"Pain is really strange" (S. Haines, 2015)
When I was 13 I had my first experiences of 'chronic pain'. I had injured my ankle, and then not long after dislocated my shoulder. The pain was excruciating at both these sites but then I started to feel pain everywhere, it spread so I had pain in all my other joints. It did not make sense, I had only injured two areas and now everything hurt?!
At the time, Doctors tried to explain to me that the pain I felt was not due to direct damage to my body, but that my brain is now confusing any signal as pain signals. I was convinced that they meant I was making it up or exaggerating my pain. I felt misunderstood, as I wanted more than anything to be pain free again and return to my sports and dancing that I missed, why would my brain make up that it was in pain?!
It has forever been a sensitive topic to me. Anytime any sort of doctor implied it was in my head I would immediately stop speaking to them during an appointment, leaving mum to awkwardly cover for me. It is only after years of living with pain and then learning the physiology behind pain as a physiotherapist can I clearly see what those Doctors meant all those years ago.
I think the language used when describing pain is so important, 'its all in your head' is kind of accurate but has negative implications, implying we want to be in pain or are faking it. Instead its more helpful to describe how your brain becomes overly sensitised to pain and to understand pain.
What is pain?
Pain is normal. It keeps teaching us, how to be smarter and look after ourselves. It is designed to prevent us from getting into danger or harming our bodies, for example a burn from spilling boiling water or back ache from sitting too long. It is essentially a clever ‘alarm system’ for us.
The nervous system is in control of the pain you feel, both the peripheral nervous system (nerve pathways throughout the body) and the central nervous system (the brain and spinal cord)
The peripheral nervous system is sent a message from one of the sensors that pick up on a sensation. This then sends chemical messages up through the spinal cord to the brain.
The brain then makes a value judgment based on the input of the message, the context and previous experience. It then responds by sending messages back telling the body to react whether its pain, moving a limb, sweating, speaking etc.
It is a myth that there is one ‘pain center’ in your brain, whereas in reality pain uses hundreds of brain parts simultaneously – these are called ignition nodes.
What is chronic pain?
Chronic pain does not mean you are making up your pain. You are not exaggerating your pain. Your pain is unique to you. It is a message from your brain based on its judgement of the threat it is facing. Burning pain, stabbing pain, deep ache, stretching pain and more are all sensations produced by your brains construction of events.
In chronic pain, the whole nervous system has becomes sensitised. The pain sensors in your peripheral nervous system ‘misfire’, meaning the neurons became more ‘excitable’ sending more signals to the brain.
Then once the signals reach the brain, the ignition nodes can also become very sensitive, and are repeatedly ‘hijacked’ into what is called a pain neuro tag (particular pattern of activity). It can lead to a something usually not painful, such as standing, activating more ignition nodes rather than it usually would, for just being upright. This can be why other stimulus such as a noise, light and temperature changes can lead to a pain response too. If the nervous system is completely sensitised, this is why any tiny noise or movement can be interpreted by the brain as pain.
To understand how the nervous system can become highly sensitised I was explained this metaphor when I was younger:
This is the same with pain signals, the route becomes over run with pain signals and it becomes well known to the brain, so it automatically sends back actions saying ‘yes you’re in pain’ without really seeing if the stimulus was enough to emanate such a high pain response.
Managing chronic pain
Understanding that chronic pain is a symptom of stressed out nervous system can also help us find ways to soothe that system, and our pain. This is why tools such as a mindfulness, yoga, deep breathing, colouring/art therapy etc are all recommended as pain management tools. They all have the same sense of trying to calm and quieten the nervous system down. It’s a way to tell the body, it’s okay I am not in danger or harm, we can relax #selfcare
Pain is awful. And you 100% are not making it up. I have learnt to stop trying to blame my body for pain, but to try to understand what it is trying to tell me. The more you panic and get upset about pain (which is totally okay sometimes) the more your body will panic and keep saying you’re in pain. If you try to acknowledge your pain, and then do calming distracting activities this is proven to help lessen pain. Even if your pain feels like it will never pass (it always does, eventually) and you have tried everything. I find just knowing pain is actually your body trying to be nice, trying to look out for you and keep you safe can help you cope with it.
Lots of love,
Explain pain - Butler & Moseley 2013 Pain is really strange - Haines 1996
Neuro Orthopedic institute