“It’s all in your head.” Depending on the intent behind those words, they can either be the best advice or the worst insult to a patient with chronic pain. In years past, it wasn’t uncommon for doctors to explain to their patients that they just “couldn’t” be experiencing the pain that they were describing and that it was all in their head. Translation, you’re crazy or lying. Fast forward to today when we know so much more about pain and, come to find out, it really is all in your head.
Pain is your body’s way of bringing awareness to an area. Sometimes it’s urgent like a security alarm letting us know we need to stop what we’re doing and assess the situation. Other times it’s a nagging alarm reminding us that something isn’t quite right.
Fortunately, nowadays when we tell patients this it’s with the best of intentions. Understanding how our brains process pain is a big step in learning how to manage chronic pain. The first thing to know and understand is that pain comes from your brain. Pain is an output from your brain in order to bring attention to a perceived threat and protect you from harm. This does not mean that we have voluntary control over our pain but it does mean that we can make changes that affect the pain output.
The pain process begins with a danger message from our nociceptors. Nociceptors are sensory receptors that respond to injurous stimuli such as intense forces and pressures, high temperatures, strong chemical solutions, cold and inflammation. Once triggered, they send a message to the spinal cord which will then pass it up the spinal pathway to the brain. The brain then uses other input it gets from the body and the environment to determine if this danger message is warranted and, if so, what to do about it.
The brain’s interpretation of the danger message is influenced by the environment, past experiences, emotions, beliefs and much more. If you sprained your ankle crossing the street, you may pause, slow down and limp across to the other side due to the pain. What if a car took the corner at the same time that you sprained your ankle and they didn’t see you. All of a sudden, that sprained ankle isn’t as much of a threat as the car and you can quickly cross to the other side. The same danger message was sent to the brain from the nociceptors in your ankle but the environment has changed and your past experiences and beliefs have influenced the output. You know that if you don’t hurry then your sprained ankle will be the least of your worries so your brain chooses to ignore the danger message coming from your ankle. Depending on the severity of the sprain, the brain may escalate that message again or not.
I’m not recommending people place themselves in life threatening situations to alleviate their pain but knowing that our environment, past experiences, emotions and beliefs can influence our pain may help us begin to explore options for pain management. Treating every aspect of pain, biological, psychological and sociological, is imperative to success. In next month’s edition, we’ll discuss some common psychosocial road blocks and tools to help dismantle them.
Cannabidiol (CBD) use for ER+ breast cancer
I happened upon this month’s recent evidence by chance while searching for more information about CBD use for pain. I have been exploring different options for my own pain management. Like many other breast cancer survivors, I take an aromatase inhibitor to prevent recurrence but it can have the unfortunate side effect of joint pain. I could not find any recent evidence for CBD use pertaining to aromatase inhibitors but did find a clinical study that is currently researching the effects. They released their testing protocol so I decided to start my own research while I await their results. I’ll follow up on my psuedo-study in a few months but until then check out this interesting article about the potential for CBD to inhibit the growth of estrogen positive tumors. I may continue to take the CBD even if it doesn’t help with my pain!
I have had two recent encounters with persons exhibiting signs of heart attack so I thought now would be a good time to refresh everyone’s knowledge of the warning signs. Fortunately, neither case was diagnosed as a heart attack. Nonetheless, it’s important to know the warning signs and not ignore them. There are a number of other medical issues that have similar signs and symptoms but don‘t let that stop you from seeking medical care if you are showing signs. There’s a reason why suspected heart attack patients go to the front of the line in the ER….
The difference between nociceptive pain from things like tissue injury versus neuropathic pain from nerve injury.