Do you enjoy a good dose of pain? Nope. Didn’t think so. No one does really. But pain is very useful. It keeps us alive.
In fact, if we didn’t have the ability to feel pain (via our danger detection system) we’d be in a lot of trouble.
So how does pain work?
Pain is the result of a super-efficient system that is continuously identifying ‘stuff’ coming into the body, and then telling the brain about it.
And when I say ‘stuff’ I mean anything that triggers a sensation or change in the body’s tissues. Let’s demonstrate with an example.
How the brain and the body communicate
Imagine, one day, you decide it would be a good idea to jump on a nail (ouch). What happens next is the body will detect the pressure of that nail as your foot lands on it, and then send a message to the brain to let it know.
Now, the body does this for all sensations – not just painful ones. In the case of taking a swig of beer or – a sip of wine if you prefer, the body would sense the chemical input (the alcohol) and then wave a little flag to the brain to make it aware.
The brain and the body are always having a good old natter. Sometimes, the way in which the body communicates to the brain is quite relaxed and chilled, whilst at others it can be quite shouty. Likewise, the brain can be rather peaceful in the way it interacts and sends messages to the body but it can also get a bit feisty.
The messages being sent back and forth always have a purpose. Say for example, it’s getting late. The body might send a message to the brain saying ‘I’m tired, let’s go to bed’ and likewise, the brain might register that and agree. Alternatively, it might go back to the body and say ‘No! Too much to think about, I’m not ready to go to bed yet!’ (which happens in the case of insomnia).
When does a sensation become a threat?
In the context of pain, it is not quite as simple as – big impact = pain, little impact = no pain. There is much more to it than that.
Think about this for a moment. Right now, I imagine you are most probably sitting down somewhere. As you do, just think about the feeling of your bottom against the chair. Until I asked you to think about it, you may not have even been aware of it. But now that I have mentioned it, you are most likely conscious of the feeling of it pressing against that surface.
But there is no pain, right?
We don’t just feel pain as soon as there is a change in the body. If it did, we would constantly be in pain from even menial things like putting our socks on.
In order for pain to occur, our lovely brain has to bring together a whole bunch of information from other sources before it decides the sensation is worthy of a pain ‘shout out’ to the body.
So does this mean pain is all in my head?
Absolutely not. It may be produced within the four (okay, one) wall of your head, but it is certainly not a psychological phenomenon. In fact, as Moseley and Butler* (two pain specialists) point out, anyone who suggests this, thus implying it is not real, “does not understand biology.” Their words, not mine. (But, I wholeheartedly agree.)
The reality is that physical damage to the body’s tissue is only part of the picture. Social, emotional and neurological factors all play a part too.
Neurologically speaking, imagine you have a map of the UK. You’ll see Cambridgeshire in one part and Hampshire in another. You’ll also notice that some cities and counties are bigger than others.
In a similar way, the brain will have locations mapped for each body part. And, the more we rely on a particular body part, the bigger the mapped location will be. So, the skin on our lips has a much bigger portion than the skin on our back.
And, get this… the mapping also varies between individuals. Should a professional violinist experience exactly the same minor finger injury as a professional dancer, the violinist will experience a higher level of pain. True story.
So the damage is the same, but the pain response is different based on the level of threat that this entails. Make sense?
There are of course, many other factors that contribute to the brain’s decision-making process in determining whether something warrants a pain response – social, emotional, psychological and more. So it is a complex process. But altogether very real.
And once it decides we’re under threat, this is the time when the alarm system is activated and physical pain is triggered.
When pain becomes reality
Now, there are three things that happen in the body once the brain has decided a pain response should be triggered:
- The ‘factory’ starts to manufacture more danger receptors: Our danger messenger will make more sensors that are receptive to pain, so there will be more ‘doorways’ open in the brain to receive those pain messages. It’s like the brain saying, “Come on in pain, the more of you the better!”
- ‘Danger receptors’ are sensitised: when the go-ahead is given, the sensitivity of our little ‘danger’ receptors is increased to make sure nothing is missed. It’s a bit like the alarm system on a house being ramped up so much, that even if an innocent cat were to brush against the front door, off the alarm system goes. What this means for our body, is that things that didn’t hurt before, now hurt, and things that used to hurt, now hurt even more.
- Our pain sensors stay open for longer: When threat is on the cards, our little pain sensors will stay open for longer. This means that more information is coming in than it normally would. Imagine you sit on a chair – rather than feeling the pressure of the surface beneath you as normal, this feeling might be amplified times 10.
Why does pain turn chronic?
Phew. There’s the ‘sciencey’ bit done.
Now the thing with chronic pain is that the body has simply become very good at processing pain messages back and forth, even though there is nothing really to shout about.
Let’s say I’ve had a calamity in the kitchen one day; I’m making a delicious dinner but somehow I accidentally bump into the cooker and burn my arm. At this point, the body will respond by sending a message up to my brain: “Incoming! Impact made – please assess!” The brain will process this message and, using a number of other factors in its consideration, reach the conclusion that this is indeed a real threat.
And there we have the pain response. It’s our brain’s way of saying “Be careful, you need to let this heal.”
Let’s now assume that in a few weeks’ time, my arm has healed and the threat is no longer there. In normal circumstances that’s fine. But with chronic pain, the nervous system is still processing that pain message. It has become stuck in a kind of ‘loop repeat’ cycle. And the more that happens, the more the steps above are implemented and repeated, meaning any small trigger will instigate the pain message.
So the body is sending over-excitable messages up to the brain in abundance. A bit like having a referee on the football pitch waving yellow cards here, there are everywhere; our little pain processors have turned into a tiny yet powerful army of jobsworths.
Now what can also happen, is that, perhaps the messages from the body aren’t that strong, but the brain has become a bit too welcoming. Like the over-sensitive alarm system mentioned above, it’s acceptance threshold has become a lot lower. So ‘danger messages’ that would normally be ignored, are suddenly listened to and immediately acted upon with a pain response.
Light at the end of the tunnel
The good thing about all of this is that, in the world of neuroscience, and the work that I do, we know that psychology has a direct impact on neurology.
The implications of this are huge, because it means that we CAN influence this. Even better than this, we can essentially switch off the pain response and train our bodies into ‘comfort’ territory as opposed to ‘pain processing’ territory when we know how.
So that’s the question, right?! How exactly do you switch off the pain process?
The Lightning Process is by far the most effective thing I have personally come across, but there are other ways of dealing with it.
Watch this space for next feature, where we’ll be looking at top tips and resources that will help you to move past the pain cycle.