In part 3 we studied how inflammation in tissue stimulates pain sensors, and also promotes healing. In Part 4, we will go inside the brain and spinal cord. Whenever I speak to a patient about pain and then mention the brain, the automatic response is, ”So, are you saying the pain is all in my head?” The answer is yes, all pain is produced by the brain: without the brain, there would be no pain. This does NOT mean that the pain is fabricated in your mind and is not real. The most recent research by Lorimer Moseley, PhD, and David Butler,PT from Australia shows that the pain sensors report the injury and inflammation to the spinal cord which feeds it to the brain. The brain then produces the actual physical sensation of pain, even though the pain is felt at the site of the injury.
Once the spinal cord has been stimulated with impulses that result in the brain producing pain, the spinal cord has now been “sensitized”. With future impulses to the spinal cord, the brain is now being told that there is actually more danger at the tissue level than in reality, there is. Sort of like when you turn your thermostat up and it becomes more sensitive to a drop in temperature. Once this has occurred in the spinal cord, 2 changes occur in the brain: 1) it makes more pain sensors, & 2) it produces more chemicals to “wake up” the sensors in the brain when an injury occurs. Overall, these responses in the brain & spinal cord are a protective mechanism to prevent further injury and/or irritation.
With Chronic Pain, inputs can occur that don’t actually cause tissue damage. Oftentimes, they are judged by our brain as dangerous,which can be enough to actually cause pain. Some people with persistent pain only have to think of a painful movement or activity for it to produce pain. Again, the brain has learned to be excellent at keeping you from anything that might endanger your tissues.
Recent scientific research demonstrates that we have the potential to have thoughts strong enough to maintain a pain state in the absence of further injury or inflammation. Butler and Moseley call these “thought viruses”. Thought viruses are very common in patients with persistent or chronic pain, who don’t understand the physiology(i.e., “the workings”) of pain. In fact, with certain thought viruses I call “The What If’s”, one can actually significantly increase the intensity of the pain perceived with no further changes at the involved tissue(s).
What if’s go something like this: “What if the pain doesn’t go away”, “what if the pain gets worse and the pain medicine doesn’t help”, “what if I cannot go back to work”, “what if I have to have surgery”, or “what if I can no longer support my family?”
With these very common thoughts in mind, it is of utmost importance that you find a Physical Therapist that will take the time, one-to-one, to educate you in the entire process of Pain Physiology(how it works). You will find that once you do this, your journey through an injury or recovery from surgery will be much more tolerable. So that’s all for Part 4. Hope it helped. Cheers.............Kale
