6 min read
In my last blog post, I touched on some of the complicated misconceptions about how pain is dealt with in manual therapy professions, as well as the complexities of the pain experience within the structure of the biopsychosocial model of understanding.
The biggest thing that I have observed is that as a general whole, pain is generally dealt with in the vein of fear, anger and animosity. No one enjoys the unpleasant sensations involved with being in pain. The spectrum can be anywhere from minor annoyance to excruciating and debilitating. It is completely understandable that the emotional toll that an injury or illness can take is far-reaching and in some cases, devastating.
Understanding pain can be the difference of it being fear-inducing to being manageable over time
What makes the topic even more difficult is the fact that each human is incredibly unique in their genetic makeup, their socio-cultural values, and emotional processing. An injury that may be graded as “severe” could manifest as feeling “annoying” pain to one person, but feel catastrophic to another. It makes rehabilitation a bit more nuanced, with no “one size fits all” approach available.
The best way to demystify the subject a little bit is to explore some of the reasons we experience pain at all.
Pain is the result of massive amounts of information being assessed by the brain based on everything from specialized nerves that monitor body changes (nociceptors), genetic makeup, cultural standards, whether the body has been exposed to an experience before, and more.
The brain uses all of this information to make an assessment as to whether or not to create the outputs that we experience as a pain experience. The brain is doing its best to determine whether or not what the body is being exposed to is in fact, in a “danger zone.” The fact of the matter is, researchers still do not fully understand how pain goes from being a collective of signals in the background to being a full blown conscious blast.
Pain serves as one of many protection mechanisms for the body.
Think of pain as your own personal biological alarm system-it is highly sophisticated, intricate and is customized for each individual human body on the planet. Most of us would agree that it is important for the body to send signals to our brain when we experience injury situations (such as our hand touching a hot stove).
We have many protective measures happening at any moment in the body, such as the immune system fighting off foreign invaders or our endocrine system engaging the body in recovery. There are many subconscious happenings for our daily lives to keep our bodies going, and we generally aren’t aware of most of them. Pain mechanisms, however, are the stimuli that overtly get us to pay attention to and protect our body. Ignoring pain can come with negative consequences.
The amount of pain does not always correlate to the amount of damage to tissues in the body
To put this in perspective, most people with a bulging disk don’t actually feel any discomfort from it at all, and yet you ask someone about how badly their paper cut hurts, and chances are, it’s on a high end of discomfort.
Pain will at times be manifested by the brain to alert you to paying attention to a part of the body that it perceives as being in danger. But on the other side of that, sometimes there is severe tissue damage to the body, and yet, pain isn’t immediately felt.
For example, sometimes when I am at home, my fire alarm will go off for no apparent reason. I look around the house, open windows, check things out, and determine there is no threat. Yet, on occasion, I will accidentally burn something in the kitchen, and my alarm doesn’t utter a peep, even though my kitchen is filled with smoke. Even though this is a generalized comparison, we can see how despite the design of the body’s pain mechanism has a purpose to determine dangerous threats, sometimes, it doesn’t always function directly how we assume it should.
Where pain is in the body doesn’t necessarily correlate to where the problem actually is.
We see this a lot in cases of phantom limb pain (when clients experience pain in a leg or arm, even if they are missing that leg or arm). The brain uses a “virtual body” map to attempt to piece together the information it has received. Sometimes, the brain will use the virtual map to try to determine where the pain is coming from. The pain felt is 100% real, but does not correlate to any new problem within the body.
(For more information about the intricacies of phantom limb pain, check out the latest Massage &Fitness Magazine at https://www.massagefitnessmag.com/)
The brain can actually become “addicted” and sensitized to persistent pain, which causes neural networks to create a larger pain response with less stimulus. This impacts lives significantly.
At this year’s San Diego Pain Summit, Dr. A. Vania Apkarian recently brought out research examining brain scans which showed that “the amount of global information disruption (in the brain) is directly proportional to the amount of pain that the patients are experiencing at that moment. Disruption impacts the WHOLE BRAIN, which means pain disrupts everything that the patients are doing (in their life).” He also brought out that “The brain becomes addicted to nociception inputs. So chronic pain has become a central addictive-circuitry- engaged condition.”
This is especially important when we are dealing with clients who are experiencing significant life changes and challenges due to dealing with chronic pain. For these clients, it is no longer a matter of “getting pain to a zero” on the pain scale. What this means for practitioners is that we need to understand HOW pain is effecting our clients as human beings, versus only focusing on their “problem” of pain.
Are you one of these clients, experiencing chronic pain that has significantly impacted your life?
First, let me start of by saying: I believe you. I believe you are in pain, and that it is real.
Second: You are not alone. You may feel isolated and alone, but there are other people who are having pain experiences and feeling kicked around by feelings of being overwhelmed.
Stay tuned for my next blog post, which will focus specifically on the challenges chronic pain clients are experiencing, and how manual therapist practitioners can help.
For more resources on understanding the biology of pain, I encourage you to read “Painful Yarns” by Lorimer Moseley.
To really delve into pain research, check out the San Diego Pain Summit
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