Stephen Adams of The Telegraph wrote (click here) about the role of genes in disc degeneration following the discovery of PARK2 by Dr Frances Williams and her team – here’s the study. Rightly, he points out that the relationship between the changes in the tissues and the experience of pain are complex. In essence this is due to pain being a brain experience. Neuroscience research has told us that pain is an output from the brain 100% of the time, in other words, a response to a situation that the brain deems to be threatening to the body. This by no means insinuates that pain is in the mind. Far from it. Pain is pain and it hurts in the body, but the actual output emerges from a widespread group of neurons in the brain that have a range of roles, not specifically to produce pain. The feeling of pain is ‘projected’ to a body region by the brain to make us aware that there is a problem that we need to address. Fascinating research in Australia is demonstrating that the brain is even capable of allocating your pain to another person’s arm! The rubber hand illusion is a another well known example of how the brain allocates pain to an inanimate object because it thinks that the rubber arm belongs to the individual – see Lorimer Moseley talk about it here. We have learned a great deal from phantom limb pain and observations of those who sustain significant tissue trauma yet report no pain.
The article touches on some of the influential factors in pain and certainly genes will play a role. The individual nature of our responses to pain is determined by what we have learned, presumably at a young age. Our coping mechanisms and outlook will affect the behaviours that we choose. In many cases we become overprotective, thinking that the pain equates to ‘damage’ and therefore we guard the back and limit movement, perhaps thinking that it is dangerous. We may have received early messages from others that we should not move if we have a ‘bad back’ but in fact the tissues need movement for health. Understanding your pain is vital in moving forwards and is the first step in gaining control and confidence in moving once more. Becoming increasingly inactive is common in a persisting pain state and this needs to be turned around as quickly as possible.
Today in The Telegraph (click here and here) is a report of a paper that demonstrated the significance of having a companion when recovering from the sensitivity of surgical pain. The study used mice to determine the physiological effects of social interaction and found a different profile in those that were isolated compared to those who recovered with another mouse in their cage. It is argued that there is less of a stress response in those with a companion. Stress has a significant effect upon pain and can cause both hyperalgesia and analgesia depending upon the context of the situation. Having a friend close-by would typically reduce stress and hence diminish the ‘threat’ and consequently calm a sensitive nervous system. The chemicals released when we are stressed can sensitise the nerves therefore any method of calming, reducing fear or concern can help reduce pain.
“Mice that were paired with a cage-mate showed lower pain responses and fewer signs of inflammation in their nervous system after undergoing surgery that affected their nerves than did isolated mice, suggesting that the social contact had both behavioral and physiological influences”
Finally, an article in the Daily Mail yesterday provoked a raft of comments objecting to the suggestion that pain ‘is in the head’ or ‘in the mind’. The report was based upon a new book quoted as arguing “that while our attitudes certainly make pain worse, when it comes to chronic pain, emotional tension is almost certainly the actual cause of the problem in the first place”. The title of the article ‘Is chronic back pain all in the mind?’ is likely to have triggered some of the upset. Pain is most definitely not imagined or in the mind. As I have said previously, science clearly tells us that pain is a brain output that we feel in our body, underpinned by a very complex set of parallel processes in the nervous system and other body systems (immune, endocrine). Emotions certainly flavour our pain and can have a huge impact on what we feel. Tension within the body is a response to how we are thinking and what we are doing. If this becomes set-in, this can cause pain and discomfort and affect the way we move.
“Prof Steve McMahon of Kings College, London, director of the London Pain Consortium, said it was “well recognised” that pain in humans could be strongly modulated by mood, expectation and attitude”
In summary, pain is complex, it is a brain output in response to a perceived threat and is very real. To tackle pain mechanisms and the influential factors we need the comprehensive biopsychosocial model to consider all the relevant factors that are pertinent to the individual who is suffering. We can be optimistic in treating pain as we understand that the systems we have been talking about are changeable with the right stimulation within realistic time frames. There are strategies that target pain at a number of levels and in essence help the individual to start moving forward and re-engaging in their life.
For information about our comprehensive treatment programmes for persisting pain and injury please call us on 07518 445493 or contact us here