Are you afraid of doing certain types of exercise due to old injury or recurring pain? Then maybe you need to take a more holistic approach and look outside the mechanical box if you’re trying to get to the root of pain
When we feel pain, we immediately worry about some damage we have done to our muscles or joints. Pain first and foremost is a very real experience felt by everybody. It is, at its most simple, a way to keep ourselves from doing any more damage. Or doing any damage in the first place. The problem with pain is, it’s not that simple. What we do know, is that it’s a terrible indicator of tissue damage. It’s very complex. So how do we get to the root of pain?
Pain is 100% an output of the brain and the nervous system. The problem is that tissues heal quite quickly, however, the nervous system is a sentimental sucker and holds on to the fear of that injury ever happening again. And how does it tell us it’s afraid? You guessed it. Pain! Pain is an alarm, a warning signal from the nervous system to tell us what might be up. The problem is, it’s not all that great at determining how big that threat actually is. Think of it like a smoke alarm in a house. The same alarm will give exactly the same signal for a full on house fire, as it would if you were cooking sausages in the kitchen. It doesn’t discriminate. Or consider a paper cut. Completely insignificant, but stupidly painful, yet people have been known to walk around with a dagger in their head and feel absolutely nothing!
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If you’re someone in pain, especially for the past six months or more with no answers, ask yourself some questions. Start looking outside the box, and figure out if there are other psychological, or social/emotional factors at play. Let’s start with the biopsychosocial model of pain.
The BioPsychoSocial model of pain: Getting to the root of pain
There are a myriad of other factors which affect pain and injury in the body such as stress, sleep, social factors, emotions, chemical, autoimmune and so on. We all too often simply focus on the mechanical side of things (slipped discs etc) and people wonder why they can’t get to the bottom of their pain or injury.
The BPS model of pain looks outside the box and considers the different things that can influence our pain experience. It’s split up into three distinct categories, however they are not mutually exclusive. But it is all about getting to the root of the pain.
Think tissue damage, trauma, breaks, sprains, muscle tears, and so on.
How you feel about your pain? What you believe about your current state or how “damaged” you believe you are?
Let’s consider the psychological, or how you feel about your injury. If you think it’s bad, it will be bad. It’s that simple. And the more pain you feel, the more you worry. The worse the fear, the more you avoid certain movements. Infact, this is called the fear avoidance model. Psychologically, we are making our pain worse.
Nocebo is the evil twin brother of placebo. Whereas placebo can trick us into feeling better, nocebo, does the opposite. Think how bad you would feel if you were a 20-something active person, and went to a doctor or a physio and you were told you had the back of a 70 year old? You now become fearful that you will do more “damage” to your back. The words used have a nocebo effect. They have served to make our perception of ourselves and our pain worse.
What has your pain stopped you doing? Do you worry about what you can’t do? Do you pay attention to people’s opinions and interactions with you regarding your pain? When people say things like “mind your back doing that” does it bother you?
The most common thing I hear people with pain say is: “I’m just afraid I’ll never be able to do xyz again”. Fear is probably more of an indicator for pain than any physical intervention. Fear creates a state of panic in the nervous system (fight or flight) and can cause tension, hyper excitement in the nervous system and avoidance of a certain movement. This just feeds the cycle, creating more fear, more guarding and so on.
Stress and sleep are two on top of the hierarchy. Heightened levels of stress release a hormone called cortisol. This can be a good thing in some circumstances as it heightens our fight or flight response so we’re ready to act in times of danger. However, chronic stress means we are constantly in a state of fight or flight. Which results in tight muscles, heightened nervous system, adrenaline spikes, and shallow breathing. All these influence the alarm in our brain, ie pain. So it stands to reason, the more stressed you are the more pain you are liable to feel.
A solid night’s sleep has an essential part to play in a healthy body and a healthy mind. It is proven that people who get six hours of sleep or less on any given night have reduced physical and cognitive function and heightened levels of cortisol. It can lead to stress and sleep deprivation, which we know can ultimately lead to pain.
Mark Hamilton is a chronic pain and sports injury therapist. For more information, visit hamiltonpainandinjury.ie