Thursday, April 23, 2015

Science Says I May Not Be Crazy!

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!


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