Pain is not what you think it is. This article is a culmination of an important email series that tackles some of the most mind-blowing facts about pain! A subject this important and this complex takes time to dissect and present, so even though you’ll need a bit of time here, it’s worth it. Not only will this tutorial help you to understand pain better, as long as you utilize the information within, it should also lead to better self-management of pain.
To start with, I want to tell you that pain is all in your head.
Yes. You read that correctly. Before you get upset at me and tell me that pain is very real, I completely agree with you. Pain is both an entirely cerebral event, and also very real.
It’s a real perception of sensory information.
That’s a super important piece to all the following pieces. Before I dive into that more, I want to clarify something: I am not trying to diminish your experience of pain. I am trying to tell you that your pain is indeed all in your head. If you separate those two things now, you won’t have to take any offense as you read through this 😉
Let’s dig a little deeper on the “perception of sensory information”.
I would like to start by giving you a prime example, that we have probably all heard about: if you don’t like getting needles, or if someone you know doesn’t like getting needles – closing your eyes [their eyes] significantly reduces the pain you experience. Yet, the needle itself doesn’t change…it’s the fact that you’re not watching the sharp tip of the needle pierce the surface of your skin and sink into flesh! (Graphic huh? Who says I can’t be dramatic 😉 )
Think about that for a moment longer: in this example, the experience of pain is largely visual. Oftentimes you’ll hear people who close their eyes and grimace say “is it done yet?”, because the actual physical sensation is often so minute that they don’t even feel it when they don’t see it.
Exhibit A of pain being visual:
There’s a pretty wild example of a man in the UK who needed to be sedated because he was hysterical with pain after coming into hospital with a 15cm nail right through his boot! The doctors and nurses cut the boot off to examine the damage after he was knocked out, only to discover that the nail had gone neatly between his toes… (reference)
And again, we see that the very REAL pain this fellow was experiencing was largely visual and not representative of anything actually being wrong physically.
We also integrate sound information into the pain puzzle – when we hear a “crack” or “pop” things tend to be experienced more intensely!
To take it the next level further-
Perception doesn’t just refer to the integration of sensory information coming from this exact instant in time – it also includes the integration of all stored sensory information, from all previous events across our lifespan.
That’s right. The degree of sensation you feel in the moment is directly related to all past experiences of pain in your life.
It’s your brain that integrates all this information, both past and present and gives you a measure of how bad your brain thinks the problem is. And that may have absolutely nothing to do with the degree of physical injury. Anthropologically speaking, this makes sense – we learn to avoid the things that our brain perceives as being dangerous or injurious. However, it gets it wrong a remarkable number of times. Better to over-estimate than to actually get an injury, right?
So whilst pain can certainly signal an injury, it doesn’t always. And whilst we feel the pain in particular areas of our body, that pain is not actually coming from the tissue directly – it’s coming from our head. And so even though we can trust this perception of information sometimes, we can’t always. We need to evaluate our past experiences as well.
Pain is a learned response:
Yes, indeed that picture is of a snake biting a man’s face. Hand up if you cringed at the photo in a little sympathetic pain….*raises hand*
Before we get into the idea of learning pain, I have a question for you first: how much do you think a snake bite hurts?
You probably cringed again, right? Well, if this was the first time the guy above had been bitten by a snake you might find that it didn’t hurt all that much. It sounds a little strange, I know, but that was the experience of an Australian Neuroscientist, Lorimer Moseley. He got bitten by a snake (actually, an Eastern Brown snake – the second most deadly in the world), and didn’t think much of it.
Not only did he not think much of it, he didn’t even stop walking through on his hike through the bush to check what had touched his ankle. His brain, without seeing the snake, had attributed the sensation to brushing up against a branch, which obviously we’ve all done many times before and is not really dangerous. His brain thought it was a meaningless little scratch, and therefore it didn’t make the event painful. So he continued his hike, only to wake up in hospital days later.
What’s made even more remarkable about this is that the snake venom is actually designed to activate “pain signalling” nerves.
Which means the brain would have been receiving a LOT of stimulation. But ignoring it, because every other time there’s been similar information, it’s just been a scratch.
Of course, he was back to hiking a year later and brushed up against “something” on the same ankle and collapsed in absolute agony. Because he’d been here before, and nearly died – so his brain said “PAIN, DANGER” and he dropped. Yet, although theatrical, the danger was not real – or at least, didn’t have a real physiological reason to be there. Because this time, it was indeed only a tiny scratch from a branch.
If you want to see his TEDx talk about it, head over here.
Not only is it learned in the context of acute pain, but chronic pain is also something we tend to learn. I’m not just going to tell you a story about chronic pain though. I’m going to tell you a story about chronic PHANTOM pain – the ultimate example of learning pain.
Gotta level it up…
The example I’m referencing here was studied in 1996 (you can read the abstract here).
One of the patients in the study, who is referenced as “DS” had experienced chronic pain for 10 years, in a limb that was no longer there. The experiment showed that not only could a mirror be used to illicit the sensations of the phantom limb moving, with repeated “exercising” the perceived movement of the phantom limb lead to the elimination of chronic pain.
Yes. That’s right. Two big things in particular I’d like to highlight here:
• Perception of movement and pain was highly visual, which we’ve already touched on.
Resolution of the chronic phantom limb was achieved through the perception of movement in an area of the body that was not moving (albeit because it didn’t exist anymore).
That’s also on top of the fact that after these experiments, the phantom limb was also “resolved” and no longer felt at all. This is a prime example of how our brain learns pain (and can unlearn it!).
