“Pain is an opinion” .- Vilayanur Ramachandran
I get a lot of inquiries on how to treat different pains. It is not my specialty, and I always recommend going to a professional. But I also believe that as a society we do not know the basic principles of how fraud worksr, and understanding the problem is always the first step to solving it.
For this I bring you this article by Guillermo Muñoz, personal trainer, nutrition consultant and, for personal reasons initially, a pain specialist. You can read more about him on his blog www.gmfitnesssystems.com.
Maria suffers from terrible pain in her lower back. There was no particular cause, the pain started out of nowhere. Decide to go to the doctor to diagnose the problem. An MRI reveals a herniated disc. According to the doctor, this is the cause of his pain and he needs surgery.
She does not want to have surgery, and goes to a physical therapist. He explains that his core is weak and that his glutes are not working properly. He prescribes exercises to strengthen them, but the pain continues.
Then visit a chiropractor. According to him, his spine is not aligned and he needs some adjustments. It treats it, but it continues in the same ones.
He then tries it with an expert in therapeutic massage. It assures you that you have trigger points in your latissimus dorsi that manifest as pain in your lower back. With a few simple massages it should improve. It doesn’t work either.
Months go by and he doesn’t know what to do. Try yoga, meditation, tai chi, Pilates, reflexology, acupuncture, stretching … Pain comes and goes, but nothing seems to fix it completely. Each expert gives you different explanations. She is desperate and confused. You feel powerless. Lose hope.
Unfortunately, stories like this are frequent. If you are in constant pain, you are not alone. About 20% of the world’s population has chronic pain (study, study, study, study). I was one.
One of the basic problems is that they do not receive the necessary knowledge to understand their pain. And understanding it helps to deal with it. This is today’s goal
What is pain?
For ancient Greek medicine, pain was caused by demons, it was a punishment from the gods. Later Hippocrates argues that pain occurs due to an imbalance of the bodily humors.
Centuries later, Descartes describes in his book I treated him de l’homme that an injury or other noxious stimulus activates pain receptors that send a message through the spinal cord to the brain, where pain is perceived. This idea assumes that pain always has a physical cause: injury, infection, illness.
A few decades ago, Ronald Melzack developed the model currently used to explain pain: the neuromatrix (study, study). This model explains the relationship between pain, damage, perception, movement, thoughts, memories and emotions.
We will use this model to explain four ideas you should understandr of pain.
1. Pain is an exit signal, not an entrance
Pain is an “exit” signal from your brain, not an “entry” signal to the brain from the body. Descartes was wrong.
Your brain collects information from the body, interprets it, and ultimately sends the appropriate signals. Pain is one of those signs.
Maria feels pain in her lower back, but the pain itself does not originate there. Pain is a response from your brain after receiving and interpreting multiple signals.
What are these signs? One of the most important is nociception, or “reception of danger.” It originates from nociceptors, receptors distributed throughout the body. But they are not pain receptors. Its mission is to detect dangers and alert the brain.
The brain receives the information and asks: “How dangerous is this really?«. The answer to this question will determine whether or not you feel pain and its intensity.
Another input signal is the proprioception. It informs the brain about movements and the position of the body in space. The brain will recognize certain positions as dangerous and others as safe, using this information to modulate pain. For example, if your back is in the same position in which you were previously injured, your proprioception will report bad news and may make the pain worse.
What you see and hear also influences perceived pain. Seeing yourself a wound can change the pain it causes you. Or if you observe a hunched-back deadlift and that’s how you injured yourself, you may experience pain just by looking at the other person (study).
Your thoughts and expectations affect your pain. If you think that a particular stimulus will cause pain, it is more likely that it will (study).
Your emotions also play an important role. Psychological states associated with depression, anxiety, loss of hope, fear and helplessness influence chronic pain (study).
In summary, our movements, thoughts, emotions and memories affect the pain we experience.
This does not mean that the pain is only in your head or that you can eliminate it with thought. Pain is real, but it is formed from many elements, and it is not necessarily a direct reflection of damage to the body.
