Let’s talk about pain.
Trust me, pain is more interesting than you might think.
For example, have you heard the story of Aaron Ralston, who severed his own arm off to save his own life? Or the knee surgery study by Moseley that showed sham knee surgery to be as effective as real knee surgery? Have you heard of referred pain? Or looked into the wonders of the placebo effect?
Understanding pain better provides the opportunity to understand ourselves better, and to not suffer pain unnecessarily.
Let’s start by looking at some of the myths of pain:
Pain is a purely physical thing– WRONG!
Pain is a Biopsychosocial phenomenon.
In other words, pain is influenced by three key areas of perception:
- Physical factors (tight muscles, worn out joints, etc.)
- Psychological factors (the beliefs associated with the pain)
- Social factors (what that pain means to us in the context of our lives)
Pain is either “real” or “in the head”– WRONG!
Firstly, pain is a perception so it is always “real”. If you are feeling pain it is real, just as if you are feeling “scared” or feel “hot”. No one else can tell you that you don’t feel “scared” or “hot” or “pain”. It is your perception. It’s your own reality.
Secondly, pain is a product of that big blob “in the head” called the brain (“no brain, no pain”). If we had no brain we would not be able to perceive anything let alone pain.
So pain is always real, and always “in the head”.
If I have pain there must be something abnormal on an x-ray or scan that shows what’s causing it– WRONG!
Pain is a perception of the brain like sight or smell. You can’t see a perception.Imagine if we tried to use x-rays to see the smell of a flower!
X-rays and scans (like spinal MRI scans or CT scans) show us all sorts of things about our body that we never knew like protruding discs, spondylosis, scoliosis, etc. etc.
The key is – don’t draw a line of correlation between these findings and pain. They are very rarely linked!
Where I feel pain must be where the damage is – WRONG!
Where the pain is felt is not always where the “danger” actually is. For example with “referred pain”, a tight muscle in the lower back may lead to a feeling of pain in the knee.
An extreme example of this is “phantom limb pain” where pain is perceived in a part of the body that no longer exists. Another more common example is when you hit your “funny bone” (ulnar nerve) and experience a feeling of pain and tingling in your fingers, even though your fingers were not hit.
The brain has a mini map of the body; this is known as “homunculus”. This mini map does not perfectly correspond with the body. When the brain perceives pain coming from a certain area of the body it doesn’t always get this location right.
The stronger the pain, the worse the damage – WRONG!
Pain is not proportional to physical damage as much as it is proportional to our sensitivity levels associated with that pain. There are many influences on sensitivity which can be compared to a volume switch: the higher the sensitivity, the stronger the pain. Our belief systems attached to the pain are one of many factors that encourage us to subconsciously turn up the volume switch of pain, or turn it down.
In a nutshell, pain levels we perceive are directly proportional to the level of threat we attach to that pain. Familiar pains (stubbing toe for example) where we are confident of a full recovery tend to die down quickly due to the strong internal belief that we will recover. Unfamiliar pains or pains we are anxious about can hang around longer as our alarm system is firing more, turning up the pain switch to try and protect us. In this way, our belief systems effectively hold the volume switch of pain.
Look at the example of Aaron Ralston who severed his own arm with a dull pocket knife to rescue himself from being trapped in a gorge. His strong belief that this was a lifesaving act would likely have significantly reduced the perceived level of pain of this act, which would normally be too painful and traumatic to do. There are thousands of similar stories from the war fields.
More insight into pain comes from the fascinating studies into the placebo effect. Here are just a few:
Knee surgery study
(Moseley JB et al, 2002)
180 subjects suffering from osteoarthritis of the knee were randomly allocated into two surgery groups and one “sham” surgery group. The surgery groups received “arthroscopic debridement” or “arthroscopic lavage”, meanwhile the “sham” (or placebo) surgery group only received two small incisions on their knee. These incisions mimicked the scars for the surgery groups. The subjects receiving this sham surgery believed they too had received surgery.
Over the next two years, the subjects were followed up and the three groups were all found to have made equivalent recoveries.
The shape of the capsules and tablets experiment
(Buckalew L and Coffield K, 1982)
This experiment found that the shape of medication taken plays a part in the effectiveness of a drug. For the same dosage of the drug, capsules were found to work better than tablets. Of these capsules, clear ones with visible beads worked best, and coloured beads were more effective than white beads.
This experiment suggests that when you take medication, the colour and shape of it alters your expectations about it. Different expectations lead to different results.
Colour of capsule experiment
(De Craen AJM et al, 1996)
This study looked at the perceived action of coloured drugs, and showed that red, yellow, and orange are associated with a stimulant effect, while blue and green are related to a tranquillising effect. They concluded that different colours affect the perceived action of a drug and seem to influence the effectiveness of a drug.
Some find these discussions on pain challenging. Let me be clear, I’m not suggesting people in pain are making it up. As a former chronic pain sufferer I should know. Read my book referenced below for more detail on all this and advice on how to overcome pain that has become persistent for you.
Pain is always real, and always perceived by the brain. As we know, our brains can be an intriguing and complex place. If pain is hanging around and becoming persistent, coming to grips with the belief systems and anxieties you attach to the pain can be the key to unlocking a path to recovery.
References on pain that may be of interest:
Overcoming pain. David Hall. Lulu 2008. Available via www.lulu.com
Explain Pain. Butler and Moseley. Noigroup 2003. Available via www.noigroup.com
TED talk by Lorimer Moseley on pain tedxtalks.ted.com
As always, have a healthy & productive day,