Healing chronic pain: understanding pain to take back your power

We are mistreating pain because we do not understand it. In our culture, the common model of treatment for pain is the bio-medical model: have pain? Here is a product or procedure that will fix it.

 

 

 

Unfortunately this model means chronic pain sufferers are made to feel like something is wrong with them. They are made to believe that their pain “is all in their brain“. We thereby increase the psychological suffering of chronic pain sufferers, making them feel unseen, unvalidated, and gaslighted.

 

 

And it is time we stop doing that! Because pain is never just bio-medical. Science tells us pain is bio-psychosocial, meaning it has a biological component, a psychological component AND a social/societal component. 

 

THE BIO-PSYCHOSOCIAL MODEL OF PAIN

There are 3 important components of pain. Treating one without the other, is just addressing only 1 part of the problem.

This is why in conditions like endometriosis, surgery alone will often lead to more pain.

I take this example in particular not only because it is a disease I know personally, but also because it is a condition that truly is visible in the body. There is tissue damage, visible by ultrasounds or MRI.

Yet, different women experience it very differently. For women that have suffered from pains for years before being diagnosed and finding validation, surgery alone is often not enough to get rid of all the pain.

PAIN IS BIOMEDICAL

That is the model that most of us experience when we seek help for chronic pain. The components of this model are:

• genetics,
• sleep,
• diet,
• exercise,
• tissue damage,
• system dysfunction

This is what our view of pain is reduced to. We are prescribed medications, or surgical procedures in order to fix this part, completely forgetting the other components of pain. We thus only treat ⅓ of the problem!

So what are the two other thirds?

Neurosciences tells us that the things we think influence the way we feel pain.

ex.: Negative thoughts and beliefs increase anxiety; anxiety tells our brain to increase Blood Pressure, muscle tension and body temperature to “get ready” to fight => thus, your pain is amplified.

 

 

Pain is adaptative. Memories of past pain experiences processed through our hippocampus help us learn.

ex.: When you burn your hand on the stove, you take your hand off and learn not to do it again. Your pain warning system is what keeps you alive.

 

 

The way we behave changes the way we feel, and changes in coping behaviours can change the pain.

ex.: Avoidance behaviours, such as staying inside, not moving, will perpetuate the pain cycle in the long term. Gentle movement however can reduce pain in the long run.

 

 

Trauma and cognitive processing affect our likelihood of experiencing chronic pain.

ex.: Early childhood trauma and pain have a 50% co-occurence. Developmental trauma makes the brain on high alert and more sensitive, thus more likely to have chronic pain. A High ACE (Adverse Childhood Experiences) score is associated to chronic pain and illness later in life.

A good example of this is the fantom limb, where people who had a limb amputated can still feel the pain “in” it. This disturbing phenomenon shows that pain lives in the brain, and not anywhere else in the body! In fact, to his day, the best known treatment for fantom limb is to use a mirror between the amputee’s legs so that they can “see” two healthy legs, and “show” their brain that the leg is fine, thereby reprocessing the pain.

All pain is processed in the brain. Pain is constructed by the brain and the body.

There is not one single pain center in the brain; it is a diffuse neurological process, meaning many parts of the brain process this experience we call “pain” – Rachel Zoffness, PhD

There is a real biological connection between pain and emotion (Melzack & Wall, 1965):

Multiple parts of the brain are at play to process pain: the cerebral cortex, responsible for thoughts, the prefrontal cortex, responsible for attention and executive processing, and the limbic system, which is the emotion center. Together they produce this experience we call “pain”.

So pain is always informed by sensations and emotions; it is always emotional and physical at the same time, thus both the physical and the emotional must be dealt with in order to fully treat chronic pain.

This means we must target the brain in order to relieve the body!

PAIN IS SOCIAL/SOCIOLOGICAL

Did you know that the worst punishment you can give a human being is solitary confinement?

Why? Because humans are social animals.

 

 

Our brain produces oxytocin (bounding hormone), serotonin (mood), dopamine (pleasure and reward), and endorphins (our endogenic natural pain killers) when we are in the contact of other people. In the absence of other people those chemicals crash, so physically and emotionally we feel worse.

 

 

Being isolated and lonely produces cortisol (stress hormone) that is detrimental to our immune system.

ex.: Studies show that isolated elderly are more prone to illness and death.

The way we respond to pain is modelled by parents & society:

In our brain is some kind of a pain dial. When stress and anxiety are UP, our brain sends a message to the pain dial to increase pain volume. Thus the pain feels worse and lasts longer.

In that way negative moods and emotions matter and affect our perception of pain by making it worse. Think of how kicking your toe on a stone would feel different at a birthday party with friends, in opposition to after a long and stressful and frustrating day at work: would your experience of pain be the same?

When stress and anxiety are low, the brain sends a message to the pain dial to lower pain volume. The same is true with mood and emotions: pleasurable activities, happy mood, a distracted prefrontal cortex will also lower pain volume. Think of how a child receiving a vaccine is distracted by a movie or the promise of a candy.

Therefor there is a “recipe” for higher pain, and a recipe for lower pain days. What this really means is that YOU have the power to lower the pain volume. You just need to find the button!

Pain takes away power. But you can regain your power, your body and your life.

By learning how to use this pain dial, and understanding the science behind pain, you can regain a sense of agency over your life and body.

CONCLUSIONS

They are many things that you can do to change your pain. Your pain dial is your power. 

YOU have the power to turn down the pain volume and make pain feel less bad.

And we can start today.

Because if it’s ok to go to a soccer coach to get better at soccer, surely it is ok to go to a pain coach to get better at LIVING WITH PAIN!

Living with pain is really hard and you deserve to understand it.

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