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On Pain

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We are all familiar with pain. Most of us have encountered some sort of injury or illness and the uncomfortable physical sensations that arise from this. The purpose of pain and how it works as a function are however less widely understood.

Acute pain is physical sensation that is tied to tissue damage – say some sort of injury or maybe an infection. Chronic pain is something that lasts longer than three months and cannot always be attributed to tissue damage or known illness.

People’s individual experiences of pain vary greatly. The severity of injury does not automatically correlate with the intensity of pain experienced. “Phantom limb syndrome” is one such example; around 80% of people with amputations experience pain in the ’phantom’ limb. Whilst the limb has been removed the brain tells them that it is still there and that it still hurts. In contrast, during the London 2012 Olympics, the 400m runner Manteo Mitchell finished his race, despite feeling a “pop” in his leg during the first relay. X-rays later confirmed that he had broken his left fibula (calf bone). Pain was not experienced until after the race.

What exactly is pain?

Pain is often described as an alarm system. It is your brain telling you that something is wrong or dangerous. The physical sensations of pain act as the siren. Something that is felt and difficult to ignore.

In the case of acute pain this is extremely helpful. Should we, say a break an ankle; pain would initially prevent us from walking or bearing weight on said ankle, which could worsen the injury. Pain draws our attention to the fact that rest and care is needed. This creates better conditions for the body to run its ‘repair process’.

In the case of chronic pain, we can however view there to be some sort of “dysfunction” of the alarm system. The siren is now jammed. Always on. There may not be any tissue damage or underlying physical cause. If there was tissue damage, it may have now healed. The pain may be disproportionately greater or longer lasting, to that which we would expect from this type of injury/illness.

Why these differences in experience?

Pain is essentially an output. The nervous system is the “processor” of pain. Your nervous system is comprised of nerves, muscles, tendons, along with memory and emotion, amongst many other things. One of the nervous system’s main functions is to establish how safe or unsafe we are at any given moment in time. It does this through constantly taking in messages from our body and environment. These messages are filtered through a lens of perception (including our mental/emotional and physical history), along with the unique, moment by moment state of our individual body and environment.

The design of our nervous system is rooted in our DNA as hunter gatherers. It has enabled our survival as a species. We are alert to threats, so that we can fight, flee or in some cases freeze, to protect ourselves. This design is perfectly formulated for avoiding wild animals yet is less helpful for modern age ‘threats’. We are rarely avoiding predators, yet our bodies are constantly subject to low level yet insidious stressors and the constant stimulation of modern society. Much of this is what the medical profession, deems as ‘psycho-social-stress’. Examples of this can include a heavy workload, the demands of parenting, grief, job loss, financial insecurity, a fear of public speaking, divorce/relationship breakdown amongst many, many other things. Our nervous system registers all these things as “unsafe” and a set of physiological processes are triggered (e.g. a release of stress hormones and certain sensations in the body tied to difficult emotions). Trauma (past or present) is also very much experienced in the body and can leave a resonant sense that the world, individual and other people around us are “not safe”. A physical accident or period of illness is also a stressor (in some cases a trauma) on the body – something that can be perceived as ‘unsafe’.

Much of this is a subconscious process. The reptilian part of the brain is heavily involved in assessing our sense of safety. This is the oldest part of the brain. It operates below language. Some or a combination of many stressors can result in the nervous system becoming highly sensitised. That metaphorical alarm is turned up and will not stop. In turn this ongoing experience of pain depletes our energy and vitality. We may worry over what could be causing the pain. It may also impact our relationships with others and create financial stress if we are unable to work. Our sense of self may be impacted. Each of these things are major stressors in themselves. This becomes a vicious cycle. Pain and its impact on daily life, is stressful. Pain is heightened (the nervous system, ramped up) through stress. That alarm keeps ringing. Its volume increased further.

How do I treat chronic pain?

