Pain as a protective mechanism.

All pain is real - but it has a purpose. To understand chronic pain, one must first understand the reason for pain. Pain acts as a protective mechanism; it is designed to help us survive by alerting us to danger and preventing us from continuing to harm ourselves. If you sprain your ankle your brain sends you pain to stop you from using it as that would cause further damage. Pricking your finger on a needle, a burn from a hot iron or sipping a very hot drink are further examples of pain being experienced which is acting to prevent continued harm

Although pain can be felt anywhere throughout the body, it is always generated in the brain. Depending on the unique set of factors at play, your brain will make a judgement on how much pain to give you. You must understand, your brain does not want to harm you as the brain’s sole purpose is survival.

Based on this concept, the brain will create pain in the face of a physical danger. However, that is not always the case. Although it may be difficult to believe, it is now known that even in the absence of tissue damage, the brain can create intense and debilitating pain or other symptoms that can be felt anywhere in the body. Here are two examples for you to consider. You may have heard about ‘phantom limb syndrome’ which involves an amputee suffering mild to extreme pain in a limb that is no longer there, which occurs due to sensitisation of the nerves. This demonstrates the ability of the brain to create pain even in the absence of structural damage as of course with the limb having been removed, there is no ongoing problem. Another example involves the famous case as reported in the 1995 British Medical Journal of the builder who fell from scaffolding landing on a 15 cm nail that penetrated his boot. He experienced excruciating pain, was rushed to the hospital and required heavy sedation only to find, once the boot was removed, that the nail was lodged between two toes. Again, this illustrates that pain can be generated in the absence of real damage to the body as in this case it was in the face of a perceived threat.

Pain and the Mind Body Link

Therefore, when faced with a threat, an automatic physiological change takes place in the body. Isolated stressful incidents as the above are not dangerous. However, it is when the body is repeatedly undergoing chronic stress, including psychological stress, that eventually a point is reached where something has to give. Pain and persistent symptoms are the result, otherwise known as Stress-Induced Conditions. Where do these threats come from? We often are not aware of the contributory factors which include:

• Current stressors (e.g stressful job, money problems, caring for elderly parents, lack of work/life balance, family issues, modern fast paced life).

• Personality traits that cause self-induced pressures (e.g perfectionism, being highly driven, overly-ambitious, being inclined to worry, good-ism, people-pleasing, non-confrontational).

• Adverse childhood experiences. (e.g abuse, parental divorce/separation, death of family member, neglect, lack of friends, change of schools, abandonment issues). Research shows that children that grow up feeling unsafe develop an over-sensitive nervous system that react more readily to stress and challenges during adult years.

Let us use the analogy of a stress bucket. The bucket represents our tolerance to stress and every individual has a different size bucket based on their genetics, life experiences and personality. The water that flows into the bucket represents all the combined stress of our daily lives, the taps that drain the bucket symbolise our coping mechanisms including: exercise, sleep, healthy diet, positive friendships/support groups and self care. When the bucket threatens to over spill due to a lack of taps (self care etc), this can lead to both mental and physical health issues, i.e stress-induced conditions.

The Pain Cycle and Oversensitised Nervous System

But this does not explain why acute pain can become chronic pain lasting for months or even years, and long after any injury has healed. This can be explained by the pain cycle and oversensitisation. Pain begins when neural pathways (nerve connections) between the brain and body are stimulated. When we learn to read, write or ride a bike etc we are creating neural pathways which become reinforced with practice. In the same way, our brain can create neural pathways with pain which can become reinforced over time.

How do they become reinforced? Well, once we experience pain we start to encounter negative emotions such as anger, resentment, fear and anxiety. We start to plague ourselves with questions such as: ‘Why me?’, ‘When will I get better?’ ‘Will I ever get better?’ ‘Why have the doctors not found what is wrong with me?’ ‘Am I broken?’. Furthermore, we may face restrictions and other pressures in our life: inability to work, exercise, reduced income, insomnia or strained relationships.

These stresses create inner emotional turmoil which activates the emotional part of our brain (the limbic system) in turn activating the danger alarm. The brain then does what it thinks it needs to do to protect us and gives us more pain to get our attention to deal with these stressors. With the constant firing of these neural pathways, the nervous system becomes oversensitised, constantly activating the flight fight response.

Think of it like a faulty car alarm that can be set off with a leaf falling on it. The alarm is activated even though no danger is present. Our thoughts and beliefs around the pain determine the extent and severity to which we will suffer it - the pain no longer comes from the fact that we are ‘broken’ but now from how we view it.

