so on it goes.
The more danger messages travel to the brain, the more road upgrades have to be made by the brain. That is called central sensitisation.
Your brain is so smart, it learns to be more aware of that finger, more protective of it and more sensitised to any messages.
Your nervous system becomes wound up.
So what can I do to help the road go back to a good old single lane dirt road (and reduce the sensitisation)?
There are many things that can help reduce the danger/fire but be aware that there also are things that can increase it.
Danger/fire reducers (aka buckets of water):
They help secrete endorphins, which helps decrease the danger messages
ANY meaningful activites to YOU. That is things that you LIKE doing, things that bring you JOY, that make you PROUD, give you a sense of ACHIEVEMENT. Be it calling a friend or family member, playing with or petting your pet (or any pet, really), looking at photo albums of good memories, helping others, gardening, volunteering, working, etc..
- Pain education. Because it reduces fear of the pain, improves your understanding of what is happening in your body, gives you some power back over your it.
- Relaxation/Mindfulness techniques. Because it helps soothe your nervous system.
- Sleep management. If you have issues with insomnia or pain at night, get help from a professional to work out how to improve it.
- Medication. See your GP or a pain specialist to review your pain medication. What to take, when to take it, how many pills, for how long. Be aware that strong analgesics including opioids can get addictive with regular use and a tolerance can develop, meaning you will need higher doses as time goes by for the same effectiveness on pain. On the long term, opioids use can even create MORE pain. The evidence does not really support their use for chronic pain. There are other alternatives, discuss it with your GP.
- Goal setting and Pacing plan to achieve these goals. Think about what you used to do before the pain started and that you would like to go back to or do more of without having a flare up. It can be about work/vocational related activities, social/family related activities, leisure/sport related activities or even domestic/personal activities. Find a practitioner with chronic pain specific knowledge/education to help you work out a pacing plan to achieve your goals and get you the tools to get there.
Danger/fire increasers (aka buckets of petrol):
These are stressors that induce the release of cortisol, which increases the danger messages
Negative thoughts, concerns, fears about the pain
Pain/recovery expectations (for example, my friend had low back pain 3 years ago and never got better, is this going to happen to me too?)
Stress at home, at work, financially
Work and personal relationship struggles
Unsupportive environment (work, colleagues, employer, friends, family, partner)
Grief, anger, depression, anxiety, etc ..
Belief that pain always equals damage
Fear avoidance behaviours of certain movements/activities
These can be worked on with the help of your healthcare practitioners, psychologists or ACT/CBT trained professionals. They will give you reassurance about what is happening regarding your pain, but also tools to use during difficult situations and day to day stresses.
It may look overwhelming. Know that you don’t have to do all of these steps in one go. Choose one, do some research about it, note your questions down and start your journey back to recovery. The other steps will slowly follow, at your own pace.
Here are some great resources to dig deeper into pain, chronic pain, mindfulness:
www.tamethebeast.org for explanations, real stories and resources on pain
– Explain Pain book by David Butler and Lorimer Moseley for a deeper
understanding of pain and chronic pain for everyone also available as a e-publication
Headspace phone application for some free guided mindfulness practices
Written by Osteopath – Dr Caroline Patin
You can see Caroline at our Alexandra Hills Clinic