The International Association of the Study of Pain ( IASP) defines pain this way, “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”.
I see pain as annoying, interrupting, concerning, often limiting, AND very normal. Say what now? Yup – that’s right I said it, pain is normal. Think about how dangerous life would be if we felt NO pain. That’s not good either!
Changing our pain is possible. It is not easy, not quick, and not always 100% gone, but it is possible to change. My journey to getting back to the person I wanted to be was a long one. I want you to know a few basic truths about pain before you keep reading, ok? It may sound different than anything you have heard from your providers so far, and that’s ok. I invite you to look into the truths of what I am sharing. It’s important to me that you look for yourself too! “Trust, but verify” is a good saying to live by. Let’s get started looking at some of the lesser-known truths about pain.
It is always real.
You are never making up your pain. It isn’t pretend, it isn’t a figment of your imagination, it’s real. Real pain is really life-altering. It is really in your body. If we were making it up we could also just make it go away. If anyone tells you your pain isn’t real, run away. While the brain is where pain is “produced” or “decided on” that does not mean you are making it up, or it’s “in your head”. Honestly, it’s no different than hunger coming from the brain, or love, or your heart beating, or your body moving, all that comes from the brain.
Chronic Pain is more than a tissue issue.
It’s really easy to get stuck on all the scans and trying to find the offending tissue causing the pain. When we stay stuck in this merry-go-round of searching for answers to why we hurt, we often miss the larger picture. Persisting pain is not about fixing tissues. It’s a lot to wrap one’s brain around, but we have learned pain is an unpleasant feeling or sensation in our bodies and it makes us want to stop and change something. Pain is no longer thought of as a measure of tissue damage by those that study it. Even in highly controlled experiments pain still isn’t a good measure of damage. Pain is now thought of as a complex and highly sophisticated protective mechanism. It doesn’t mean tissue doesn’t matter at all, just that there are so many other things we can change, when we often can’t change the tissue, like arthritis.
Pain is protective
Listen to it, it is a warning system. Chronic pain is just pain that has gotten too good at its job. Pain is only one of the ways we are protected. There are so many other things our bodies do to protect us and we don’t even think about them. How often do you think about what your body does when you get sick to protect you? I can tell you I am blissfully unaware of my immune system releasing inflammatory molecules to kill invaders or repair broken tissue, or my endocrine system stimulating healing and recovery; or my motor system tweaking movement patterns to modify and vary mechanical stressors on certain tissues. It is only the feelings – pain, fear, hunger, thirst, and fatigue – that engage our entire being in the task of protection and preservation. I find that fascinating.
The reason this is so important is that in order to reduce pain we need to reduce the credible evidence of danger. When it comes to pain not associated with a clear or ongoing injury, which is almost all of us, the challenge then becomes a more complex one. Identify all the sources of credible evidence of danger – they might exist in how the immune system is working, or the endocrine system, or the movement system, or the evaluative (cognitive system) it sounds like a lot, and it is. But the best part of the brain and the nervous system is that it can change, and change a lot. We need to find safety.
There are no pain receptors.
So, there is no such thing as a pain receptor. Crazy right? If you have always thought something is damaged or broken and it sends a pain signal up to the brain, you are thinking the same as most people, but we are wrong. We don’t have pain receptors, however, we do have specialized nerves that detect potentially dangerous changes in temperature, chemical balance, or pressure. These ‘danger detectors’ (or ‘nociceptors’) send alerts to the brain, but they cannot send pain to the brain because all pain is made by the brain. Tissue doesn’t make pain, the brain does. Once a dangerous message does arrive at the brain, the extent and complexity of evaluation are truly mind-boggling. Many brain regions are involved and the exact mix of brain regions varies between individuals and in fact, between moments within individuals. Are you fascinated yet?
Pain changes the way the body works
Neuroplasticity is a cool term meaning our brain and nervous system have the capacity to change. With persisting pain, changes do happen. Brain fog and the ability to think clearly increased anxiety, and increased depression, all happen. As our bodies change to manage the threats and dangers, changes happen. This is one significant reason that recovery from persistent pain is seldom a quick fix, but requires a journey of patience, persistence, and good coaching. Our efforts focus on decreasing sensitivity in the system and training it, gradually over time, to be less protective.
BioPsycho what?
Pain involves Biology, psychology, and sociology. When viewed through a whole person lens we call that the Biopsychosocial model of pain. Pain is an experience, it’s much more involved than “just” tissue damage Below are just some of the pieces that may contribute to our experiencing pain. All these bits and pieces connect through the nervous system and are processed by the brain. No brain – no pain… which I am pretty sure is also bad. We also need to remember that emotions, thoughts, and stressors, all have an effect on our bodies in different systems that also affect our pain.
Our thoughts and beliefs matter
I am the first one to admit, if positive thinking could have solved my pain, I would have been “fixed” months into my journey and not years. However, I also have to admit that thinking I was throwing my back or SI joint out every time I twisted my torso also wasn’t very helpful. What we believe about our pain matters because it drives our behaviors. If we believe there is no hope left, and nothing more we can do, then we are probably correct. If we believe that we can change our pain by seeing it differently, or trying a new way, then we at least have a chance. We can calm stuff down and build our lives back up. It just takes a perspective shift, time, and practice.
Where will you start?
