“It’s all in your head”…

Every therapist knows never to say this because it sounds kind of insensitive and dismissive. But hear me out! An understanding of the role of your brain in pain can be really helpful in becoming pain free…

A friend with chronic pain recently told me “I wish someone else could experience my pain and tell me if it’s really as bad as I think it is”. Of course it’s really helpful to have people around you who are sensitive to your pain. But at the end of the day it is your pain and your experience. If it affects your life, your function, or your mood then it matters to you and that is enough to make it valid. Whilst it’s important to recognise that, the topic of pain as perception is really interesting and that’s what this post is about.

Pain Is A Perception

Me and my Mum have this running joke that my Dad is colour blind. He has a shirt that is clearly blue but he calls it his “green shirt”. It’s just a joke, but does he see the same colour as us and call it differently? or does he actually see it as a different colour? Pain is kind of similar. This is why I don’t really use numbered pain scales – one person’s “4/10” is another persons “9/10”! It’s more useful to know whether the pain is bearable or not, and whether it changes to become better or worse.

It’s All In Your Head

It may sound a little hippie, but pain is a perception. Perception means the ability to become aware of something through the senses, and the way that we interpret or process it.

Our bodies are full of little receptors that collect information and send it to the brain to be processed. This is how we are able to interact with the world, use our senses, and maintain homeostasis. The receptors are very specialised.

The receptors that detect pain are called nociceptors. Nociceptors protect us from harm. For example if you accidentally put your hand too close to a cactus, it’s the nociceptors that alert the central nervous system (CNS) to danger and trigger the reflex arc that automatically pulls your hand quickly away from the spikes! The event will also be “saved” to our memory and contribute to learning “cactus = pain” so we know not to get too close again.

When It Goes Wrong

Obviously, being able to perceive pain is really important as it motivates us to act in ways that are good for survival!

People with the rare condition Congenital Analgesia cannot feel pain (and are born this way). As infants they may not learn to avoid danger in the same way as others. At all stages of life there is a risk that they could suffer from a serious injury (such as a deep cut or bump to the head) without realising. Congenital analgesia is caused by a gene mutation that interrupts the normal function of the nociceptors. But what about people who feel too much pain?

My treatments are guided by my client’s pain. In some cases this means that a very small amount of pressure can elicit a very large amount of swear words. This isn’t always easily explained by recent trauma and we know that (whilst it is always useful to strive towards “efficient posture“) bad posture or abnormal biomechanics doesn’t always equal pain. So what else could be going on?

In some clients there may be influence of memory. As noted earlier, pain is a strong influence on memory and learning – if it hurts once, don’t do it again. So if you have previously had an injury that caused pain in a particular range of motion you may avoid using that range of motion even once tissue damage has healed.

Central Sensitisation

But rather than just consciously avoiding a once-painful movement, some clients actually still feel pain in that range, and we know that pain can occur without any tissue damage at all.

If you liken the body to a car, both the car and the body have many different working parts that can go wrong. In your car, if a problem occurs, a mechanism is triggered to switch on a light on your dashboard. In your body, if a problem occurs, a mechanism is triggered to send an alert to your brain. If the brain deems the message credible then you will percieve pain.

Central sensitisation suggests that we can feel pain when the message isn’t credible (no tissue/cell damage). It’s as if the light on your dashboard has come on but actually the car is fine!

What Can I Do?

Although this post talks about pain that ‘isn’t’ pain, as stated at the start of this post, your experience matters. Whether your pain is due to tissue damage or a clunky nervous system, you still deserve to feel better!

First of all, if you are in pain it’s always advisable to see a specialist or your GP who can help you to get a diagnosis.

Your pain may be chronic or acute, long term, or temporary. But if you choose to come in for some soft tissue therapy, here are a few things I might do with you:

 

  • Muscle Energy Technique – a nervous system hack that helps to reeducate the CNS about safe ranges of movement.
  • NMT (within your pain threshold) – Using sustained pressure to desensitise trigger points.
  • Mindfulness and acceptance – observing and accepting different thoughts and sensations. Challenging unhelpful belief systems. If a lot of work is needed here I can recommend other therapists (e.g. talking therapies, EFT practitioners etc.) who can help further.
  • Problem solving – what adjustments could you easily make to make it easier to live with your pain?
  • Early mobilisation (for acute injuries) – using and increasing range of motion as soon as safely possible to reduce the risk of unhelpful belief systems forming

To Sum Up…

Pain is very complex and can occur with or without tissue damage. Pain is often an alert to danger or damage. But sometimes the alarm can be too sensitive and sends inappropriate pain signals. There are techniques that can help to reeducate the nervous system and the belief systems that surround our pain.

If you would like to chat about your pain or book an appointment, click here or call 07858107595!

Examples of specialised receptors:

  • Photoreceptors in your eye detect light.
  • Golgi tendon organs (GTOs) in the tendons detect tension.
  • Thermoreceptors in the skin detect temperature.

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