This is going to take a while to explain, and it gets a little technical, but it is the
basis on which everything follows. Pain is a complex physiological process. It is
your body telling you there is something wrong. It can have many descriptions,
throbbing, burning, aching, pinching, referred, stinging, sore, and many other self-descriptive words. Pain can be localized or over a large area, even your whole body.
Pain can range from bothersome to debilitating. The same diagnosis and cause of
pain affects people differently. Some people have a higher tolerance of pain. We do
not know exactly why, but it is thought that several things play a role. It may be
modified by personality traits, attitudes, previous experience, economic factors,
gender, and particular circumstances under which the pain is experienced and
duration. Moods such as anxiety and depression are associated with a greater
intensity of pain. On the other hand, more intense pain can result in a lower mood.
In contrast, a positive mood can relieve pain. The behavior, because of pain of a
given intensity, is highly individual and greatly influenced by what the patient
believes will be helpful and how serious he or she believes the situation is.
Tolerance is not only tied to cognitive functions but also the intensity, anguish,
suffering, and anxiety commonly accompanying pain. Experience teaches you the
levels of pain that exist. It is important to understand what type of pain you are
experiencing so that you seek appropriate care.
There are specific types of treatment that medical professionals will refer you to
and often they are helpful, but there must be some point when you realize that
you must participate in your care. A long list of wellness modalities can and will
change your life. You should know how pain works, what kinds of pain there are,
how your nervous system processes information and replies to the pain signals,
what the fight or flight response has to do with the type of pain you have, how pain
can be present without an injury, and how our nervous system forms semi-permanent pathways for pain if you know how you can re-train these pathways.
There are good models for the treatment of acute pain but there are poor models
for the treatment of chronic pain. Not only do they provide little information about
muscles, joints, and tendons that are most often affected by chronically painful
conditions, but they do not address the vast array of psychosocial factors that
influence the pain experience profoundly. We need better models.
So, what is pain, how does your body process it? Here we are talking about what is
called the pain pathway, everything we talk about in this section is describing the
pain pathway. First, we are primarily speaking of the central nervous system. It
includes the brain and brain stem, and the spinal cord. Then we have peripheral
nerves that go to our body from the spinal cord. Each nerve has specific functions.
This is a complicated process, but I am going to try to make it make sense to you
because later it is important. When pain occurs, a signal must travel from where
the injury is, this is called an “afferent signal”, or I like to think of it as, “away” from
the source and to the spinal cord. Then there is another nerve that travels from the
spinal cord to the brain to be processed then back again with the “efferent”
message of what the body should do.
What is Pain? Session One Homework
What is Pain?
The space between nerves is called a synapse and, in the synapse, we have
neurotransmitters that take the signal from one nerve or axon to the end of the next nerve
which is called a dendrite. We have specialized nerves that transmit pain called nociceptors.
When a pain stimulus or provocation occurs, such as pressure, pinching, temperature, or
chemicals, the nociceptors do their job to take that signal from the area of the pain through
the peripheral nerves, or the nerves that extend, from the spinal cord to the rest of our
body. They do this with the help of the above-stated neurotransmitters. This cycle runs
along what are called tracks, or pathways that go up and down our spinal cord. Nociceptive
pain can be present in your bones, muscles, ligaments, skin, tendons, and joints.
Nociceptive pain can also be a result of tissue inflammation such as arthritis, inflammatory
bowel disease, and other autoimmune diseases. Conditions like arthritis, endometriosis, flu,
and fibromyalgia can also cause other symptoms like nausea, fatigue, swelling, and mood
changes. Mechanical, pinching, pressure, and temperature stimuli usually have brief
responses. A chemical stimulus, however, is longer lasting. The signals carry the stimuli
from the affected area to the central and autonomic nervous systems. You can also
transmit signals resulting from potential injury. This is important with chronic pain.
All signals reach a part of the brain called the Thalamus. The Thalamus then transmits the
signal to other parts of the brain to be processed. The brain decides the appropriate
response, and the signal now must travel from the brain back to the area of pain following
the same process down the efferent track. If the stimuli or injury is sufficient, then you will
get an inflammatory response in the local area of the stimuli. The signal from the thalamus
can be one of two things. It can be a signal to decrease, and your brain will release natural
painkillers called endorphins or it will stimulate the immune system to respond to the
stimulus and increase your pain.
You ask, why would your brain send a signal to increase your pain? Remember that pain is
your body’s way of telling you something is wrong. If it is trauma, you will be aware
immediately. But if it is not, it can start as mild pain and progress. One scenario is that a
signal travels to your brain and because it was processed as a serious problem, the return
signal increases your pain. Eventually, the pain gets worse and worse, and the signals
continue to increase.
We have two nervous systems. The central nervous system, that we spoke of, and the
autonomic nervous system. The autonomic nervous system is divided into two systems, the
sympathetic and the parasympathetic. They regulate the function of everything you don’t
think about. For instance, our heart beats, and our internal organs continually function
without us having to think about it. The two autonomic systems work together to provide
us with our flight or fight response. The sympathetic nervous system allows for the flight
response. It responds to noxious or harmful stimuli, for instance, something that scares you.
Like a dog growling and running towards you, in a stressful situation like public speaking,
your breathing rate as well as your heart rate will increase. It will make you sweat and
shake, and it should send out pain signals at appropriate times. The parasympathetic
nervous system settles things back down once the stimulus is gone.
What is Pain?
The zebra is grazing one minute and the next it is running for its life. This is the
fight or flight response in action. We are not zebras though so how does this
apply to us? The major diffe4rence is that we excite our flight system, (our
sympathetic system) just by our thoughts as mentioned before. We are in a
constant process of flight. Mindfulness meditation is designed to calm those
thoughts and allow you t be in the moment, let the to do list go and do one thing
at a time. For you that may be getting out of bed, walking around the house, and
then being grateful that you accomplished that. Give yourself gratitude for the
positive things and let go of the negative.
What is Pain?
It is important to know the different types of pain, understanding them is vital to your
treatment, both your own approach with wellness, and developing a treatment plan with
your team of doctors. We will go over the types of pain as they are vital for you to
understand. We will talk about this in our sessions.