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Pain is a fascinating experience and our understanding of this phenomenon is rapidly evolving. In absence of pain - we wouldn’t be here. We wouldn’t realise that fire is scalding, that a broken leg needs to heal or that our body needs rest.
Not so long ago, we believed that pain was a result of tissue damage and inflammation. We used the term ‘nociception’ which is derived from the Latin word ‘noceo’ meaning to injure or harm. Recently, science has started to realise that nociception doesn’t even scratch the surface of how we experience pain. Pain is just that - an experience that is influenced through not just tissue damage but our entire perception of biological, psychological and social influences. If we’re going to understand this a bit better, we can look at how it gets processed in the brain.
Pain is predominantly processed through the most primal part of the brain called the brainstem. The brainstem normally processes our automatic functions including sleep, blood pressure, breathing, heartbeat and digestion. Pain processing also has strong connections with the amygdala which is the part of your brain that triggers a fear response (survival centre) and also with the anterior cingulate cortex (ACC) which is involved in emotion and attention allocation. These parts of the brain can act a bit like an ‘amplifier’ for pain with the potential to increase or decrease perception depending on whether it’s perceived as a threat or not. What this means is that when there’s nociception from the tissues (ie. breaking your leg), unless there’s something of stronger importance for the brain, there will be a pain response which is near impossible to ignore and normally triggers a fearful reaction - to get off the leg. I’ll remind you that this is why you’re here. This is clearly a fantastic response to pain and protection, organisms have been perfecting this since the inception of time and we need to be grateful for having this experience. In saying this, it’s not perfect. This works great with a broken leg but in cases of more unknown injury, it can work against you. I’ll tell you how. Let’s say, you’ve done something to your lower back. Your doctor orders a CT scan and sure enough there’s a bulging disc in your lumbar spine. Your friend tells you the same thing happened to her cousin and he ended up in a wheelchair needing surgery. How do you think the brain will play this one? I’ll try explain.
Whenever your brain receives nociception (pain) signals, the amygdala and ACC will trigger a survival response,
This survival response amplifies the signals of pain and will flood the body with cortisol (stress hormone) whilst also telling your body not to move.
You stop moving your lumbar spine from fear and develop what we call mal-adaptive movement patterns.
Over time, you get fearful to sit, stand, drive, walk. Eventually just about everything becomes a painful and fearful experience.
You stop participating in social activities, stop being able to work and you start to lose meaning in your life. The pain has essentially hijacked your brain and taken over.
So, how could have played out differently? Well, the evidence tells us that most people have a disc bulge or disc degeneration who are pain free and fully functional - think of it like internal wrinkles. It’s far more likely that a bout of back pain is simply from tight muscles or poorly adapting to old injuries - often very treatable with a solid plan. Instead of looking for a diagnosis, your GP sends you to a physio where this gets explained. You’re told that pain is actually helpful and shouldn’t be feared/ avoided but the best thing to do is modify your activity rather than stopping. All the while, you can work on treating the underlying reason why you had the problem in the first place. In this scenario, there is no real long term threat, there’s certainty in how you’ll get better and there’s a focus on function rather than pain. When you do this, you’re actually re-wiring the amygdala and ACC which can ‘turn down’ the pain amplifier. A pathway to success. Now, I know I make this sound quite easy and this is far from my intention. In cases of chronic or persistent pain where negative emotions have fuelled a negative pain spiral for months or even years, the wiring of the amygdala and ACC can be difficult to reverse. But never impossible. In these cases, it takes persistence and hard work to change beliefs and fearful perceptions of your problem. But where there’s a will there’s a way and the brain is always ready to grow and change. Whenever you create a positive experience through new movement patterns and positive emotional responses, you are re- wiring your brain. The best tools I’ve found for this have been meditation and Pilates, but it’s often best to do this with some help.