Pain Education in a Nutshell

Understanding pain and what to do about it has been shown to be an effective strategy to manage persistent pain across different pain conditions. We recommend that you get the book, Explain Pain by David Butler and Lorimer Moseley or The Pain Truth, and Nothing But by Dr. Bahram Jam or Why Pelvic Pain Hurts by Adrian Louw, Sandy Hilton, and Carolyn Vandyken, to fully understand the nervous system and the wonderful way in which our body tries to protect us with pain. Pain is our alarm system and without it, we would die. However, when pain goes on for longer than several months, our alarm system becomes too sensitive. Here are the basics of what you need to understand about our pain system.

The Purpose of Pain:

• Pain is a very effective warning system designed to warn the whole person that there is a threat or a potential threat.
• It is uncomfortable so that we will be motivated to do something about the threat.
• The sensation or warning is increased if the threat has caused problems in the past (if you remember the pain).
   

The Pain System:

• Pain is a complex electrical and chemical response in our nervous system.  It also involves our autonomic nervous system, including our parasympathetic (rest and digest) and sympathetic systems (fight or flight). These are regulatory systems in our body.

The nervous system is made up of: 

1. Cells or neurons.
2. Nerves (electric wires).
3. Chemicals that influence the communication of the message.
4. Synapses (gaps between cells and nerves).

There are danger sensors everywhere in our tissues (thermal, chemical or mechanical). When they are triggered by events in our body, they relay a message, which is an electrical impulse along the nerves to the spinal cord. At the spinal cord there is a gating mechanism that sorts the electrical impulses. The impulses can:

1. Leave the spinal cord quickly OR
2. Be delayed in leaving the spinal cord OR
3. Be canceled altogether

What happens at the spinal cord depends on the chemical balance in your body at that time. The chemical balance is affected by many things including our thoughts, emotions, diet, and lifestyle. The electrical messages are not pain messages yet.

GABA, Endorphins, and Serotonin are chemicals which try to STOP the transfer of the pain message.

Glutamate and Substance P are chemicals that INCREASE the transfer of the pain message.

The brain has to make a sensible story of the information from the body.  Many parts of the brain are involved:

• The memory centre is thinking: what happened the last time I had this problem?
• The learning centre is thinking: I don’t want that to happen again.
• The emotional centre is thinking: that was embarrassing or potentially embarrassing.
• The thought centre is thinking: I don’t want to miss any time at work.
• The autonomic and immune systems: is the sense of general well-being.
• The sensory centre: is sensing tight tissues causing irritation of the nerves.

So, it stands to reason that, if any part of the brain thinks the person is in danger from the threat or potential threat, it will communicate this to the spinal cord through chemicals. This excites the spinal cord. This is called up-regulation.

Possible threats that can communicate danger to the brain are:

• Fear
• Stress
• Anger
• Depression
• Negative thoughts and attitudes
• Painful memories

If the brain does not perceive a threat, it communicates this to the spinal cord through chemicals. This calms the spinal cord. This is called down-regulation.

When the spinal cord gets excited enough, it finally sends the threat message to the brain. This threat message is then processed along with other impulses in our brain, such as our thoughts, memories and other activities going on at the moment, and the brain decides whether it is going to create a pain response.

The Pain Truths are:

• No perceived threat = no pain.
• Increased threat = pain is produced.
• The brain decides how much pain you feel, not the tissues.
• Pain is an output response of the brain 100% of the time.
• Our response to the pain can re-trigger more pain, perpetuating the pain cycle.
• The intensity of the pain does not indicate the amount of tissue damage!

The goal of treatment is to down-regulate the nervous system and eliminate the threats so that the brain is no longer creating a pain response.