Understanding the “Pain Brain”

Have you heard of the “pain brain?” For years, doctors have thought that pain was just a result of either localized tissue damage or underlying disease. Typical treatment involves inspection of the body part and direct physical interventions (often through specialized treatments, or more drastically, surgery,) followed by prescriptions for pain-killing medications, and rest and recuperation. Increasingly, for pain sufferers, after the resolution of the temporary pain-causing event, instead of the body healing and returning to its original active self, pain stubbornly remains, evolving from an acute to a chronic pain state. This underlying and constant manifestation of pain, either in one area or throughout the body, brings with it negative emotions --- fear, anger, anxiety, depression --- which can take a very long time to heal. When the pain remains long after the damage is resolved for no apparent or identifiable reason, pain sufferers, particularly those on opioid medications, are often viewed with skepticism by their doctors, insurance providers, even family and friends. In the worst case, being viewed as neurotic, hypochondriac malingerers creates an even greater mental and emotional burden for the individual, in addition to the never-ending physical pain.

Let’s look at how pain occurs. Acute pain, like when you accidentally stub your toe or cut your finger, is ‘regular’ pain which acts as a warning to tell us that something has gone wrong in the body and needs attention. Nerve signals are sent to the brain, which is the critical ‘command center’ for dealing with the pain, wherever it occurs in the body. In the case of the cut finger, the body responds by generating blood platelets to the cut to stop the bleeding capillaries, sending white blood cells to battle any incoming bacteria, and beginning the process of repairing the wound itself. Skin metabolism moves into high gear and skin cells form a protective scab over the cut. After a relatively short time, the pain subsides and disappears as the physical injury repairs itself. The pain has served its purpose, and eventually disappears.

However, for many people, traumatic incidents such as a car crash, slip or fall or an unsuccessful surgery create pain issues which seem to take much longer than expected to heal. It is not uncommon to hear from people who suffered trauma (such as being in a car crash) in their much younger years, who still feel aches and pains in the damaged body part, often with crippling results. The need to constantly redirect actions in their current daily lives, shielding or protecting the painful area, and generally working around this ‘phantom’ pain create a physical, mental and emotional burden that can affect their work and home lives as well as their relationships. Depression, anger, loss of interest in life are often undesired side effects in their battle with their very real pain. When this occurs, chronic pain is the result. Chronic pain is now considered a disease in and of itself, and manifests as joint pain, muscle pain or nerve pain, resulting in diagnoses of arthritis, sciatica, fibromyalgia and other serious conditions. Chronic pain can linger for weeks, months, years, decades --- becoming an all-encompassing state of mind and bringing limitation and unhappiness that seem unsolvable.

Have you ever heard the expression “pain --- it’s all in your head?” Well, technically, this is true. No matter where the pain occurs in the body, pain is actually constructed entirely in the brain. This does not mean that the pain you experience is any less real --- it’s just that your brain literally creates what your body feels, and in the case of chronic pain, over time your brain helps perpetuate it. Chronic pain is an interconnected body/brain problem, and slowly, without even knowing it, we fall victim to our “pain brain.” We are all familiar with the concept of the body’s immune system attacking itself in diseases like rheumatoid arthritis and lupus. In much the same way, the “pain brain” constantly generates pain signals that affect our entire body and psyche, leading to sleep issues, anxiety, fear, anger and frustration with our symptoms. Many people visit doctor after doctor, specialist after specialist, searching unsuccessfully for a magic pill or solution to the pain that they are experiencing. Instead, we need to understand how our “pain brain” develops, and what we can do to take charge of our health and improve our quality of life, returning to our youthful, active, happy, healthy selves.

So, how exactly does the “pain brain” evolve? Our brains are magnificent organs, and they are ‘neuroplastic,’ meaning that the brain has the ability to form and reorganize synaptic connections and generate new neurons (nerve cells.) Neuroplasticity allows the brain to compensate for injury and disease and to adjust its activities in response to new situations or changes in the environment. This is evident when someone suffers a stroke, and must ‘relearn’ past functions as complex as speech and movement. Neuroplasty also comes into play when learning a new language or skill --- the brain creates new neuron pathways to realize the desired learning. So, in the case of the “pain brain,” how does the brain ‘go wrong?’ Your central nervous system (CNS) ‘remembers’ all the myriad details of the painful event (or events) and physically remodels your brain, which literally changes in response to the physical and emotional experiences of the event. Your brain then becomes an inflamed, aggravated, hypersensitive version of its former pain-free self.

