Core Client Habit: Explain pain

How To Know You’ve Done This: Can You Explain How Pain Works To Friends And Family?
 

Since infancy we learn that our world can hurt us. We learn that we can skin knees, bump heads, and even feel painful tears when we are left out or angry. We learn some of our hurts heal while others linger. Sometimes we even experience pain so profoundly that it alters the course of our lives. Chances are you know someone whose pain lead them to drastic choices, like leaving a job, a marriage, or even their religion. You probably know even more people who have pursued risky surgeries or developed dependencies to medications aimed at reducing pain. Yet despite its ubiquity, few understand what pain actually is. 

 

Take a moment right now and try to define it. Is it a feeling? Is it a signal? Is it physical? Emotional? Is it good? Bad? Helpful or harmful?

 

Chances are, if you are over the age of 30 and you are reading this, you have had at least one debilitating episode of pain in your life. Whether it was pulled muscle in your back that kept you home from work for a week, migraine headaches, or even shin splints from that time you started running again, we have all winced and thought, “man I really did myself in this time.” Pain is one of the most familiar human experiences. Since we are a company focused on maximizing the human potential for vibrant, enjoyable living, we deal a lot with the kind of pain that holds people down. 

 

What we’ve found clinically, and what research has proven many times, is that understanding HOW pain works in our body helps to make pain less threatening and well, painful. 

 

Simply understanding pain can decrease the level of pain you feel. 

 

“Do you think the pain is in my head?” is a question I’ve often been asked by patients. Even though what they are really saying is “Do you think my pain is real?” I explain that all pain is processed and determined by our brains. But anyone who tells you your pain is not real is a quack!

 

Teaching others about something you’ve learned forces you to truly understand a subject in order to explain it. Therefore, we’ve title this habit “Explain Pain”. 

 

We know that if you can explain how pain works to a friend or family member (or heck, even the barista at your local coffee shop) the pain you experience or will experience in the future will be lessened. 

 

Three Keys To Understand Pain

 

There are three key points you need to understand to explain pain well. 1. Danger, not damage. 2. Pain depends on context. 3. Pain physiology.

 

1. Danger, Not Damage

Pain communicates DANGER; it does NOT communicate DAMAGE.

 

You see, our bodies are hard-wired to protect themselves from damage BEFORE it happens. Imagine a car alarm that only went off after the car was stolen and long gone. That would be useless! To be effective, a good alarm must go off at the first hint of danger.

 

We often ask patients to think of security at LAX. If somebody sees a cloud of smoke, security is not going to wait to uncover the source of it before they take measures to ensure travelers’ safety; whether the smoke is coming from an actual fire or from a toaster in the employee lounge all or part of the airport is going to get shut down. Our body’s alarm system is no different. Sometimes the alarm system can be a little too… alarming!

 

You might be thinking, “Okay, but what about when I know there is actual damage- when I can SEE that I’ve broken a bone or cut my skin?” Great question!

 

As far as I know, nobody likes to go to the doctor and get a needle stick. However, for some people that little pin is a minor nuisance. For others, it is absolutely excruciating. It’s not because people have different NERVES. Its because people have different MINDS.

 

If the pain we feel when we get a needle stick was a communication of DAMAGE, it would be a pretty mild experience for everyone. However, because it is a communication of DANGER, a person’s personality, past experiences, and prior knowledge all affect what is felt.

 

Let’s break down that last sentence a little bit:

 

What contributes to a sense of danger?

 

Personality:

 

Are you a high-stress or low-stress person? Type A or Type B? Do you get excited by risky situations or do you prefer safety and stability? Our unique personalities, beliefs, and worldviews influence what we feel.

 

Past experiences:

 

Sometimes our past experiences can sensitize us, and sometimes they can desensitize us. A small fender bender accident might be much more traumatic to someone who had recently been in a big car crash. That person would be sensitized by the experience. Let’s say that the person in the fender bender was a professional stuntman. A little fender bender might not even elevate his heart rate! The stuntman had been in so many similar experiences that his brain was bored and desensitized to it.