2. Pain does not equal bodily harm
As a general rule of thumb, the more damaged your body is, the more pain you will feel. But the relationship is not direct many times, and discrepancies are frequent. In many cases there are severe injuries without pain, or severe pain with minor injuries (even without actual injury).
Hurt without pain
These data reflect the physical situation of people who they have no pain:
- In a study in pain-free people, 52% had at least one bulging disc and 38% had problems with more than one vertebra.
- Another study shows that 33% have a substantial abnormality in the spine, increasing to 57% in the case of those over 60 years of age.
- 77% of hockey players have at least one abnormality in the hip or pelvis (study), as well as 67% of the general population (study).
- 60% of people show abnormalities in the knees (study). Another study reflects degeneration in the menisci in 13% of people under 45 years of age and in 36% of people over 45 years of age.
- More than a third of people have shoulder rotator cuff tears (study, study, study).
Remember, we speak in all cases of people who do not suffer any pain. Conclution: physical damage does not necessarily mean pain.
Pain without harm
On the other hand, many people suffer pain without apparent harm. A typical example is lower back pain, like Maria’s. Many cases are classified as non-specific, that is, not attributable to a known pathology in the back (study).
Why is pain not a good indicator of tissue damage? For two reasons:
- Pain does not exist to measure the severity of damage, but to encourage protective behaviors.
- Pain protects you from a perceived threat, not a real threat.
3. Pain is an action signal, not a damage meter
The main purpose of pain is not to tell you that a body part is damaged, but to encourage protective behaviors, such as withdrawing from a noxious stimulus or avoiding movements that worsen damage.
The end goal is the same as always: increase your chances of survival.
Pain, therefore, is a sign of action. It forces you to do or stop doing something. If no action is necessary, or the action has already been taken, the pain is useless.
A classic example: soldiers with severe injuries, including limb loss, reporting little or no pain (article). If the pain had paralyzed them in combat, they might not have survived to tell the tale.
Another purpose of pain is to allow an injury to heal. If enough time has passed and the injury healed as much as it could, pain is not necessary either. It may be the case of permanent damage, as in some of the studies we saw earlier. Can you imagine that all those people suffered pain? They would be limited for the rest of their lives. But they are not.
They do not suffer because that pain would not promote a behavior beneficial to their survival. Why continue to feel pain in something that will not change (such as degenerative problems)?
As always, the placebo effect also comes into play, or pain reduction due to the confidence that a certain intervention will work (study). You take a pill, inject a needle, visit the doctor … the brain concludes that help is on the way and reduces pain.
Protective action has already been taken. Pain is no longer necessary and the brain reduces it, despite the fact that the body continues to send signals of some kind of danger (article).
4. Pain protects you from a perceived threat, not a real threat
Our brain is often wrong. Do you see straight or curved lines?
Your brain will tell you that they are curves, but they are actually straight, parallel lines. Equally, the brain can make mistakes when responding to a threat.
An extreme case: the phantom limb. Many amputees feel pain in a limb that doesn’t even exist (article).
Another example: a minor injury to a finger will cause more pain to a violinist than a dancer, because damage to the finger poses a greater threat to the violinist (Butler & Moseley, 2013). Your brain therefore perceives the injury as more serious, causing you more pain.
It is like a home alarm system. It detects danger and signals the need for protective action. This signal occurs whether the alarm was triggered by a real thief or your cat by mistake. Even though your cat is not a threat (I hope), the alert goes off.
Our threat information processing system is flawed. The brain does not always know what is happening and where.
Pain is complex, dynamic, and individual. Many times we will not know exactly why you are in pain and what you should do about it. The only certain thing is this: the brain is always the one who decides if something will hurt or not.
There are components of pain that we cannot consciously act on, but we can we can influence others. To some extent, pain is an opinion, and you can train your brain to reduce it.
In the second part we detail tools for this.
If you are interested in learning more about migraine, listen to my interview with Dr. Arturo Goicochea or this article on back pain.