• The second note is an important element of WHY we feel a lot of our musculoskeletal pain. Muscles are made for movement, and when the brain isn’t perceiving a lot of movement, it signals pain so that we MOVE! Hence, the chronic pain was resolved once the “limb” got a little movement practice…
Not only do we feel pain due to the lack of perceived movement, we also experience it (as we touched on above) due to the perception of danger! So the degree of pain we feel is directly related to the perception of how bad the situation is. And to be super clear, this means that the degree of pain we feel often has nothing to do with the ACTUAL severity of the situation.
The experience of pain doesn’t necessarily mean that something is wrong…
This next section expands upon the fact that the degree of pain we feel rarely has anything to do with the real severity of the situation.
The examples we looked at previously dealt with some pretty significant circumstances – I mean, being bitten by the second deadliest snake in the world should send a whole lot of “danger” signals to the brain. And yet the brain ignored this input, because no one saw the snake.
And on the other side of the coin we saw that there can be pain (and chronic pain to boot) in a limb that no longer exists.
So there are already two examples of how the intensity of pain felt has nothing to do with degree of severity of the situation. No pain was felt when it was a serious life-threatening situation, and pain was felt when it was not possible.
Now I’d like to teach you about something that is significantly more common and therefore relevant to the general populace.
I’m about to explain something to you that could account for a huge portion of your general aches and pains – both the things that nag at you, and those that put you out of action – and perhaps cause you to occasionally come for a massage, or some other kind of manual therapy. If you’ve come to see me, I may have even mentioned these things to you.
What I’m talking about are “Trigger Points”.
These are microscopic events in muscle tissue. And technically there’s not really all that much wrong with the muscle. As in, you’re not in any danger if it persists.
And yet, Trigger Points are responsible for some of the most significant pain syndromes we experience on a daily basis. When we “sleep funny” and our neck hurts to move – Trigger points. When we think we have sciatica – it’s generally actually Trigger Points in the piriformis muscle. When we have “tennis elbow” symptoms, again Trigger Points. Back pain that’s coming from no discernible injury? Yep, also Trigger points.
Not only are they generally responsible for some of the most pervasive conditions we experience, but also they can “create” HUGE amounts of pain. For example, Migraines – there’s a decent number of migraines out there caused by (or complicated by) Trigger Points.
There’s also a case of someone experiencing what they believed to be a heart attack! Only to be told at the hospital that they aren’t (after spending 48hours in hospital, baffling the doctors and staff). This man’s pain disappeared only after a massage with a manual therapist who has knowledge and experience with Trigger Points.
You can find that particular case study here – the free version mentions it, but you’ll have to purchase the e-book to read the full thing.
Now, you might think that knowing this now, your pain will disappear?! Well, see here’s the thing. Knowing about Trigger Points is super helpful, but it doesn’t necessarily make this puzzle of pain any simpler – in fact, it could even complicate things even more.
Trigger Points can be VERY difficult to find, because they’re almost always NOT located where you feel pain.
*And the plot thickens*
And they’re super tiny. So tiny, that they haven’t yet been captured on any magnification of examination. And remember, not only are they small, there’s almost nothing wrong physiologically, and yet our brain absolutely freaks out about them.
We’ll tackle the idea that pain in one area is caused by problems in a different area (aka referred pain) below and we’ll start working on strategies to find these nasty Trigger Points.
It’s all about location
Part of the reason that so many people experience chronic pain is because the majority don’t know enough about pain. This includes the fact that pain is rarely found at the location of the “issue”.
Too often we look for the problem where it hurts. Whilst that might seem logical to some degree, unfortunately pain doesn’t work that way. The referral of pain is a very real and a very common phenomenon. Take for instance the common knowledge that heart attacks often radiate intense pain down the left arm, yet the issue is clearly not in the arm.
So what causes pain referral? Well, the mechanisms of such a thing aren’t all that well understood yet – so we don’t really know how it happens, but we know that it does happen.
The main hypotheses that are gaining weight involve a degree of “convergence” of signals coming from one area and governed by a group of larger nerve bundles that ultimately dilutes the signals marginally, and a degree of “central sensitization” where the central nervous system gets more sensitive to weaker stimuli — these are significant over simplifications…but they are handy to know.
Above, we touched on the idea of Trigger Points and their pain referral patterns. Here, I’m giving you an example of this that many of you might be able to relate to – when you wake up with a “cricked” neck and can’t move it properly…
There was simply too much information to type out in an email, so I had to video it this time. Heads-up it’s a 15-minute video, but it’s worth setting aside that time (especially if you’ve ever had neck pain…). In the video I cover:
- Trigger points and their challenges
- Self-massage tools to address this scenario of a “cricked neck”
- Muscles to approach first, and the method of approach
- Signs and signals to keep an eye out for to measure your “success” in the use of these tools and techniques.
- A lot of the content in the video is also transferrable to other pain scenarios (minus the specifically named muscles).
Click below to watch the video:
I hope you get a whole lot of great things out of this – not just this video, but the whole post above. For now, I’m going to leave it at this – it’s a lot of information to digest. If you have specific things you’d like me to address, please pop them below!
A quick review of what we’ve covered above:
Question your pain. Recognize the governing role that the brain plays (the governor) and how it learns pain. Understand that chasing pain is often a huge contributor to lasting pain. And know that the brain plays tricks on you (out of a desire to protect you).
Give me a shout with any questions you have!
Last updated: September 2, 2018.