 

Prior Knowledge:

 

This one is huge! Why? Of each of these three factors, prior knowledge is the most changeable. We have no control over our past experiences, little control over our personalities, but quite a lot of control over our education and understanding of our own physiology. Simply knowing and understanding a phrase like, “Pain communicates DANGER; it does NOT communicate DAMAGE” can change how pain feels.

 

If we can change how pain feels without drugs or surgeries, life will be a lot better.

 

Pain is a very personal, very complex experience! It is less objective than we often think it is. However, this does not mean that pain is all in our heads or that if you have pain you just need to get over it. What is needed most is understanding, patience, and good communication with your body. Once the danger “alarm” has sounded, it is time to assess the situation and uncover what is really going on. Is it a real fire or just a smoking toaster?

 

If we could peek at the MRI reports of most people over 50, we would be shocked to find degeneration in many of the joints of their body. Are these people all riddled with pain? No way! In fact, many folks walk around with bulging discs, degenerative disc disease, and arthritis and feel no pain. How could this be? Don’t bulging discs hurt? Doesn’t arthritis = pain? Nope. 

 

It’s actually ONLY when our brain perceives a potential threat that we will feel pain. You could break a bone, tear a nerve, or slowly be developing arthritis and unless your brain picks it up as threatening, you will not have pain. 

 

Pain is labyrinthine and depends on many different factors. The brain determines whether or not we experience pain every single time. 

 

Imagine walking across the living room and stepping on a tack. You’ll quickly be alerted to the presence of the tack inside your toe by a jolt of pain. The pain prompts you to remove the tack from your toe and do important things like clean the wound. Without pain in this tack instance, you may not have noticed the tack. If left in your foot, the tack could do some serious tissue damage, cause infection, and potentially lead to the loss of the foot. 

 

Consider the paper cut. It’s so small and the damage is so minimal, yet it hurts! Or how about those with phantom limb syndrome who have pain in their leg even though it has been amputated. On the other end of the spectrum, consider the person who has been wounded in combat, yet doesn’t notice until after because they are so distracted with the battle at hand. 

 

Take the story of a WWII vet who came in for a routine chest X-ray to find that he had a bullet lodged in his chest for the past 60 years and didn’t even know it! 

 

2. Pain Depends On Context

 

Our brain seeks to protect us from harm. The brain uses all the resources at its disposal to alert us to potential threats. We use our vision, smell, hearing, touch, and even our memories to assess a situation and see if it poses a threat to our safety. If it’s threatening enough, our brain will alert us through pain to get our attention. 

 

There was an interesting study done where subjects were shown a red or blue light before a painful stimulus. Interestingly, more pain was reported by subjects shown the red light than the blue.

 

Males tend to have a higher pain tolerance when females are around. Macho man, anyone? People report more pain when the boss is present vs. being absent. 

 

The pain we experience can be increased or decreased by what we see, hear, smell, and remember regardless of the actual damage being done. Pain depends on context.

 

3. Pain Physiology​

In PT school we read a book called The Gift of Pain. The book follows a medical doctor who worked with sufferers of leprosy overseas. 

 

People used to think that folks with leprosy lost limbs due to the disease itself. However, what we now know is that the disease causes destruction of the nerve endings responsible for sensation. This loss of sensation makes it difficult to detect sores on the feet, burns on the hands, and to ward off infections. The failure of the person with leprosy’s alarm system is their demise. 

 

We use memories, our eyes, our hearing, and our sense of smell to warn us of danger and protect us. 

 

Imaging your body as a neighborhood. Each house is a small area of the body. Let’s say the “knee house” is robbed. You tear your meniscus playing soccer and have a knee surgery. What would you do if your house was robbed? I bet you’d get some additional security systems, alert your neighbors, and be suspicious of anyone looking suspicious! If your house was robbed again and again, the neighbors like the shin, hamstring, hip, and ankle can start to light up as well. This is how chronic pain spreads. 

 

In the same way, your brain will go about protecting your knee. It will be more sensitive to pain from movements that did not used to be painful, and the areas around the knee may be painful.

