The Endogenous Brain

In the last blog, I followed on the great work by my nerd in crime Dr. Nathan Harten. This time without using the Batman & Robin analogy; I am writing this blog solo!

Recapping from the previous blog:

Pain is such a complex phenomenon.

There needs to be more credible evidence for danger over safety for a pain experience.

Pain is not an accurate marker for tissue damage.

The brain will decide to make you hurt when scrutinising A LOT of information, ranging from the environment to past experiences. Remember those neurotags?

Moving along to the endogenous brain!

Now there are some wonderful drugs out there that have done wonders in the field of medicine (naloxone being one). But did you know that endogenously, us humans have the most powerful class of drugs; ready for your disposal, at any given minute, located in your central nervous system?

These classes of endogenous drugs are:

Endorphins (euphoria, opioid agonist)

Dynorphins (modulation of pain & homeostatic regulation)

Enkephalins (regulation of nociception)

Endocannabinoids (mood & euphoria)

So just give me my own prescription pad and away I go right?

Lets pause you there momentarily.

The central nervous system decides when to give you access to your own drugs. Doesn’t sound very fair. So let me explain two scenarios where you can get full access.

Disclaimer. I don’t endorse, nor recommend example 1!

  1. One is sure you have seen on the news , where there has been a shark attack. A limb has been lost; with reports the victim has only felt a slight bump or no pain at all! Is it advantageous to feel pain when a great white shark is trying to eat you? Absolutely not! It’s a 50% of sale, and you’re shopping trolley is full! All those drugs are swimming out of your central nervous system, exiting the blood brain barrier, trickling down the spinal cord and distributing into neighbouring peripheral tissues. Now is your chance to get the heck out of there! Your sympathetic nervous system has turned into a high functioning Formula one Ferrari. Amping your physiology to get you out and away from danger. When the threat of danger has passed. All the drugs will stop binding to there adjacent receptor(s), excitatory neuromodulators will kick in with DRS speed like danger messages to the central nervous system. And you know what will happen next…?
  2. Have you ever tried to flunk your morning run, and just couldn’t be bothered to do-so? So you pull out your favourite dance tunes to get you moving. Slowly but surely there is some swagger to your running stride. You push a little harder, and this run feels not-so hard after all. 30-45 minutes in and you’ve found another gear. You race around corner, knowing that the finish line (your house) is in sight. You finish buzzing (endorphins), legs don’t burn as much as they previously did (dynorphins, enkephalins), and you are more spaced out than Harold & Kumar (endocannabinoids) (movie reference😉). All of the aforementioned: starting from the music, to the increase in tempo and lastly seeing the finish line; all triggered those powerful endogenous drugs mentioned.

As you can see, we humans are pretty sophisticated indeed!

James 👨🏼‍⚕️

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Hide & seek. Pain may not be hiding where you think it is…

Following on from the great work from my colleague Dr. Nathan Harten; Batman (Nathan) will pass the torch onto Robin (myself) to continue educating you all on the latest pain neuroscience.

You may have been allluded to our brains wonderful capacity to protect to a ‘perceived’ threat.

Perceived you say?

Lets delve further…

There needs to be credible evidence of danger over safety for a pain experience (1).

Pause and reflect…

It is advantageous to have fast acting danger messages to make us pull are hand away from a hot pan right? Danger over safety is highly relevant here.

What about an ankle that had been sprained ten months ago? That is still hurting to load, difficult to localize, and you have exhausted Google & the pharmacist for an answer?

Not advantageous at all is it?

Pain is not a true marker of tissue damage…

Pause and reflect…

Pain is an output constructed by the brain (1), by many contextuals. Contextuals ranging from:

Is this pain going to interrupt my job?

Is this what an ankle sprain feels like?

Can I still play in the football grand final?

How long am I going to be out for?

Should I just rest?

All of these constructs add to a pain experience (3); storing memories, emotions and motor patterns in a highly organised network, AKA your central nervous system. Even your immune cells (microglia) and endocrine system (HPA axis) are activated! (3) plus more!

So you you see pain isn’t all in the tissues. Especially persistent, chronic pain (1). But somehow, your brain is still warning you. It still wants to protect you from a perceived threat and make you hurt.

This may sound like a rhetorical question, is this advantageous at all?

Pause and reflect…

Maybe the threat of losing your job is adding to a pain experience?

What if you are a professional athlete?, trying to protect your pain from the coaching staff, perhaps because your contract is up at the end of the year?

Are you still blaming the driver who hit the back of your car? Causing hundreds of dollars or medical bills?

All of the highlighted words are ‘threats’, and thus the brain will scrutinise all of the aforementioned and will decide whether it’s important or not to let you know; and to make you hurt.

Becoming aware of perceived threats and dangers are so important to understanding your pain (1, 3).

I hope now you think of pain as a biopsychosocial paradigm (2). Bio meaning the biological mechanisms (tissues). Psycho meaning, thoughts feelings and beliefs. Social, the environment (workplace, home)

Challenge your beliefs on pain. Address what threats are in your life (work, financial). Learn how your stress system works. All of this is great at assisting you in the short term, but not 24/7 (think of having to listen to your car alarm all day!). Seek help from someone else! Know that you are safe to move (even better with an exercise physiologist!). Finally, know that we are neuroplastic and bioplastic… meaning, you can heal!

 

References

  1. Butler, DS & Moseley, GL 2013, Explain pain, 2nd edn, Noigroup Publications, Adelaide, South Australia.
  2. Gatchel, RJ, Peng, YB, Peters, ML, Fuchs, PN & Turk, DC 2007, ‘The biopsychosocial approach to chronic pain: scientific advances and future directions’, Psychological bulletin, volume 133(4), pp. 581-634.
  3. Moseley, GL & Butler, DS 2015, ‘Fifteen Years of Explaining Pain: The Past, Present and Future’, The Journal of Pain, vol. 16, no. 9, (pp. 807-813).