Pain science has made great strides in the last few years. More and more pain is being understood as a complex phenomenon which is governed not by what is happening at the site of the uncomfortable sensation, but what is happening in the brain. “Pain is in the brain” is what studies show. This is why neuroplasticity is being linked more and more with the decrease and eventual abatement of chronic pain. It goes like this:
- an injury or insult occurs in the body (surgery, accident, illness) which causes tissue damage and acute pain (not chronic).
- the body responds by sensitizing the area of the damage so that the organism (you) will be mindful to attend to it.
- sensitization happens at the site, along the nerves and in the brain (the central nervous system).
- acute pain is your brain’s way of communicating to you that the tissue damage as serious. Pain = RED ALERT!
- this process is meant to help you heal your body.
- the brain interprets signals coming from your body, AS WELL AS a whole host of contextual cues in order to evaluate the level of danger your tissue is in. The contextual cues are OTHER FACTORS that play a part in how your brain interprets signals – it does not rely on the site of injury only.
- the more healing occurs, the less sensitization is needed, and acute pain decreases.
- if the central nervous system remains sensitized even though the tissue damage has healed, pain continues. This is now chronic pain.
So, now we understand that how the brain behaves determines pain experiences. Knowing this allows people who suffer from chronic pain to take control of their discomfort and actively decrease it. Here’s how:
- pay attention to the OTHER FACTORS your brain is attending to when judging how severe your pain is. Your brain checks out the whole system to determine health, resiliency and coping capacity, as well as previous experience and knowledge of what is happening.
- for example, your brain evaluates the system in the following ways:
- is the system unhealthy or compromised in general? – if yes, danger signal is amplified; if no, signal is reduced
- is the central nervous system stressed? – if yes, danger signal is amplified; if no, danger signal is reduced
- is this tissue damage serious (evaluation)? – if yes, signal is amplified; if no, signal is reduced
- does this system know how to deal with this tissue damage? – if yes, reduced; if no, amplified
- can this system find support/help? – yes, reduced, no amplified
- does this system feel safe? – yes, reduced, no amplified
- so, tissue damage is just one factor which leads to the brain sending a signal of PAIN (ALARM).
This means, you can reduce pain by creating an optimal environment for your central nervous system. This often means UN-LEARNING many habits which keep the central nervous system escalated, unsafe, stressed, unsupported, powerless or scared. This is the psychology behind pain management – understanding how what you feel, believe, think and act like contributes to chronic pain experiences.
Pain science research outlines to people how to approach calming their nervous systems down so that pain signals are softened. Here are the basic ideas:
- learn how to interpret pain signals differently. Try to neutralize the alarm associated with pain. PAIN is the last resort signal used by the body to get your attention. Try to notice other sensations besides pain. Use different language and vocabulary to express your experiences. Try to view your discomfort as sensory information. What does it actually feel like? Hot, cold, electric, tingling, buzzing, throbbing, aching, tense, stiff, frozen, etc. There are a vast array of words you can use to experience your discomfort without taking it to a level of PAIN every time.
- learn how to calm your central nervous system down when you are experiencing discomfort. Just as an injured child will stop crying when soothed, so will your central nervous system. Soothing is key. Rather than disconnecting, ignoring, “pushing through” or getting angry, try comforting and soothing the discomfort. See what happens!
- learn how to calm all the “background” signals in your central nervous system which keeps it primed to experience pain: trauma, stress, illness, poor coping strategies, negative mindset, anxiety, depression, loneliness. When in any of these states, the central nervous system is heightened, which means pain signals are amplified.
- notice the small incremental changes toward comfort and ease. Most people suffering with chronic pain end up focused on the pain. Although this started as a way of problem solving and ridding the body of uncomfortable feelings, it ends up hyper-focusing and actually further sensitizing the system. It is a negative feedback loop. It is a delicate balance to acknowledge the sensation and soothe it, then to let it go and notice the comfort. But this is exactly the balance to find. The more comfort you notice, the more comfort you are creating in your central nervous system. Just as chronic pain is a negative feedback loop, finding comfort can be a positive feedback loop.
- don’t forget that your body thinks it is helping you. It is very common for folks with chronic pain to end up in very negative relationships with their own bodies. It is natural to feel let down, disappointed, frustrated, limited, or even betrayed by your own body! it is very common to disconnect from such a problematic part of yourself. But this negative relationship only adds to the negative feedback loop. Your body was designed to keep you alive, to keep you metabolizing, growing, healing and reaching homeostasis. It wants you to survive. Chronic pain is simply a habit, as is being addicted to sugar, cigarettes or caffeine. You can break the habit and help your body reach a calm comfortable state, if you work together!
Megan Hughes, MA, Stillwater Counselling and Pain Management, June 4, 2021