Saturday, 18 June 2011

"Why am I always in pain at the worst moments?"

Your child's sick, your boss is demanding that report yesterday and the car engine's just blown up. You bend over to spit out your toothpaste - something you've done a thousand times before - and all of a sudden your neck spasms and you're in agony. 'Why me? And, why, oh why, now?' you may, quite reasonably, ask. Well, amazingly, it's not just the universe conspiring against you! Let's have a look at what's going on inside your body...

The traditional way of understanding pain tells us this happens:

1. Something bad happens to a part of the body

2. A danger signal gets sent

3. That signal produces pain

So, pain = harm. And probably pain is proportional to harm. So, bad pain = bad news.

Sounds sensible, but weirdly, isn't really true.

The latest pain research (here, for some great summaries) tells quite a different story, that goes something like this:
 
As, you can see, that's not nearly as linear, not nearly as simple. And at first it doesn't make nearly as much sense. But have a think about these examples - can you fit them into the traditional model? How about the newer one?

1. Phantom limb pain - there's lots of examples of people who've had amputations still feeling pain in the amputated limb. How does that work? Well if we throw out the idea of harm = pain and start to think of pain as something that's produced in the brain, it all makes a lot more sense. The brain uses a representation of the body to understand where various signals originate from and the representation of the amputated arm is still there, in the brain. So, if something else causes activity in that area, the brain will interpret that as pain in the arm - although there is no arm.

2. Obviously harmless activities becoming painful and therefore fraught with danger. How many times have you turned your head when driving? Or brushed your hair from your face? Even if you cared to count, you couldn't - such familiar activites are nearly subconcious in their execution. But when you're in pain, familiar activities seem terrifying. Turning your head must be harmful - it hurts so much. But why would an activity your body could previously do perfectly safely, without even thinking about it, suddenly become so dangerous? Usually, it's not. In fact, most pain conditions are helped by movement. But because we're so strongly conditioned to believe pain = harm, we shut down, stop moving and desperately try to stop any more 'harm' happening.

3. Not feeling pain because it's dangerous to. We've all heard the stories about people doing amazing things despite terrible injuries because they needed to get themselves out of danger. And what do they all have in common? They feel little or no pain until they've got the situation sorted. Their brain quite simply doesn't interpret the 'harm' signals from the body as pain because pain would distract from the more important 'get out of danger' actions. Sensible, but again, doesn't fit the harm = pain model.

So, next time you're in pain - particularly if it's an old, recurring pain - bear in mind that the pain you're feeling may have little or nothing to do with how much damage there is to your muscles, ligaments and bones and everything to do with what's happening in your brain. Context is hugely important, hence why sick children, dead cars and stressful deadlines makes pain so much more likely to happen and so much worse. Your brain is taking all of those 'danger' signals, adding them together and coming up with 'ouch!'

Over the next few months on the blog, I'm planning a number of entries about how pain works - and what to do about it. In the meantime, you're in pain and want some help with strategies to get your body - and brain - working again, then do contact me.

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