Our resident pain expert Deirdre Nazareth shares her knowledge and insight on the subject of pain.
With an MSc in Pain Neuroscience from King’s College London Deirdre hopes to shed some light on why we experience pain the way we do and how understanding pain a little better can change the way we respond to it and experience it.
We all understand pain to be rather unpleasant, yet feeling pain is important in order to make sense of our surroundings, and ultimately survive. A number of experts within the field of pain and pain management believe that pain is a cleverly concocted illusion produced by the master illusionist itself, the brain. Our brain does this in order to protect us from further harm.
You’re probably thinking, “but the pain I have felt and do feel is very real.” This is true, the pain you feel is very real to YOU but the explanation of why you feel pain is not as straightforward as it seems. Not all things produce pain and things that one would assume would be painful, are not always. I still find this a challenging concept for patients to grasp, pain has more to do with their expectations of the injury/trauma they have sustained and what they need to relieve their pain.
Our bodies are designed to feel things through very sensitive structures in our skin called receptors (the ends of sensory neurons) that relay information from our external environment to our brain and spinal cord. Our brain looks at that information and decides that the best and most appropriate response should be in order to help us. Information that is potentially harmful is transmitted by these neurons through a process called nociception and although nociception results in tissue damage it may or may not result in pain. It’s your brain that decides 100% of the time whether you feel pain or not, without exception.
Our autonomic, endocrine, circulatory, and immune systems are all intimately related to our central nervous system and are triggered to release chemical messengers that will carry the brain’s message. That message could be, for example, to turn down the stimulus so that a person can complete a race despite having a sprained ankle or a wounded soldier can run off the battlefield despite being shot. They may not even feel pain at all.
Pain, it’s More than A Feeling
Pain is influenced by many things such as stress, anger, anxiety/fear of pain, attention to pain, the social context of it. The loss of a loved one can make you feel like you are in a pain that literally takes control of your life and your ability to function. This is because pain is an experience and cannot be separated from the person’s mental state, cultural background, environment, past experiences and all other nuances that make you who you are. Pain is unique, just like you.
Knowledge is power!
Okay so what? Why bother writing about this at all? Even after completing a Masters’ Degree in Pain Science and working with so many different people over the past 15 years, those either in chronic pain or those rehabilitating from minor or debilitating injuries, I find myself sometimes falling into old schools of thought with my own injuries. Changing ideas or beliefs is not something that happens overnight, and part of my duty is to educate my patients and anyone who can benefit, i.e, everyone.
Pain is something we can all relate to. We have all been in it at some point in our lives. Maybe you are in it now, reading this. Pain can make you desperate to try anything to relieve it.
Research has shown that education and understanding about one’s pain works better than just manual treatment or any pain aid alone, and that even goes for surgery. Furthermore, knowing the brain is affected by all of these different inputs shows there is greater scope for creativity in finding what can decrease the implicit threat and therefore one’s pain. It also gives you more control in a situation where you feel completely vulnerable and defenceless.
Your beliefs and expectations about what will help you are also key in managing pain, so stick to what you know and feel comfortable with. Graded exercise, manual therapy, acupuncture, massage, psychological help and even surgery and pain killers have all been shown to have placebo analgesia, but more improbably they are all forms of empowerment. Just because something has a placebo effect does not mean it is less effective. The mind is truly a powerful thing. You can change your pain just by changing your attitude and thoughts about it. Professional athletes often hit their personal best after recovering from an injury.
Through adequate understanding of the biology of injury (tissue healing and the physiology of pain), you already have a great arsenal of information to help manage your expectations, beliefs and ultimately, pain experience. So, understand that pain does not always signal more damage. It is there to cue us to the potential of threat. The point is to prevent persistent pain from taking over your life and stop you doing what you love to do by training your brain to know you shouldn’t fear movement and that it is not threatening. By removing the fear, you will remove the threat and ultimately the pain.
We are experts in helping you manage and solve your issues around chronic pain, especially when related to longer term chronic pain and related conditions such as IBS, Fibromyalgia and Chronic fatigue syndrome.