How exactly does this happen? It starts in the amygdala, located in the center of the brain, atop the brain stem. The amygdala is known as the ‘reptilian brain,’ as it is the earliest, most primitive part of our brains, as well as its emotional center. The amygdala is responsible for our ‘fight or flight’ response, dating back to our caveman days when, as we learned in school, we had to fight, or run away from, life-threatening sabre-toothed tigers. When the amygdala is over-stimulated, as when we are in chronic pain or stressed by the hectic pace of modern everyday life, it sees bad news everywhere. The part of the brain responsible for ‘calming down’ the amygdala is the anterior cingulate cortex (ACC,) as well as the insular cortex (IC,) both key processors of pain information. The anterior cingulate cortex is involved in several complex cognitive functions including emotional empathy, decision-making and impulse control. The insular cortex is responsible for sensory processing and motor control. The hippocampus, the area of the brain responsible for learning and memory, is also affected. Disruption to the activity of the hippocampus affects our ability to fully enjoy memories or learn and experience new things. When continual stress, emotional distress and negative thinking are present, together with the influence of stress hormones such as cortisol, the resiliency of the brain is taxed and these key pain processors are unable to achieve homeostasis. Physical changes to the brain make it difficult for chronic pain sufferers to make decisions, focus, reason or control their emotions. The unremitting stress makes it impossible for the central nervous system to calm down, leading to the condition that neuroscientists have dubbed ‘central sensitization.’ Simply put, the “pain brain” is always hyper-aroused and on edge, feeling everything more intensely, including the sensations of pain.

Now for the good news! New technology and research is increasing our understanding of the way in which our “pain brains” operate. This new area of pain research and analysis is known as “biopsychosocial.” The emerging field of biopsychosocial medicine differs from traditional allopathic medicine in that, instead of focusing on pathophysiology and disease, it considers all biological, psychological and socio-environmental factors and their complex, intertwined effects on one’s total health. The new field of biopsychosocial pain management addresses beliefs, emotions, expectations and situations that cause people to experience pain in their own particular way. Biopsychosocial methods don’t mask or numb pain --- instead, pain sufferers learn to manage or ultimately eliminate pain by modifying or changing what their brain is telling them. These methods are non-pharmacological, and encompass visualization, relaxation, ‘distraction,’ and spiritual and integrative therapies. Since pain varies as a result of mood, attentiveness and circumstances (pain professionals often view pain itself as an ‘emotion,’) we hold the power within ourselves to make the necessary changes to ameliorate it. The key to successful pain management in the long term is openness and willingness to seek and try out the various progressive pain relief methods and techniques that appear attractive to us, with the goal of finding and utilizing the best modalities for each of us personally.

In my monthly articles, I’ll unravel many of the common misconceptions about pain and provide insights into innovative new methodologies that are slowly being integrated into the medical mainstream. You are sure to find subjects that you will find intriguing, and I’ll provide resources to lead you forward into exploring the many topics presented. You may choose to look into structural therapies like chiropractic for the first time, or try out one of the dozens of ‘touch therapies’ like Swedish or deep tissue massage. Expand your horizons with movement therapies like yoga, Qi Gong, tai chi, stretching, dance and many more. More ‘spiritual’ approaches like Reiki, various forms of meditation, and mindfulness techniques might be for you. Above all, I want you to feel encouraged and inspired to resolve any nagging pain issues you may have, as you do have the power inside you to do so. Pain has been with us since the dawn of time, but we do hold the means to control it. As the Roman philosopher Seneca wrote two centuries ago: “We are more often frightened than hurt, and we suffer more from imagination than from reality.” I hope you will enjoy travelling with me on this journey. Until next time, wishing you a happy, abundant and pain-free life!