The study of pain and the experience of pain are vastly different. To understand the science of pain is to know concepts rather than what it is like. Having my own pain gives me a different perspective.
Running ultras is painful. This I am getting used to now. Or perhaps I have simply developed ways to deal with pain that allow me to keep going. More on that later. For now, I want to describe an incident that happened yesterday.
I had just rounded Battersea Power Station, marvelling at its structure and presence. Workmanless because of Covid-19, it is an iconic symbol, perhaps made more so by Pink Floyd‘s album Animals. And a flying pig. But there was no flying swine today, just a flying runner as I found myself mid-air. Then something surreal happened.
Time seemed to slow down. I was able to decide that I could land on my right shoulder and roll. And that’s what I did. Landed, rolled, got up and ran on. I was surprised, but had to continue my journey to work.
I checked myself whilst carrying on running along, reaching up and behind to see if I could move, rolling my neck and pressing around my right shoulder. There were a few sore bits, but nothing major. I could move with a little soreness reaching forwards and across my body. ACJ I thought. On I went.
An interesting array of thoughts pop in about whether I had injured something, whether I would be able to use my right arm, why it didn’t seem to hurt too much, I’ll be ok, I know what is going on inside me, together with a tendency to keep checking the area with my attention. None of this on purpose, or by choice. Thoughts just arise and then pass like everything else we perceive.
The regular scrutiny was much like wiggling a wobbly tooth or pushing one’s tongue into an ulcer. What we are doing is trying to update our model of the body by gathering sensory information that the brain can predict the meaning of. It is normal.
Attention and expectation
Two of the big players in pain are attention and expectation. What we focus on governs how we feel — is a basic rule in life. Much of the time we do not choose, it simply appears without any effort. We can choose our approach once we have established our existing methods, and then decide what works and what does not. Then, what I expect (somewhat consciously but mainly subconsciously in the form of priors) also plays a significant role in what I experience. Helping a person overcome a pain problem requires practices that help them work with their attentional biases and expectations.
What was it like?
Gradually more painful and difficult to move.
Half an hour or so later, I was wincing with every movement. Trying to hold a conversation whilst now rubbing, holding and reaching out. If I had been looking at me, I would have noticed the facial expressions and the gestures that signify discomfort and pain. Perhaps that is why we do it; to let others know.
Getting moving again, initially my arm was saying no by trying to stay by my side. But as I built speed, my arm that was occasionally feeling like it was not mine, started to swing. There was a moment of relief as the area relaxed. A change of state.
I know that keeping still for long periods causes more stiffness. On a daily basis I am encouraging people to move when they expect it to hurt, and now I was in that boat. I teach ways of doing this to have good experiences of movement. Could I do it myself?
All the things that I would normally do became more complex. I found my arm pinned to my side, with all the effort of movement being transferred to my elbow. My shoulder had shifted responsibility to its distal colleague. You can still reach your face without moving the shoulder, I discovered.
Shoulder and arm pain at night is notorious. Which position will work? I feared the worst, envisaging waking often and then a terrible day of tiredness. We have a natural inflammatory cycle in the early hours and blood pressure drops at night. Both can mean that we can wake when we are sensitive. I took a dose of ibuprofen just in case, and smeared some muscle balm over the area.
The feelings of impending sleep emerged. I turned out the light somewhat awkwardly, trying to muffle a few groans so as not to disturb my wife who was reading. I was pleased to be able to lie on my back and let go of my right arm. Clearly I had been holding it in a position that would be appropriate if someone were about to run into me. Relief again. Then I tried lying on my left. That also worked.
My first waking was after 1am. This is not unusual. I got up, padded quietly around the room and then eased my way back onto my left side. Then it was 7am.
To be continued…