When experiencing chronic pain, it can be helpful to remember that the nervous system has learnt this state of sensitisation. Something that is learnt, can therefore (in keeping with the principles of neuro plasticity) be to various levels, unlearnt. This does however take time, a lot of compassion for yourself and the process, support, and a willingness to change certain things that may have contributed to your condition.

As a facilitator, I firstly look at how I can support you in developing a felt sense of safety. Words and even thoughts alone, are not enough. We need to work with the ‘processing sensors’ to signify to the nervous system that we are okay. This means working with both the mind and the body. It means viewing each individual person as a whole and unique being. It is listening to you and honouring your experience.

Practically, we will explore relaxation techniques, to support you in dealing with pain and reducing stress. We will look at ways in which you can self soothe and maybe process some of the difficult emotions that arise from living with pain. We may look at how you can restore a sense of trust in your body – the feeling that your body is not your enemy. We will examine how you can be more compassionate with yourself and how to create acceptance around your current situation.

Regarding movement itself, the practices offered will very much be tailored to you and where you are at on any given day. Movement will be gentle and playful. We will look at ways to maintain movement patterns, so that this transitions to greater function into your day-to-day life, over time. We will address any barriers around fear of movement and look at how to adopt healthy strategies to steer away from “boom bust” cycles (periods of overactivity, followed by a flare). We will look at how to develop greater strength and mobility. We will also explore your relationship with rest.

Mindfulness techniques help you tune into your body more deeply. Recognising and tending to symptoms at a much earlier stage, to reduce their severity and avoid flares.

Mindfulness can help us move away from excess thinking and potential worries about the past or future. It offers us techniques to savour more joy in our day-to-day lives and also in how to strengthen our connection to ourselves and others. This can all improve our quality of life, whilst experiencing pain. It also helps reduce some of our ‘stressors’ and rebuilds a felt sense of safety. This all helps in ‘turning down the bodies alarm system’. Reducing pain, over time.

The onset of chronic pain is multifactorial, it therefore requires multidisciplinary treatment. Do continue to see your GP/medical practitioner and rule out any potential unknown underlying causes illness. You may also wish to seek nutritional support, physiotherapy, trauma therapy, counselling, or bodywork (amongst other things) in addition to this service, if these routes feel right for you.

I have an inflammatory condition or have seen MRI scans of tissue damage that I believe to be the root of my pain. Can this approach still help?

Yes. As discussed, the level of pain experienced does not always equate directly to the underlying cause. The medical establishment is relying less upon MRI scans to determine pain levels as many patients experiencing high levels of pain present with “clear” MRI scans. Other patients do not experience pain, whilst their MRI scans show various levels of wear and tear, disc bulges etc. There is no consistent correlation. Mindfulness and movement can help you better manage your health condition, as we are working with your experience of pain and ensuring that you can safely continue to move, to prevent stagnation and further deterioration of muscle, bone density etc.

This approach will likely reframe how you experience pain, in turn improving your quality-of-life with a chronic health condition, even if this is inflammatory in nature.

How we can work together?

I offer personalised, online, one-to-one sessions. Please see the ‘classes’ page on my website for full details and rates. I offer a complimentary 15 minute consultation, if you would like to discuss this further over the phone, to see if this feels like the right approach for you.

Please also sign up to my newsletter to hear more about group classes and courses that will be launching over the coming months.

Bibliography

Haynes, Steve, ‘Pain is Really Strange’, Singing Dragon, 2015.

Burch, V & Penman, D, “Mindfulness for Health”, Piatkus, 2013.

Taylor, M, J, “Yoga Therapy as a Creative Response to Pain” Singing Dragon, 2018.

Manchester and Salford Pain Centre, “Explaining Pain” booklet, Salford Royal NHS Foundation Trust, review date April 2020.

Live Active Clinic, ‘Understanding Pain in Less than Five Minutes’,  https://youtu.be/C_3phB93rvI (accessed on 17/07/2020)

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2 Comments

  1. Really great post. This answered the majority of my questions. When I read this I actually opened up a word document and started taking notes haha. Lizette Olag Rolando

    • I’m so glad that this was helpful. Thank you for reading.

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