Knowledge of Pain Can Change Your Pain

I recently finished reading a book called Therapeutic Neuroscience Education. And although it’s dense and technical (it’s meant for the practitioner, not for the general public), the information in it is valuable for the general public, especially those in pain. Why? Because it can completely change the way you look at pain, and even how much pain you feel (regardless of where it is – in the back, knees, shoulders, etc.).

So in this article, I’ll summarize the most important points from that book, in a non-scienc-y, user-friendly kind of way.

• The new model of pain is the biopsychosocial model. That is, what you think, feel, and believe about your condition will impact your examination, treatment, and prognosis. The old model: the biomedical model. It’s only partially correct.

• According to one study, doctors who experience the same injury as non-doctors experience less pain and disability. This is likely due to allaying the fear of pain, and the expectation of recovery. To the non-medical professional, they hear medical terms that sound foreign to them, so the unconscious thought process is “oh, there’s a name for what I have. That must mean it’s really bad.” Whereas a doctor might think “oh yeah, I know what that is. I know the treatment, the prognosis, etc.” Isn’t it interesting that just knowledge can change a person’s sensation of pain?

• Factors that contribute to lower back pain, besides mechanical damage (which doesn’t always result in pain anyway, since we know from studies like this one, that a HUGE part of the population has mechanical damage in the lower back – but no pain):

  • Behaviors:

    • Extended rest

    • Withdrawal from social life, daily life, and people

    • Compliance issues with therapy

    • Report of extremely high intensity of pain

    • Excessive reliance on the use of aids or appliances

    • Problems sleeping

    • High intake of alcohol and medication

    • Smoking

  • Work:

    • History of manual work

    • Job dissatisfaction

    • Problems with peers and supervisors

    • Low educational background

    • Low socioeconomic status

    • High physical demand

    • Working shifts

    • Negative experience of workplace management of pain or injury

  • Compensation issues:

    • Lack of financial incentive to return to work

    • History of claims due to other injuries or pain problems

  • Emotions:

    • Fear of increased pain with activity work or therapy

    • Depression

    • Irritability

    • Anxiety

  • Diagnosis and treatment

    • Conflicting diagnoses

    • Diagnostic language

    • Number of healthcare providers visited

    • Expectation of a “techno-fix”

    • Lack of satisfaction with treatment

  • Family:

    • Overprotective spouse

    • Punitive responses from spouse

• In one study, 57 people with lower back pain were divided into 2 groups:

  • Group 1: Physiotherapy + education

  • Group 2: Just physio

  • Results:

    • Group 1 reduced pain and disability to a greater extent than group 2.

    • The treatment effect was maintained 1 year later

  • The education group 1 received was about pain neurophysiology – not about lower back pain

• The body does not have pain receptors. Therapists (physios, chiropractors, etc.) are often taught that the pain receptors are called “nociceptors.” But that’s not correct. Nociceptors are danger receptors – not pain receptors. It’s the brain that converts (or doesn’t convert) danger signals into pain. For example, the ear doesn’t have sound receptors. It has receptors for vibrations of different frequencies. The brain converts those vibrations into a coherent sound. The eye doesn’t have receptors for vision. It has receptors for different light waves. The brain makes the conversion to vision. Same concept for nociceptors.

• “Pain is a decision by the brain, based on the perception of threat.”

• Part of the reason chronic pain is chronic is the decrease in “brain chemicals” (like opioids, endorphins, serotonin, and enkephalins). These brain chemicals decrease pain.

• There’s no single part of the brain that’s considered to be the “pain centre.” Rather, there are different parts of the brain involved in pain processing. So 2 people with the exact same mechanical injury may have a different sensation, because each person’s pain perception/experience is different (not to be confused with the pain threshold/pain tolerance. They aren’t the same as pain perception/experience). That’s called the “pain neuromatrix”.

• According to one study, injuries that happen in stressful environments are 7-8 times more likely to produce chronic pain, even when the “amount” of mechanical damage is the same.

  • Children who play contact sports early in life are at a lower likelihood of developing chronic pain, according to this study.

  • According to this study, demolition derby drivers get into 1500+ motor vehicle accidents over their life (it’s their job to get into accidents, for God’s sakes!), but less than 10% of them get chronic neck pain. In the general population, it’s 33%.

• Your nerves have electricity running through them all the time. The amount of electricity goes up or down, depending on different factors (like temperature, pressure, etc.). For the most part, it doesn’t register with the nervous system. Once the amount of electricity reaches a certain threshold, that message is relayed to the brain for interpretation (that interpretation may be to cause pain), and possibly action. For example, if you step on a nail, the amount of electricity will be high enough to register in the nervous system, an internal “alarm bell” goes off, and you feel pain.

Original source: here.

• Pain is not due to damage, but due to nerve sensitivity. Some people’s resting level is well below the threshold of “alarm”, and other people’s resting level is closer to it. The latter group is more susceptible to chronic pain.

• Central sensitization: when a normal pain signal gets amplified. EX: pushing the “P” button on a keyboard, but getting “PPPPP”. The computer overanalyzed the input. Same thing happens in the brain, and a signal that ordinarily wouldn’t have registered, now gets perceived as “pain.”

  • Sensitive nerves are like an alarm. If an alarm goes off in your house, it will likely wake the neighbours up as well. Same happens in the body. Neighboring areas start to hurt as well.

• The more a person “practices” being in pain, the less of a stimulus it takes for that person to feel pain, and the more pain becomes chronic. If you know of a person who really thinks about their pain, and just loves complaining about it, as insignificant as it may be, that’s “practicing” being in pain.