First up on the topics for this semester: Pain. And what did we learn? It’s all in your head.
Seems an appropriate topic to start with, given my last post. I’m trying to take it as a lesson. (For the record: school is not that painful. Being a full time student is actually more rewarding and totally awesome than I ever thought it would be.)
But what about the pain that comes with an actual injury? And what about chronic pain, when it just never seems to go away and might even get worse over time? Our textbook definition of pain (from Michelle Cameron’s Physical Agents in Rehabilitation) states that it’s a combination of physical and psychological input based on actual or potential damage to tissue. Potential damage would be like walking barefoot on gravel – not actually going to injure you, but you probably shouldn’t run. The physical input comes from the actual tissue sensation itself, and the psychological input is based on your previous experience, general knowledge about what should hurt and what shouldn’t, and even sometimes what you see can affect the way you perceive pain. This TED talk explains it so well, and in an Aussie accent to boot:
Just like the snake bite in the video, your nervous system can strengthen pain responses and make you more sensitive to certain things in certain areas. That can be a good thing, because pain is a way that your body protects you. Unfortunately, those stronger pain responses can also lead to a not-so-helpful version of chronic pain.
We can block pain at the spinal cord level or reduce the peripherial nerve activation at the site with medications. We can use physical agents (like cold, heat, electrical stimulation, and others) to reduce inflammation or keep the painful stimuli from traveling up to the spinal cord. Exercise has been shown to increase the pain threshold and decrease sensitivity to pain, which can be tremendously helpful for sufferers of chronic pain. It has also been proven that conscious distraction can significantly help reduce pain levels, though that is a tough one to implement. Re-training the brain to understand that “hurt does not necessarily equal harm” can be a major bonus, too.
Pain is so intensely personal, and it’s also very, very real. Yes, it’s “all in our heads”, but our nervous systems are powerful machines. Bringing it down to levels we can live with requires a good variety of combined approaches, but it will be so important for me to explain to my future patients how it all works. If we can take the mystery out of it… well, it might not hurt so bad.