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).

 

 

 

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