 

Inside our body, we don’t have specialized sensors for pain. We have sensors for pressure, temperature, and even acid. What needs to happen for us to feel pain is for the brain to take all the incoming information in and determine it is threatening. Inside our brain a complex series of interactions takes place to determine if we will experience pain or not. Hundreds of different parts of the brain are involved in the experience of pain. There is not simply one area in the brain responsible for pain but rather a great, complex many working together. 

What Happens With Chronic Pain?

Imagine your brain as an orchestra. An orchestra can play an infinite number of different songs. Think of pain as one of those songs. When your taking a nap on the living room floor and your toddler decides it’s the opportune time to cannonball onto your low back, the pain tune in your low back will start to play in your brain. This is normal and good. 

 

But when the pain tune in the low back is played over and over, as is the case with many of the patients we work with in chronic pain, our brain can forget how to shut off that tune. We become so used to activating the same areas of our brain which correspond to the pain experience that we get “stuck” in pain. 

 

Imagine an orchestra that can only play one song. It would be a lame orchestra! People would stop coming to the shows. Members of the orchestra would get frustrated and maybe even leave. When we hear the same song over and over again, it starts to sound like nails on a chalkboard. 

 

Like we talked about earlier, if the “house” (your knee) is robbed over and over again, the body will increase the sensitivity of the alarm system to protect you.

 

When our brain becomes overly sensitive to stimuli even things normally not painful like a touch on the skin, squatting, or running are perceived as threats. The alarm system is sounded and the pain tune continues to play.  

 

The increased alarm system is supposed to protect us from threats in the environment. But what if it was so sensitive that it went off every time a leaf blows by? It would be annoying if every time a leaf blew by your house the alarm system was going off. You’d probably just unplug the whole thing. 

 

We can’t just unplug pain. But there is hope.

Hope For A Pain Free Tomorrow

Thankfully, our nerves and brains are changeable. Our nerves are plastic which means they change constantly. They are always dying off and regenerating. Yes, it seems you can teach an old dog new tricks. At any age, given the right education and communication, you can signal your orchestra to begin to play a new tune (many new tunes!). You can turn down your alarm system and get back to doing the things you love. 

 

1. First You Need Education And Understanding

 

Reread the section above. The book Explain Pain is an amazing resource as well. 

 

Understand pain so it doesn’t terrify you. 

 

2. Pace Yourself

If walking for 20 minutes flares up your knee pain, you may need to start with 10. Then, the next time you walk, go for 11. Add a minute every time and soon you’ll go right past 20 with no issue. The key is to stay under your brains “threat level” and keep bumping up the activity level. 

 

3. Communicate Well With Your Body

 

Everything we’ve talked about leading up to this point in the book plays a role in your experience of pain. If you are always in an inflamed state, chronically stressed, and breathing poorly, you’ll be more likely to have chronic pain. 

 

Add to that the medications, surgeries, and current understanding of pain in our medical world, and it’s a recipe for disaster. 

 

Simply applying good nutritional and movement communication could be a major player in enabling you to live life pain-free. 

 

4. See A Movement Specialist

 

There are many components of moving well that are far too nuanced to include in the pages of this book. I spent eight years getting educated to become a DPT and am constantly taking courses, reading, and learning. 

 

Therefore, seeing someone in person is still the best way I can help them to move well. 

 

If seeing us in our clinic at Village is not a possibility, find yourself a good physical therapist, chiropractor, or other movement specialist who will spend enough time with you to figure things out. 

 

We spend an hour every session with our patients and even offer a free 30-minute consultation. 

1  "Pain is Weird: A Volatile, Misleading Sensation - Pain Science." 26 Aug. 2018, https://www.painscience.com/articles/pain-is-weird.php. Accessed 27 Sep. 2018.

2  "How the Color Red Influences Our Behavior - Scientific American." 1 Nov. 2014, https://www.scientificamerican.com/article/how-the-color-red-influences-our-behavior/. Accessed 27 Sep. 2018.

3  "Gift of Pain, The: Paul Brand, Philip Yancey: 9780310221449: Amazon ...." https://www.amazon.com/Gift-Pain-Paul-Brand/dp/0310221447. Accessed 27 Sep. 2018.

4  "The Brain in Pain - NCBI - NIH." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4405805/. Accessed 27 Sep. 2018.