Many people have the experience of going to the doctor with
some type of pain. The doctor often
orders tests to try to make sense of the complaint. We want that.
At least we want that until we have been to doctor after doctor and they
can’t seem to find a problem. That is
when we get the psych referral and are told that the problem must be in our
head.
We resent this. We
feel the pain. We know that we have a
problem and that if we just see the right person – they will listen to us, run
the right test, and finally fix our problem.
It really starts getting to us. We have bad feelings toward our caregivers. Many of us begin to mistrust the medical
profession. We blame big pharma, the
insurance company, and the government.
Our life begins falling apart. No one sees any blood, cast, or wheel chair
and they too often begin to wonder – is it all in their head? The saddest part of this is that deep down –
we often begin to wonder about that as well.
A Way Out – Understanding!
I would like to offer a way out of this mess. It is only possible to do this by helping you
to understand what we now know about both you – and your pain. I will start with a definition.
An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.
This definition comes from
International Association for the Study of Pain. [i] It is the definition that
is followed by most health care practitioners.
It is really good to have a definition like this because in its absence
we really have no accepted way to have a discussion about it. We are simply left with opinions. This is a helpful definition.
Tissue damage is not a requirement for a person to have pain! This is very important because all of those
tests that get used to find out what is wrong with the tissue are looking for –
you guessed it – TISSUE DAMAGE!
This means that just because the
tests are negative that you can still have a legitimate pain problem. If you are complaining about pain or
experiencing it – you probably actually have it regardless of the outcome of any
number of tests.
This became clear when people
began complaining of phantom limb pain.
There was no limb to have pain in and yet many people in the absence of
those limbs consistently complain about pain.
One of my favorites is the rubber hand illusion
where a person can be taught that a rubber hand belongs to them and they can
actually feel pain when it is struck with a hammer! People did not even have to believe the hand
was theirs in order to be benefit from acupuncture or TENS in this abstract
at the World Confederation of Physical Therapy.
This may all sound a bit
strange. We have pretty much assumed
that pain is an input from our tissues since the time of Descartes. Yet the science seems to be pointing in an
altogether different direction.
In the picture above we see the view
of Descartes in the left hand corner that we have nerve receptors in our skin that go directly to the
brain and carry pain signals. The
problem with this traditional view is that there is no such thing as pain to sense.
Think about it. If you get a cut - did pain leak in? Did you put some pain on a slide in high
school and view it under a microscope? Have
you ever seen, heard, or tasted pain? If
you answered no you are in good company.
We are all in the same boat!
The reason the rubber hand
illusion works and why people who have lost limbs can feel pain is that you don’t
need a body to feel pain. You just need
a BRAIN! The big finding of modern
neuroscience is that pain is actually an output rather than an input of the
brain. Let me explain.
Pain researchers have found that
the brain takes everything into account regarding our beliefs and attitudes as
well as the sensory input from the surface of the body when a potentially bad
issue exists. It asks the question, “How
dangerous is this?” The answer to that
question determines what you are going to feel.
Here is how this looks in real
life. You have a minor fender
bender. There is a slight scratch on
your bumper. No big deal. It was low impact. The complicating feature may well be the
emotional attachment you have to the idea of an accident. If you know someone who suffered serious pain
from an accident and that influenced you a good deal – you may be set up for a
pain experience. If you have been
studying disability statistics for a paper and have really focused on the bad
outcomes you may well have set your thought processes up to cause a pain
experience. Your brain takes all of this
information and if it answers the “How dangerous is this?” with – dude, you are
in big time danger – then you may well have a horrible pain experience. This could be in the absence of any tissue
damage and a minor scrape on your bumper.
All of this gets registered in
various portions of your brain. Related
pieces of information are stored all over in your cranium. As you go through life you create these
connections and reinforce them. In any
situation the activation of a number of these pieces of information (called
neurotags) may lead you to experience pain – even in the absence of tissue
damage.
My favorite is the memory I get when
walking through the mall and I smell cinnamon.
I immediately see the living room from when I was a kid waiting for my
mother to bring her newly made cinnamon rolls.
Some people drive by where they had an injury and can feel the pain –
even after the tissues have healed.
At This Point Things Get Really Interesting
If you are having a pain
experience and your tissues are healed why would you be continually treating
your soft tissues? Most scar tissue is
formed by 2 months. At this point the issue is pretty much a brain issue. People often continue to get expensive
treatments for pain. These are based on the idea of fixing issues
in the tissues that have healed long ago.
What really needs to happen is to
realize that a more effective and sensible approach is to deal with the
sensitization of the nerves that has occurred.
You need to deal with the neurotags.
Your nervous system can change. That
will soon be the subject of another post!
Everybody should find the best pain clinic for every treatment.
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