“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.