In part 1 of this series, Your Pain Relief Plan Introduction I discussed why we feel pain and introduced the concept that the degree of pain felt could vary widely from one individual to the next due to lifestyle factors and that when long term, typically over 3 months, the brain would lock the pain in. Emotional trauma, even as far back as childhood, had been found to lock in pain for almost a lifetime.
In part 2 of this pain relief series, I will get into more detail about how pain works and discuss the implications of aging and the differences between acute and chronic conditions and the most effective ways of treating these. But first, a quick look at the brain, how it has evolved and how this relates to processing pain.
The oldest part of the brain is the reptilian brain, which deals with basic survival instincts. Next came the mammalian brain, which added the ability to feel emotion. The third part is the human brain, the Cortex, which gives us our human qualities of cognition, sensory perception and spatial reasoning and is in charge of the human decision making process.
How Pain Works
Your nerves transmit pain signals. Inside your nerves, you have sensors for temperature, stress, movement, pressure, immunity molecules and blood flow. Similar to car sensors, any damage or fault to any of these sensors will put a light on your dashboard, to alert you of a problem. The nerve does the same thing by increasing pain.
These pain impulses travel up the spinal cord, to a part of the brain which acts like a router(called the thalamus) and as a simple analogy, this router makes phone calls to other parts of the brain.
Hence our brains decide, like a panel of judges, how much pain is appropriate for us to experience at any one time
The pain experience is complex and involves many areas of the brain:
1. Body sensation and location
2. Movement – muscles may need to brace the area
3. Focus & concentration
4. Fear response
5. Memory area recalling a previous similar experience
6. Motivation - processes pain
7. Stress response - weight, digestion, sleep, temperature
All seven areas interact to decide on the suffering experienced. This may have little to do with the degree of injury and hence makes it clear that a qualified and knowledgeable therapist is needed to properly diagnose and treat the injury.
The Consequences Of Aging
As we age, we need to put more care into our diet, supplementation, exercise, and our workload. It sounds simple, but many of us fail to even acknowledge that as we get older, we have to change the way we use our bodies. As we age, naturally occurring enzymes are fewer, inflammation is greater, and the production of inflexible scar tissue becomes much more extensive. Therefore, long-term solutions for pain relief also need to address our ongoing biochemical changes.
Sleep quality tends to deteriorate and ongoing deprivation can lead to symptoms virtually indistinguishable from widespread pain, fatigue and diffuse tenderness. Early evidence also shows that anxiety, depression and sleep disturbances have been common reactions to the COVID pandemic. Thus the problems faced by Long COVID sufferers are likely to be with us for many years to come.
What is the difference between Acute and Chronic Pain?
Chronic pain, by its nature, may not be resolvable
Chronic pain is long term pain, beyond 3 months, as the brain has hard wired the pain in by that time. Chronic pain can occur because of numerous conditions, such as emotional pain, joint wear and tear (osteoarthritis), spinal disc thinning, bulging or rupture, bone thinning
Suffering is not related to the degree of injury
(osteoporosis), unresolved tendon or ligament damage, to name but a few. Chronic pain, by its nature, may not be resolvable. It may need a lot more treatment than acute pain to bring down to acceptable levels and will benefit greatly from ongoing maintenance or wellness treatment to prevent reoccurrence.
Modern science confirms benefits of a more holistic approach
The latest neuroimaging technology, which can see the electrical activity in the brain in response to different lifestyles, has allowed the world to delve deeper into the understanding of chronic pain. It has been confirmed that pain is modulated by factors such as attention, anticipation, empathy, placebo, meditation, fear, anxiety, posture, emotion and movement. This, in turn, has confirmed the benefits of a more holistic approach to assessment and treatment.
This new insight into chronic pain helps explain why, for example, X-rays showing the degree of osteoarthritis in joints has no correlation to the pain being felt.
To summarise, we have shown how each person's brain can process pain differently, to the extent that one person may feel tremendous pain, when another, with essentially the same condition, might feel little or no pain at all.
The availability of the latest MRI scanning technology has verified that many non-physical factors can impact the way pain is handled in the brain. This in turn supports the benefits of a more holistic approach to assessment and treatment.
Acute problems are usually caused by a recent injury and are best treated promptly, whereas chronic problems are longer-term and tend to be related to the ageing process. Chronic pain in many cases cannot be resolved and lends itself to a longer-term control of symptoms, rather than treatment of root cause as with an acute injury.
In my next blog Your Pain Relief Plan Part 3 I will explain neuropathic pain and the effectiveness of both exercise and drugs and where these may be the wrong solution.