Pain as an Experience

This blog is meant to explain my current thoughts about chronic pain. I am not talking about short lived pain that seems to heal itself in a week or two, though these injuries can influence future events. This is talking about that pain that we have a harder time understanding. 

Pain can be very well explained through the lens of neuroscience. Basically, we have tons of different nerve endings (receptors) that collect sensory information. We can sense pressure, touch, tickle, itch, stretch, vibration, temperature, and pain. Each of these sensations has a specialized nerve ending receptor for each specific sensation. Every time a receptor receives a proper stimulus, it triggers that specific nerve receptor to send a signal to the brain, in detail, what it is sensing. Once at the brain, we process that information and give it meaning. Our motor output, or how we decide to move, is dependent on the meaning we assign to this information. Something interesting to note is that all of us have pain receptors firing off pain signals all the time...constantly! This is true even for people that are not currently experiencing pain. This is possible because we have built in mechanisms (pain dams) that can block, or lessen pain signals and how we perceive them. So if we just have a few tiny pain signals coming in, we don't perceive pain. But if we reach and go beyond the threshold of our pain dams, we now experience pain even though the signal could have been there for a long time. 

I think it's safe to say that we all have times in our lives when we lose awareness of our minds and bodies...until we have pain. So could this also be the reason we have make us aware. "Hey! Something isn't right. We should do something about this before something bad happens." Another note of interest is that pain can occur without any tissue damage or injury. Pain does not equal damage. Many "abnormalities" that are found on highly sensitive MRI and CT scans have a very limited correlation with pain.  Because of this, medical imaging can get us in trouble, scaring and shifting our focus to what has now become a medical diagnosis. As best I can, I steer people away from this line of thinking that things are forever broken. When I talk with people about pain, it is not diagnosis that we as human beings have or possess, but rather something that we experience.

I don't have knee pain, I'm experiencing pain in my knee. 

I don't have a 'bad' back, I'm experiencing back pain. 

The great thing about having experiences is that we get to learn from them. Something that I have observed over the years is that people can and will respond differently to the same stimulus.  So what is it that makes each of us different? The reasons could be linked to the health of muscles and joints, but is also related to what we've experienced in the past or are currently experiencing. Previous experiences with pain? Comorbid health issues? Stress? Injuries? Physical trauma? Powerful emotions of fear, anger, or loss? How have all of these shaped who we are and how we respond to situations...including, but not limited to physical pain. 

It seems as though I have taken something relatively simple and made it complex to the point where you might be saying, "so what the heck am I supposed to do?!" First, we all have to accept that we are responsible for where we are in life, how we choose to perceive, and the things that happen in the world around us. Pain and suffering can have multiple layers and drivers, but once we identify something we can try to get to the bottom of it.

I'm going to borrow something from a friend talking about fear and a tight muscle...

"Maybe fear and anxiety is triggering a tight psoas also. And it is not YOUR fear and anxiety. It is fear and anxiety that I am experiencing for one reason or another. It is my responsibility to find out why I am choosing to have this experience and is the experience healthy. Fear of getting too close to a cliff and falling? Healthy. Fear of getting hit on the side of the road as I walk my dog. Unhealthy and will shut down the core which in turn will keep the psoas from being functional and just may tighten it." -Kim McIntire

If we become fearful, our brain will immobilize that body part to protect our organism so we can survive. This occurs despite the fact that it can cause more and longer lasting pain. And the longer we are in pain, the better we get at feeling and attaching to the pain we are experiencing with less and less focus on other things about our body, movement, and life. 

What I do in my practice of physical therapy is to introduce things that will hopefully alter someones experience of pain. When someone feels relief after a manual technique or a specific movement, it's not because I have magic hands that cured your hip that's 'out', healed a strained muscle, or lengthened tissue. This happens because whatever I did had some effect on their body and nervous system, as to how that person experiences their body.

If you are having a problem with pain 1) take responsibility for it, 2) be open to things outside of tissue damage as contributing to what you experience, 3) let go of what isn't healthy. Choose what is healthy and 4) ask for help if you need it (and you may end up asking/trying several people before you find someone that can open a space for you to heal in.)  If nothing else, just calmly breathe and focus on something outside of pain. It's going to be a process, but trust in it.