Pain Explained

How to Heal Persistent Pain

“We have learned more about the physiology of pain in the last ten years than in the previous thousand years.” ~ Lorimer Moseley, Explain Pain

“Knowledge produces powerful changes in your nervous system. Understanding pain neurophysiology is linked with less pain, improved movement and decreased perception of disability.” ~ Neil Pearson, Understanding Pain

I recently joined Toastmasters because I wanted to be able to articulate what I understand about pain in a way that makes sense. You’ve seen me write about this before, so here’s a new take on an old, but important subject.

One in four people suffer from persistent pain. So if it’s not you, it’s very likely to be someone you know. When we understand what pain is and how it is generated in the nervous system, we’re more likely to find relief. So just reading this might help. Let's dive in.

What is pain?
The past few decades have seen an upsurge in pain research. Here`s what we know.

• Pain is there to protect us. It’s an internal alarm system that alerts us to danger.

  Your pain is not in your tissues.

• There’s a very old idea that pain comes from the body’s tissues.
• If there’s nothing wrong with the tissues, so goes the idea, there must be a psychological problem.
• Research shows this is wrong, but the idea persists.
• And believing this can actually increase your pain! Ouch.

Pain is complex, and personal.

• Two people can have the same injury:
  • One will be in agony.
  • One may feel nothing.

Everything seems to check out, but you`re still in pain.

• Pain is generally called persistent or chronic, 3 to 6 months after an injury or accident.
• Long after the injury has healed, you might have moderate to severe pain.
• Maybe you`ve seen multiple doctors and specialists, and nothing seems to help.
• But you still have pain and it might be driving you crazy.

Simply put, our pain system can malfunction.

• Just as a fire alarm can malfunction, our internal alarm system can become hypervigilant, even when we’re not in danger.
  

When this happens, the nervous system has become hyperactive.

• Danger neurons send signals to the brain. Neurons may become hyperactive over time.
• They send more and more signals to the brain, even after the initial danger has passed.
• The pain threshold can lower. If your pain threshold drops, a slight touch that might not have bothered you before now feels painful.
• This hypersensitivity can spread to other areas of the body.
  

This hyperactivity creates persistent pain.

• Danger neurons send signals to the brain; these signals increase and spread.
• The brain analyzes these signals, and may or may not send pain depending on certain factors.
  

Pain is complicated.
The brain analyzes the danger signals, and considers

• Thoughts. “Might there be bad consequences if I’m really injured?”
• Emotions. “Am I afraid of this? How bad is it?”
• Past experience. “Have I had this experience before? Was it dangerous?”
  

This analysis is rapid and we’re usually not conscious of it.
The brain decides whether to send pain. If it senses danger the brain can amplify the danger neuron signals by sending a chemical (cholecystokinin) to increase pain.

• For example, if you bang your thumb with a hammer and you’re a surgeon who depends on having sensitive fingers, you might feel way more pain than a construction worker who is used to the occasional bang on the thumb. The felt sense of danger is relative, and very personal to our own experience.

How do we change persistent pain? Start by recognizing our thoughts and feelings.

• Simply changing our understanding of how pain is created in the brain has been shown to reduce pain. Simply reading this can help to change your pain.
  

  Assess your real risk.

• Ask: Is this really dangerous?
• If you’ve been assessed and nothing seems to be wrong, retrain the brain to interpret danger signals differently. You can say to yourself, “This hurts, and I’m safe.” You might have to repeat this until your brain gets the message.
  

Set goals. Ask yourself:

• What do I want to change?
• How will my life improve?
  

We have natural painkilling chemicals in our bodies.

• The brain can send chemicals, including endorphins, that turn off the danger messages.
• Endorphins are 40-50 times more powerful painkillers than opioids.
• "You can stimulate your nervous system to release these chemicals." ~ Neil Pearson, Understanding Pain
  

 
Change the nervous system and retrain the brain to feel less pain.

• Nervous system change thrives on slow and subtle methods, practised with internal awareness (interoception).
  

Respite, Calm, and Challenge. We need all three for nervous system change.

• Respite (distractions) temporarily relieve pain.
• Calming activities restore balance to the nervous system and promote faster healing.
• Challenging activities raise the pain threshold so we can do more with less pain.
  

The three P’s: Practice, Patience, and Persistence.

• The brain gets good at what it practises.
• Danger neurons are reconstructed every few days. Good news! This means you are rewiring the nervous system and reducing the danger signals to the brain. Fewer danger signals = less pain for the brain to consider sending.
• Practising a lot over time lowers the danger signals to the brain and raises the pain threshold.
• Be patient. Your practice will pay off.
  
• Be persistent. Practising for short periods of time often will offer better results than practicing only once every week or so.
  

Yoga and mindfulness practices can help. Practise gentle movement and calm breathing, asking yourself:

• Is my breath easy? Keeping the breath calm and easy quiets the nervous system, so the brain won`t sense danger.
• Does this feel safe? Move in your safe range of motion and it will gradually increase.
• Will I pay for it later? If it feels as if you might, do less (smaller movements), so the brain doesn`t sense danger.
  

Practise what you want to become.

• Practise moving gently, breathing calmly, with pleasant distractions.
• The danger neurons will calm down and your brain will practise safety, not danger.
  

 Practise this mindfulness body scan for pain.

• Notice the breath.
• Feel the sensations.
• Be curious.
  

This way of thinking about pain and the brain can be a complete paradigm shift. Here are some comments from some of my clients about their experience with changing their pain.

I`d love your feedback on what you think about pain. What is your experience of pain? Do you have any questions or want more information? Please leave a comment below.