Don’t Let Pain Hold Your Brain Captive

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Don’t Let Pain Hold Your Brain Captive

People tend to gloss over the things they think are “basic” or “common sense,” like sleeping an adequate amount (7-8+ hrs.) or paying attention to their mindset. Ironically, these are arguably the most powerful and controllable factors you can influence.

Don’t think it’s important? Tell that to the 180 patients that were split between knee arthroscopy surgery and a sham surgery (incisions and simulated procedure), who showed no significant difference in follow ups [1]. These are people who had pain before and then improved following a surgery that never actually happened…

Is there an illusion to getting “fixed?”

After exhaustively studying physiology and biomechanical factors for pain, scientists and clinicians have started to look deeper into psychology. “Pain Science,” for lack of a better term, has opened our eyes to the emerging view that pain is more than a simple cause and effect.

It’s well established that there can be an “issue in the tissue” but no pain. Plenty of research has shown that people with hip labral tears, rotator cuff tears, or disc herniation can all be asymptomatic. Take a look for yourself.

 

  • In 2016, 100 Olympians were given an MRI of their spine and 52% had moderate to severe “spinal disease” with no symptoms [2].
  • Another study found that 81% of asymptomatic people had disc bulges or annular tears [3].
  • “72% male and 50% female elite soccer players had radiographic impingement (FAI) despite no symptoms.” [4]
  • “Mental Health has a stronger association with patient-reported shoulder pain and function than tear size in patients with full-thickness rotator cuff tears.” [5]
  • “Structural measures of tear severity have no correlation with reported pain, symptom duration,or the patient’s activity level” [6]

What gives? Could your MRI possibly be “wrong”? Or maybe we can stop with the human and car analogy. Cars are machines with parts. Humans are complex, living, adaptable organisms influenced by emotional, psychological, and physical inputs.

The Pain Experience

It may be more helpful to view pain as an experience. Think about one of the best (or worst) experiences of your life. You can likely remember exactly how it made you feel, maybe you even feel it right now. Or maybe you got food poisoning once and now when you think of or see the food, you physically feel sick.

Pain is no different. Your previous feelings and thoughts influence your current state of mind. The mind programs how the brain will function. The brain then governs every movement we make. So if you’ve dealt with knee pain in the past and then re-injure your knee, your nervous system is hyper-sensitive to this experience.

You build a model in your brain of what “knee pain” means to you. Maybe you expect stairs to bother you, or purposely move less to “guard” this injury. These expectations are weighted heavily by your brain and form new beliefs and movement patterns.

And what happens if you violate this model? What happens if you trained step-ups to be stronger and found different ways to challenge this pattern without pain? If it’s violated enough, you adapt and build a new, more resilient perception.

Your Pain is Still Real

However, just because anticipating pain or catastrophizing an injury can make it worse, doesn’t mean the pain you experience isn’t real. It just means that sometimes your perception of the “injury” or “damage” can be wrong, and the pain can simply be an error or overestimation. Through appropriate movement and awareness, this can be significantly improved.

I will finish with a quote from one of my favorite authors on the brain, Moshe Feldenkrais.

“Most conventional treatments assume that function is wholly dependent on the “under-lying” bodily structure and its limitations. Feldenkrais discovered that his pupils’ difficulties were caused as much by how their brains learned to adapt to their structural abnormalities as by the abnormalities themselves.” 

 

[1] https://www.ncbi.nlm.nih.gov/pubmed/12110735?fbclid=IwAR27M2t221bO5MKEwqyPH2XYzodiL8bdIO1OOc8cHEca9OKyt-7DtEFhpkU

[2] https://bmjopensem.bmj.com/content/4/1/e000335

[3] https://www.ncbi.nlm.nih.gov/pubmed/9423651

[4] https://www.researchgate.net/publication/221841213_The_Prevalence_of_Radiographic_Hip_Abnormalities_in_Elite_Soccer_Players

[5] https://www.ncbi.nlm.nih.gov/pubmed/26888672?fbclid=IwAR1r9edGGAyUqIbIklEsy1qHBelKDdINosFAMfGVcB72WOTHiUrPhGrlHzY

[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4018774/

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