Chronic Pain
PAIN
Pain is an unpleasant experience. That’s what makes it most effective. It motivates you to take action to move differently, think differently and to behave differently. However, sometimes the system fails. Sometimes pain can linger, even coming and going in no specific pattern, much past the biological healing time of the original injury.
Sometimes asking ourselves why this is and forming an understanding of our pain can help us deal with it more effectively.
HOW THE BRAIN LEARNS
You see, the brain learns based upon assessing new information and comparing it with old information, then it’s predicts what its thinks is
the correct response.
If it’s predicts correctly, it provides a positive feedback loop, basically
cheering itself on, eg. You shoot a basketball and get it in the ring
– the brain then learns that that is good technique.
If it predicts wrongly and receives negative feedback, ie. You miss the
basketball ring, then the brain learns and adjusts for next time
eg. you adjust your shooting technique.
What has this got to do with pain?
Well, pain is a production of the brain in response to potentially threatening or dangerous stimuli. This stimuli can be of all kinds, including mechanical eg. pressure on the skin, chemical such as hormones and smells and even your thoughts and emotions have a large role. Think about something that makes you nervous…you’ll notice that just with the thought of this thing, your heart starts to race, you might even feel flushed… this is all the brains doing as it thinks this is what you need. Unless you tell it otherwise, that there is no need to be nervous, it will continue to send these signals.
A similar thing occurs with pain. You may have originally had an injury, very minor or potentially very large impacting several aspects of your life, physically, mentally, emotionally & spiritually. Let’s say you broke your toe, or you even underwent major surgery whilst juggling all the other stressors in your life; social, financial, professional & personal.
Your brain would have assessed the original tissue damage and concluded to provide you pain to ensure that you could protect the area while it healed. This is the correct brain response and is very effective to protect acute injuries. To protect the initial acute injury, the brain adjusts it’s level one protection strategies. Let’s dive into this a bit more.
PROTECTION STRATEGIES
To ensure the acute injury heals, the brain ups-the-anti with it’s level one protection strategies which are constantly and unconsciously being altered to ensure our body remains in homeostasis; this is done by our sympathetic, parasympathetic, endocrine and immune system.
Level one protection strategies:
Inflammation – Often swelling and fluid build-up of an acute site
Hormones – often adrenaline rises to help us move
Splint or sprint – Often reduced range of movement within a joint to stop us using it
Tissue injuries usually take up to 3 months to heal but sometimes when pain lingers for 3-6 months after injury, it’s more to do with the an hyper sensitive nervous system protection strategy, even when the injury has healed long ago.
Remember how you had that broken toe? Or that major surgery? Well, the acute tissue injury has now healed. However, you still have all the stressors in your life plus some from the recovery. We know that long-term stress can increase circulating inflammatory markers in addition to increased adrenaline and cortisol which can result in potentially threatening stimuli to be disproportionately magnified by the brain, causing it to assess something’s as ‘threats’ when they really aren’t.
Your brain believes your level one protection strategies are not enough to ‘protect you’ and still assumes and predicts that it is making the correct assumption by providing you pain, even though there is no biological need for it. Research has now demonstrated that the amount of pain does not actually relate to the amount of tissue injury (ref), as pain relies on context from our brains.
At this point, our body can’t remain in homeostasis, so it ramps things up and employs it’s level two protection strategies which are the symptoms we experience. In chronic pain, individuals may experience a heightened central nervous system or a ‘constant state of alarm mode’. This is our bodies way of telling us to do something differently, however it can’t tell us what to do, it just says “change!” and sometimes it uses the language of pain.
Level two protection strategies:
Pain
Fatigue
Depression (emerging evidence)
Anxiety (emerging evidence)
At this point, our brain has learnt to give us pain. Remember the feedback loops from earlier? The brain has been receiving positive feedback about it’s behaviour, therefore strengthening it’s incorrect predictions. With this, the threshold for ‘pain’ becomes smaller and smaller and the required stimulus becomes less and less specific, where eventually the brain’s response to many unrelated stimuli, for example many and varied movements are ‘pain’. This is a miscalculation in the brain.
However, we know that if the brain can learn something, it can also can unlearn it.
UNLEARNING PAIN
There are three effective and research proven ways that assist us to unlearn a pain response.
These are;
Quality sleep
Reframing your thoughts
Exercise
Although not demonstrated in current pain research, Northside Movement believes a fourth pillar of Nutrition is an integral factor of wellbeing as evidence suggest that malnutrition has the ability to increase internal inflammation markers, thus leading increased demand on level one protection (ref).
Sleep
We know that Serotonin levels can actively decrease the heightened body ‘alarm system’ by decreasing neuron excitability (ref), therefore quality sleep is a major player is improving pain behaviour.
Framing your thoughts
As mentioned earlier, your thoughts and beliefs are actually powerful nerve impulses too. Therefore, if we can decrease the threat value of pain, that is gaining an understanding of our pain, then we can increase management.
Exercise
We know that completing activities you enjoy such as a fun gym classes and spending time with loved ones can have an incredible positive effect on our bodies internal workings. For example, it provides an increase in our brain’s production of Oxytoxin, a hormone responsible for ‘love’ and ‘happy’ feelings which drives the bodies anti-stress and anti-inflammation response.
However, this doesn’t mean you jump right in with no care. We need to teach your brain that movement is not dangerous with graded exposure, allowing it to learn little by little, devaluing the threat that it has incorrectly assumed. With graded exposure to movement, the brain is able to assess the new information it is given and compare it with it’s old information, coming to the realisation that this particular stimuli ei. A movement, is not threatening. This relearning does take time and effort, however this is where we can help. We know that chronic pain can be a long and often debilitating journey and we are here to meet you where you’re at and help you understand your pain and work towards better movement and wellbeing.
