We’ve learned a lot about pain in the last few decades and the more we discover, the more surprises we uncover. Beyond the physiology, pain has a lot to say about human psychology and even culture. So much for simple boo-boos.
The Telegraph Model Of Pain
If you are the average person you probably think of pain as working something like this: Nerves sense stimulus to the body, send a signal to the brain about that stimulus, and if the signal is perceived as potentially harmful the brain creates a pain sensation to get you to react. While this nerve-to-brain-signalling model probably fits well with your experience, we know that pain is actually much more complex than that. Besides the fact that some people appear to tolerate pain better than others, we also know—thanks to advances in medical technology—that people with the very same type and degree of ailment can have wildly different symptoms. We’re talking anywhere from debilitating pain to no pain at all and everything in between. How can this be?
Pain Is Mysterious
The fact is, how pain works and why people have such different experiences with it is unclear. There are some ideas out there though that are taking us in new directions.
For those who like to think about the body a little more mechanically, one hypothesis is that the nerves that send the all important signals to the brain can short circuit. For who knows what reason, they begin to send frantic signals that end up amplifying normal sensations. This scenario, called central sensitization, basically means that ordinary stimuli get registered at far higher levels than they should, turning a tiny issue into a four-alarm fire or a non-issue into an annoying distraction.1
For the biology fans out there, another hypothesis is that there is a genetic component at work. More serious pain conditions like fibromyalgia have been shown to run in families. Experiments with rodents have shown that pain sensitivity can be bred. In other words, maybe people are just genetically different in how they react to the same stimulus.2
For those who are all about the mind-body connection, another hypothesis is that our inner psychological world has a profound impact on our experience of pain. We know that emotional states have physical impacts. Fear goes along with increased heart rate, stress goes along with high blood pressure, and so on. The idea with pain is that because the central nervous system and our consciousness are an integrated unit it is quite possible, maybe even probable, that psychological factors regulate our experiences of pain as much as nerves do. Fear of the pain and/or a belief that the pain is a harbinger of bad things to come may cause it to linger or even get worse. A positive outlook, on the other hand, may help us recover more quickly and more fully.3
These are not the only ideas we’re investigating, there are others. Moreover, all of these ideas might be correct and could interact with one another in myriad ways. The research is still exploring. What we can say is, things are more complicated than they may appear.
How These Hypotheses Might Help You
What are some of the practical implications of these ideas?
First and foremost, they let us know that trying to connect pain directly to pathology in a simple, straight line is unrealistic. Degenerated discs in the low back, to name only one extremely common example, can cause severe pain in one person and no pain in another.4 Furthermore, even when we can say with relative certainty that something we see is a source of pain, we must remember that why it is bothering the person could still be unclear. It may hurt because of physiological, genetic, psychological components, or a combination of all three and more.
Given that cause and effect is elusive, we need to be open to the fact that treatment may be wildly different from person to person. Some people with the same rotator cuff tear might do just fine with physical therapy while others require surgery. Still others might need a physical intervention combined with a psychological one. Some people will recover if they just give their body time to heal. There will not be a one size fits all solution.
We must also change how we think about the role of psychology in treatment. The fact is, mental health is still highly stigmatized in American Culture. When someone hears that their pain is partly psychological, they can quickly feel like they’ve been called crazy. Moreover, the idea that their own psychology might be contributing to their pain feels like an accusation—like the pain is somehow their fault. Neither is true. The fact is, it is simply a matter of understanding that how we think about our own pain and discomfort, as well as how we feel day in and day out, can and does influence recovery. It should at least be a part of the conversation.
Finally, it is worth re-examining how we view pain culturally. The dominant narrative on pain is that it’s a sign that something is wrong and that it must be corrected. This black and white attitude might actually make things worse. The idea that pain always signals some kind of defect requiring complete correction leaves us open to fear because we worry as long as pain is present, we’re in trouble. This in turn opens the door to never-ending treatment. More and more, pain specialists are embracing the idea that this approach is simply unhelpful. Some pain is a companion to life and it can’t, and doesn’t always need to be solved. In fact, it may be our very fixation on the pain and the need to solve it that amplifies it to debilitating levels. Being willing to acknowledge that not every ache has to be eliminated may, paradoxically, be its own powerful form of treatment.5
Seek Answers, But Stay Flexible
None of this is to say that pain is unimportant, or an illusion, or a false messenger. Obviously, pain is there to help us sense danger and react to it. It does let us know when something may be wrong and we should always do what we can to investigate what is going on and do what we can to resolve the situation. The issue is that we must be open to more possibilities than we are typically presented with in our current health and wellness culture. Sometimes, there will be more than one answer. Sometimes, there won’t be clear answers. Sometimes, no answer will be the answer. Figuring it out will require open communication and a willingness to experiment. Look for that wherever you seek your treatment.
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