Where does pain come from?
If you are struggling with chronic pain or persistent symptoms you’re not alone. Over one hundred million Americans currently live with chronic pain or persistent symptoms, and almost all human beings experience pain over the course of their lifetimes. But despite its prevalence, pain is not well understood. Many people living with chronic pain are fed up and frustrated. One reason that this is so misunderstood and there have been so few solutions is the fact that, until recently, pain was considered a purely biomedical problem, purely physical. “Biomedical” means the result of biological issues like tissue damage and system dysfunction, exclusively. It was therefore believed that pain required purely biomedical solutions, such as medications and surgeries. This has been the predominant approach to pain management for decades. However, while biomedical treatments are important and live-saving, research and clinical evidence indicate that pills and procedures alone are insufficient for effectively treating chronic pain and many of the persistent symptoms people experience today, such as Fibromyalgia, IBS, chronic fatigue, migraine headaches, etc.
Pain is constructed by the brain.
It is easy to believe that pain is exclusively located in the body, in the place that hurts. But despite the fact we experience pain in our bodies, pain is constructed by the brain. We have evidence that this is true because of the phenomena known as phantom limb pain. This is a condition that arises when an accident survivor loses a limb, then continues to feel pain in the missing limb even after it is gone. If pain was located exclusively in the body, no limb should mean no pain. Pain, then, must be constructed elsewhere, and science tells us that it is constructed by the brain. The basic functioning of your pain system starts with sensory receptors in your body called nociceptors, which collect information from the world around you and alert you to potentially damaging stimuli by detecting extremes in temperature, pressure and chemicals. Information from these sensory receptors travels up your spinal cord to your brain. Your brain then interprets the signals and decides how to respond. Is there an emergency or is this a false alarm? What behaviors need to change for you to stay protected and safe? If there is any reason to think that protection is required, your brain may predict pain based on your experience from the past. Your brain's appraisal and then prediction of how to respond to the situation is a critical determinant of the pain you feel. Context, thought, emotions, prior experiences and memories, as well as the meaning you assign to your pain all change your experience of it. Put another way, pain is not an accurate indicator of tissue damage. Pain is an interpretation, your brain’s best guesstimate based on all available information. The information from the sensory receptors is shared with various parts of the brain, including your emotion center, which all work together to reach a conclusion about how to respond. Some of the information the brain incorporates is context (fell on concrete), past experiences (similar fall last year), prior knowledge (possible injury), emotions (panic or worry), and physiological responses (bruising, swelling).
Did you know that your pain is just guess work at its best?
The pain system, like most systems, is imperfect. Sometimes there are glitches. For example, the brain can misinterpret a warning signal from the body as “dangerous” even in the absence of true danger, resulting in the generation or amplification of pain for weeks, and months when no protection is required. When this happens it often leads to ongoing pain that interrupts your life, compels you to quit work and hobbies, prevents you from spending quality time with family and friends, terminates your sex life, and even prevents you from leaving your house. It can make you feel angry, depressed, anxious and afraid. Because pain is a guesstimate, your brain’s best assessment of whether your body requires protection and how much context is critically important. Context is the result of all available information from your internal and external environments. Context includes information from your five senses, including where you are, whom you are with, and what’s happening, past experiences, and memories, thoughts, beliefs, and expectations. This includes emotions, future predictions, and prior knowledge. For example, an arm pinch feels worse if made by a frighteningly long needle than by a friend’s loving reassuring squeeze. If you injure yourself at work or during exercise on a stressful day, that very same injury can feel worse than if acquired on a pleasant, relaxing day. Memories of a previous injury can exacerbate the pain of a new and different injury in the same area. Pain feels worse when you are lonely and sad than when you are happy and surrounded by people that you love. It has been proven through research that taking a placebo, believing that it is an effective medication will often decrease your pain simply because you believe it will. The takeaway here pertaining to context is indications of danger make pain worse, while credible evidence of safety reduces pain.
Take a moment and remember a time you noticed that context influenced your pain.
The Whole is Greater than the Parts.
I’m sure you have heard the concept of, “the whole is greater than the sum of its parts.” This concept is often lost in modern medicine because many people are eager to pinpoint one region of the body or one specific event as the cause of their issue. The reason is we have evolved over time to use cause and effect to survive. It is simpler and more direct to blame a specific tissue as the cause of pain than to address three or four contributing factors. The brain tries to organize the chaos of the world by separating the parts from the whole. Additionally, it is human nature to follow the path of least resistance and many people are resistant to change. For example, if a patient has pain in their shoulder, there is a tendency for both patient and their medical provider to blame a specific tissue, such as the rotator cuff, as the singular cause of pain. It’s common to fail to recognize other contributing factors, such as lack of physical conditioning, nutrition, stress, emotions, metabolic syndromes and sleep impairments as underlying components that all contribute to the individualized experience of pain. These factors may play a greater role in one’s pain than the injured tissue and can even lead to the experience of pain in the absence of injured tissue altogether. Since we now know that there is no singular cause of pain it becomes even more important to consider our thoughts, emotions, beliefs, stress and nutrition to reduce our pain. This is great news. It means you have more control over your pain than you may have thought. By learning to manage your emotions, nutrition, social stress and behaviors you can turn your pain dial down.
Did you know that Pain = Biology + Psychology + Social Factors.
You’ve got this!