Chronic Pain

Pain is something we are all familiar with. When something happens to our body that is immediately not good for it, we get these signals from the injured area called pain. Pain is there to warn us that we need to do something right now to prevent further injury. Furthermore, that particular pain will persist if an injury has happened to warn us to be gentle with the injured area until the injury has healed. This is the appropriate and actually very helpful arena of acute pain. I have often wished that I had such a helpful warning system to let me know before I take the first bite of something that ultimately is not good for me. Cookies should be painful. Ice cream should be painful. Anything fried should be painful, but they are not.

Some patients have told me that they wished they never had to experience pain. I generally point out to them that this is available in the form of leprosy. Leprosy kills the pain nerves so you feel no pain. Unfortunately, without the pain, you can’t feel when you have injured a body part. Without the pain during healing, you keep reinjuring the wounded area making it worse and worse until it gets infected and gangrene sets in. This is how leprosy causes the loss of limbs and digits. It is all about the lack of pain. So pain is a valuable response in the body. It screams a warning about an immediate injury that needs your attention right now.We tend to think that pain comes from the area where we feel the pain. It does not. The signals from injured areas come primarily from stretch sensors and compression sensors. These typically signal the brain to tell us how tight or loose muscles and tendons are. Sometimes signals from temperature sensors and touch sensors talk to the brain about things that the brain then interprets as pain as well. I remember seeing this in action while I was in school. We watched a video of the impact of suggestion through hypnosis on the body. The hypnotized subject was told that they were going to be touched on the arm with a red hot poker. The hypnotist then touched the subject with a pencil eraser. Almost immediately the subject screamed in pain and a red blister formed where the eraser touched the subject, just as though they had actually been touched by a red hot poker. What the heck? The point of this video was to demonstrate that pain does not come from the signals where we feel the pain. Pain is an interpretation formed in the brain. We now know that at least 44 different brain regions are involved in creating the experience of pain. Pain is a brain phenomenon, and it is based on what we believe is or has happened. The body sends signals to the brain that something is going on, but it is the brain that decides whether to go into the fight or flight fear reaction we call pain.

What I found most interesting in this hypnotist demonstration of the power of our mind was how the area touched reacted with a blister even though nothing hot had actually touched the subject’s arm. The brain not only believed it was burnt but caused the body to react as though it had been burnt. Now this demonstration was pretty dramatic and depended upon the highly suggestible state of the hypnotized subject to create the belief that they were going to be burnt. But this demonstration shows us how vital our interpretation of our experience is in making our experience of pain. This plays directly into the world of chronic pain.

Most injuries in the body heal up within a couple of weeks if we are healthy. A broken bone might take more like 6 weeks, but that is the worst-case scenario for healing time in the body. So what is going on with chronic pain – that stuff where people have pain for months and years? When I first got out of Chiropractic school, I thought that chronic pain was due to joint degeneration like arthritis. It was accepted that of course a bulging disc or ruptured disc would be painful for a long time. But then I saw X-rays on the lower back of a patient of mine who had minor discomfort in his lower back that would get better with just a couple of adjustments. The X-ray showed dozens of massive 1-inch bone spurs in his whole lower back. I had no idea how he could even walk. Back then MRIs were a new technology and you only got one if you were in a lot of pain. Sure enough, when there was a lot of pain you would find a bulging or ruptured disc. We naturally assumed the disc injury was responsible for the pain. Many years later when MRIs were common and people would get them for lots of reasons besides pain, it was noticed that lots of people had bulging or ruptured discs that had no pain. Again, what the heck?

A couple of months ago I had a new patient who told me in her history that she had nine bulging discs in her back and that for years she was in excruciating pain. Her only option medically was to put steel rods in her back to stabilize her spine and hopefully reduce the pain. She was courageous enough to say no and look for a different approach. She found a book called The Way Out by Alan Gordon about a different way to heal chronic pain. It took a few months, but she gradually became pain-free. She is now a trainer for folks improving their bodies. That story was so amazing to me I immediately ordered the book and read it. This book lays out a very gentle process for retraining the brain to get out of the chronic pain state. The key concepts revolve around what I have been describing – that pain is a brain interpretation of bodily signals that have been misinterpreted. Somewhere in the brain processing a few wires got crossed and the brain got stuck telling you that normal or slightly uncomfortable signals from the body are about terrible pain from immediate damage happening. This cross-firing of brain signals has been termed neuroplastic pain. The term reflects the modern understanding of how plastic the brain’s connections are. The brain rewires itself every day. Sometimes it wires things up wrongly and produces false interpretations of reality.

It is our fear that something terrible is happening that triggers our brain into misinterpreting normal signals as signals that damage is happening right now. The fear creates the experience of pain. Fear rewires our brains. This sounds just like all forms of suffering in our lives. It is our fear that creates our experience of suffering. We may not like what is happening in our lives, but it is fear that turns dislike into suffering. Reading this book brought this down to the level of how our brain works with things in our body that don’t even involve any thoughts. This stuff is below our conscious recognition. I suspect that is why this powerful understanding of chronic pain has not been used clinically. We are a very intellect-driven society. We like to believe that we can control everything through the power of our thoughts. As a result, we tend to ignore things that operate below the level of our conscious awareness. We like to force things. We rarely like to just feel things. We want to be able to just push our way through our pain. Chronic pain does not work that way.

This book describes a progression of several different techniques to help you gradually experience your pain differently and develop a different relationship to the pain until you are able to finally eliminate it altogether. I loved how gentle the techniques are – no pushing or forcing or strength of will trying to override things. These are attention-based processes. They expand your experience to allow you a different and less painful way to experience your body. Is every chronic pain neuroplastic? No, unfortunately. Bone tumors, brain tumors, neurologic diseases, and similar nasty things produce chronic pain that is about real right now threats to your body. Look instead for chronic pains that move around, or are everywhere. Pain that gets worse when you are stressed or might go away when you are distracted is likely neuroplastic. Another clue is pain that only comes on after an activity but not during the activity. Symmetrical pains that come and go are also suspicious. Pains that were not started by some injury or appeared at a time of high stress are another sign of neuroplastic pain. If any of these conditions sound like your chronic pain then I recommend you get a copy of this book and dive right in. Link to book.

Personally, I am not a fan of pain. I am encouraged by having this new understanding of chronic pain and an approach to eliminate it.

Take care

David

Ellen​​​​​​​ 

One of the things Ellen has missed since her stroke is the ability to clean the house – really, no kidding! Last week I bought a very light weight and easy to use vacuum  cleaner that is battery operated. We were testing it out today to see how easily she could use it. She is doing just fine it looks like to me.

Link to vacuum on Amazon