By Danél Lombard, MPT, PhD
Pain is a protective system. You experience pain when your brain concludes that your body or your tissues are in danger and something needs to change. This needed change could be your movement patterns, your activity level, even (and maybe most importantly) your thought patterns or attitudes.
Your pain is such a powerful protective mechanism that it is always steering you in the direction of safety. Your job is to follow its cues, perhaps with the help of an integrative team.
But how does it work?
In their book Explain Pain Supercharged (2017), Butler and Moseley explain how one’s level of pain is influenced not only by one’s biology, but also by one’s environment, relationships, thoughts and beliefs, to name but a few. We understand that we are biopsychosocial beings sending a myriad of signals to the brain at any given moment. These signals come from your body and its tissues (bio), from your environment (socio), from your memories and thoughts (psycho) and the brain determines whether you are safe or in danger.
Based on all the information coming in, the brain determines whether or not you should experience pain (and how much) to protect you. In other words, pain is a meter of the amount of protection you need as determined by your brain. If in the moment, the brain decides you are in ANY danger whatsoever, it will protect you by either producing pain—to protect the specific body part—or by numbing the pain—to escape the dangerous situation. The brain is in control of the level of pain you experience 100% of the time. Let’s look at a particular scenario from a biopsychosocial perspective, shall we?
You are on a ski-slope. You have a really bad fall and break your leg.
Biological inputs (what is happening in the body physiologically):
- Broken bone and affected soft tissues like muscles and ligaments signal tissue damage to the brain.
- Immune system kicks the healing response into action – immune cells surround the various synapses sending signals from the body to the brain.
Sociological inputs (what is happening in your environment):
- You are among friends who care about you and love you.
- You have a cell phone and cell phone reception—the ability to signal for help.
- A rescue team is able to reach you and take you to warmth and safety.
Psychological inputs (what are the thoughts you may be thinking):
- You are going to be ok with the help of your friends.
- Bones heal, and the body is extraordinary in its healing capacity.
- You are in good health and will get better.
Based on all of these inputs, the brain determines the intensity of pain output to protect you from further damage or death. Skiing down any further could increase the tissue damage, therefore pain as an output would be appropriate to stop you from doing just that.
But what if, in that same scenario, you were alone on the mountain without a lifeline such as a phone, or the support of your friends. You would be at risk of dying from hypothermia. So the physical inputs would stay the same, but the psychological and sociological inputs would change. The brain’s determination of level of safety and danger for you would significantly change the amount of pain you may be feeling. You may HAVE to ski down the mountain to survive. Therefore, the pain output of the brain may be significantly less, just to get you down the mountain and to a safe place.
Similar scenarios have been reported. People obtaining a severe injury in combat, or in the face of a life-or-death situation, without feeling any pain until they are back to a place of safety. Over and over again, the brain’s main function is to keep you alive depending on the different circumstances you find yourself in on a daily, or more accurately, moment-to-moment basis.
But what exactly does this mean for your neck pain? Or your back pain? Surely, you’re not facing life and death situations. What purpose could your neck or back pain serve in light of this safety vs. danger scale the brain continuously weighs?
Once you understand that your back pain is not necessarily a result of one specific physical input from the area that you are experiencing the pain in, you can start to develop a different relationship with your pain. Become curious about all the other inputs happening at the exact same time. How are the relationships you find yourself in, or the circumstances at work? What are your thoughts about your pain, or the words you use to talk about your body (and your pain)? All of these put a weight on either the safety side of the scale, or the danger side. And whichever side weighs heavier will determine the amount of pain you are experiencing.
Contemplate this for a moment: “my back went out,” “I have a frozen shoulder,” “I have a slipped disc,” “my knee is bone on bone.” Which side of the scale gets heavier with language like that? Safety, or danger?
What about “my job is sucking the life out of me,” “This relationship is so draining,” “I just have to survive the next few months”? These statements, or thoughts, or beliefs, are they shifting the scale in favor of danger or safety for you? Know that all of these factors influence your brain, and therefore your pain. Where can you change a danger weight to a safety weight on the scale? Every ounce counts.
At Akasha we know our patients live in a biopsychosocial environment. Rather than operating in a biomedical model of health, we treat from a biopsychosocial perspective. With an integrative team, we are able to support you in the entirety of your biopsychosocial being.
Reference: Explain Pain Supercharged (2017) by Butler and Moseley