At the heart of this is the self-perpetuating pain cycle driven by our negative emotions and daily stresses. Just like when we learn a new skill, the more time spent doing it, the easier it gets. Likewise, the more the brain creates pain, the easier it gets at creating pain again.

In other words, our nervous system learns to create chronic pain in the absence of any pathology or structural damage in the body. This can go on for a very long time, keeping us locked in pain, until we break the cycle. Break the cycle: break the pain!

Fear of everything - Conditioned response

To add to this, triggers can develop which amplify the pain experience. Ivan Pavlov, the Russian scientist, established that every time he rang a bell when feeding his dogs, the dogs would salivate at the sight of the food. He learned from this experience that even in the absence of the food, the dogs would still salivate at the sound of the bell due to an association made between the sound of the bell and the production of the food, that is, the stimulus and the conditioned response. In the same way, chronic pain can also be triggered due to a conditioned response.

Imagine you are suffering from back pain. One day whilst sitting in your office desk you experience pain in your back that intensifies the longer you sit. The pain is due to your feelings of stress, but your brain has made an association with the simple act of sitting and pain (even though you have done this act thousands of times in the past with no pain). So now every time you sit your brain switches on the pain in order to protect you, thinking you are in danger. You become increasingly afraid to now sit and this fear only serves to fuel the pain cycle.

Your brain remembers everything like a mental database of all the actions that give you pain and soon, your everyday movements and activities become triggers for your pain: bending, lying down, typing, walking, even certain weather conditions, foods or particular people due to conditioning. It is like your brain is stuck in high-alert and this hyper-vigilance leads to chronic pain and other persistent symptoms being self-sustaining and the cycle continues.

There is hope!

The great news is that there is hope for recovery due to neuroplasticity!

The brain is constantly learning and creating new structural pathways. Many studies have revealed that the fact that the brain is ‘plastic’ means that it can be re-wired in order to change our relationship with chronic pain.

Once we understand that fear and repressed negative emotions keep the pain cycle going, we can work on dispelling these. It is all about conveying messages of safety to the brain to calm down the over-sensitised nervous system and allowing the brain to stop activating the danger alarm. With repetition, conditioned neural pathways that are producing pain can be unlearned and reversed in order to interrupt the negative cycle of pain.

Because chronic pain is so complex, treating it successfully requires a multi-faceted approach in which we take into account everything that makes us human; the biological, psychological, emotional and social factors.

The reason why you are still hurting today is most likely due to a faulty medical diagnosis. Medicating with drugs, injections or surgery will not target the underlying cause of your pain but simply mask it. The pain or symptoms will either be temporarily relieved or a different part of the body will be targeted to keep you distracted. So ask yourself: Why learn to just manage your pain when you can be free from it? Until you change your expectations, beliefs and thoughts around the pain and calm down your oversensitised nervous system, your pain and symptoms will persist.

My Pain Free Programme has had a 100% success rate in treating chronic pain patients using this new approach. You are the captain of your own ship, the master of your fate. If you want to become pain free you must be willing to take the first step, then I shall hold your hand for the rest of the way. Although you may feel disillusioned due to all your previous failed efforts, there is hope for a new, pain free life.

What have you got to lose, except your pain!

Stress-induced Pain/PPD - Overview of how it all happens.

1. Stressful lifestyle (common stressors mentioned above) - e.g stressful job, family stresses...

2. Personality traits (perfectionism, people pleasing, highly driven) leading to further self-induced stress.

3. Lack of emotional awareness. Negative emotions (anger/frustration/worry/sadness) are suppressed as easier to ignore them than process them.

4. Lack of self-care and work-life balance.

5. Perhaps unresolved trauma from the past, leading to further inner emotional turmoil.

6. Sudden onset of pain - may be caused by injury/accident or stressful event.

7. Once pain is manifested in the body neural pathways are created which become learned due the experience of pain.

8. Leading to sensitization of nervous system. Leading to more pain.

9. Continued lack of self-care combined with on-going stress, anxiety and fear of pain. Pain increases and the pain cycle ensues.

10. GP misdiagnosis provides only short-term solution. Causing more negative emotions.

11. Pain/symptoms becomes chronic pain/persistent symptoms. Can last for months to years.

12. Discover true cause of pain - oversensitised nervous system and learned neural pathways.

13. Enrol on Pain Free Programme and start applying simple but powerful tools and strategies to reverse the above.

14. Become pain free. Regain your life!