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December 12, 2018
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Pain in the brain?

Are we looking in the right place for the answers to chronic pain?

Living with pain can be hard, especially if it’s long-term—or chronic—pain. Long term pain can make you sleep badly, feel tired and bad-tempered, and have a hard time being active or working. It is likely to put a strain on your relationships with family and friends, making it hard to be the kind of person that you want to be. For so many it can it can lead to feelings of depression or anxiety, these feelings may make your pain worse, because they can make it harder to manage pain.

Chronic pain is a silent epidemic that affects more than two fifths of the UK population. With an estimated 28 million adults living with pain that has lasted for three months or longer.

Chronic pain is extremely debilitating and can affect all areas of your life. Everyday tasks that the rest of us take for granted, like getting out of bed, climbing the stairs, making a cup of tea become so painful that getting through the day minimising activities that cause pain becomes the sole focus. When these simple tasks become so difficult if not impossible others start to question whether the pain is even real!

That statement can seem outrageous to those that live with pain day in day out, because pain is not visible it can’t be seen, it’s not tangible others often fail to understand it. This can lead to a reluctance to talk about pain even though it has a devastating impact on the quality of life.

The experience of pain is subjective, it is unique to you, only you know how you experience pain. There is still much debate between professionals as to how pain is processed in the brain, we understand that all pain signals are regulated by the brain regardless if these are new pain messages from a recent injury or old messages from unhealed wounds. Regardless, it is the nerve fibres that are sending these messages to your brain telling you to feel some sort of pain.

It is the job of the amygdala and limbic area of the brain to alert us of danger. Any injury will typically activate the danger signal, which therefore triggers the cortex region of the brain to register pain.  Therefore pain is the result of the brain creating this signal of danger.  The actual experience of pain is in the head, not in the body.  And, surprisingly, (or maybe not) this is true of all forms of pain.

Can you have an injury without having pain?  I am sure many of us have witnessed at some point a child falling over and they only begin to cry when they see their parent, or you may have experienced it yourself when you have cut yourself without realising and its only when you noticed it that the pain started.

Equally, pain can occur without an actual injury. In a well-documented case, a construction worker had jumped off of a scaffolding onto a large nail, which went through his boot.  He experienced an extreme amount of pain and was administered with IV pain medication and sedation at the hospital.  When the boot was removed however, the nail had not broken the skin and was in fact lodged between his toes. A study by Derbyshire and colleagues showed that pain induced whilst under hypnosis was identical to physically induced pain in relation to which areas of the brain were activated.  This is strong evidence that the brain can in fact produce pain and that this pain is the same as physically induced pain.

It turns out that the key to understanding pain is whether and how the subconscious parts of the brain activate the alarm or danger signal.  If we look at pain messages as similar to a fire alarm, the fire alarm is designed to warn us in the event of a fire, when a fire is detected the alarm is triggered and we put out the fire. With chronic pain conditions such as fibromyalgia, chronic fatigue, arthritis, it’s like the alarm has been triggered but the alarm has not been reset and continues to keep ringing. The problem with this is not only does the person continue to experience pain long after an injury was supposed to heal, but we become accustomed to the sound of the alarm and would be unaware should another ‘fire’ break out.

While everyone knows that physical pain can cause emotional pain, not many realise that emotional pain can also cause physical pain.  This becomes particularly important to recognise in the setting of chronic, medically unexplained pain syndromes.

Therefore when you start to think differently about your chronic pain, you’ll be able to change your experience of it. Even though the pain is very real, understanding that it’s simply something your mind is creating. You don’t have to live with chronic pain, the truth is that pain is something you can control if you put your mind to it.  When you constantly focus on the pain, you’re only making it worse, but by redirecting the way in which your mind processes the pain, you can lessen it or turn it off. A study by Dr. Mackey and other researchers at Stanford University showed that we can teach the brain how to deal with pain after they used real-time FMRI brain imaging to support this theory. They were able to show patients with chronic pain their brains when they were distracted with either pleasant thoughts or soothing music, which showed parts of their brain associated with pain subsiding in activity.

So if you suffer from chronic pain and would like to experience a better quality of life, it’s time to change your mind.

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