Recently, I was asked to record an audio lecture on some of the changes that occur in the nervous system with chronic pain. One point I made is that clinicians often do a poor job of explaining how pain works to their patients. I then realized that I often do a poor job at this as well! So to try and fix years of errors, I’m writing this post to help my patients understand how our bodies produce pain. Since we all like lists, let’s go through four of the biggest pain myths.
Myth #1: Our body detect pain.
Truth: Our brain CREATES pain.
The idea that our bodies feel or detect pain is easily the biggest of all pain myths. So why do we actually feel pain? Because our brain PRODUCES pain. Yup, when you feel pain, it is always “in your head.”
Step on a Lego? Pain produced by your brain.
Bend over and “throw” your back out? Pain produced by your brain.
Burn your hand on a fire? Pain produced by your brain.
What can our bodies detect? Danger, or potential danger. We have specialized nerve cells that can detect pressure, temperature or chemical changes. So if you were to be poked by a hot needle in your left thumb, those neurons would detect the temperature of the needle, the pressure of the needle and the chemical changes as tissue is damaged. These danger signals are then relayed to the brain and the brain uses that information to create pain.
Now you might say that it doesn’t matter where the pain is produced, as the amount of damage is what determines the amount of pain anyways. Well, that’s wrong as well.
Myth #2: The level of pain is related to the level of tissue damage
Truth: Pain levels are very, very, very poorly correlated with levels of tissue damage.
Let’s look at some examples.
Example #1: A soldier is shot in battle and experiences no pain (lots of damage, no pain)
Example #2: Person born without a limb has intense pain in a hand that isn’t even there. This is called phantom limb pain (no damage, lots of pain)
Example #3: X-rays/MRIs of pain-free individuals often show high levels of degeneration, disc bulges/herniations, torn muscles, etc. (lots of damage, no pain)
Example #4: A construction worker steps on a nail which goes through his foot and he experiences horrible pain. At the hospital, clinicians have to give him high levels of morphine before they can even attempt to take off his boot. Once they remove it, everybody realizes the nail went between two of his toes and didn’t even leave a scratch mark! (no damage, lots of pain)
All of these cases are well documented in the literature. As you can easily see, pain does not correlate to tissue damage! Why is this? Because our pain system works as an alarm system.
If we’re in a battle and get shot, our brain might not want to alarm us of the pain. Doing so would cause us to fall down in agony and potentially be killed. So in that instance, the brain decides it’s better to wait to create pain until the soldier is somewhere safer.
If we look and see a nail sticking through our boot, our the brain might just go ahead and assume that it went through the middle of our foot and create lots of pain. It wants to alarm us so we can go to the hospital and get treatment to avoid an infection or more damage.
If a muscle or joint slowly degenerates over time, our brains know that these changes aren’t a big deal and it’s just a part of this wonderful thing called life. Thus, no pain is created even though your x-ray or MRI might look horrible.
Just like the alarm system in your house or car, the alarm system in our bodies is basically a very complex electrical process. Like anything electrical, it doesn’t always work correctly. Phantom limb pain is an example of that. Many cases of chronic pain fit into this category as well. In these cases, those special nerve cells might be detecting lots of danger even when there isn’t any actual danger present. Also, the brain in patients with chronic pain becomes very efficient at creating pain, and very inefficient at decreasing pain.
Myth #3: Pain during an activity means damage is occurring
Truth: Hurt does not equal harm.
Since pain is poorly related to tissue damage, it also means that pain is not always a signal that damage is occurring. Many people believe that if they experience pain with a certain activity or exercise this means they should stop immediately. This is not always the case. Sometimes, pain is necessary for an exercise to be effective. We wrote a whole other blog article on recommendations regarding pain during activities so click HERE to read more about this topic.
Myth #4: Pain is only influenced by biological “parts” (muscles, joints, nerves, etc.)
Truth: Psychological and social factors are important for pain treatment.
As mentioned above, any time you have pain it is produced by your brain. A lot of factors play a role in the production of pain apart from what is happening in our muscles, joints, discs or nerves. If our brain is stressed, this makes it harder for our brains to decide what should or shouldn’t be painful. As a result, we often feel more pain if we’re fatigued, or depressed, or struggling financially. All of these issues ramp up our nervous system and make it easier for our brains to produce pain. That’s why if you’re dealing with pain, it is very important to address all aspects of your well-being and not just focus on things like exercises and posture.
Psychological factors can also be the main source of pain as well. John Sarno MD wrote about this extensively. He coined the term “tension myositis syndrome” (TMS) for pain conditions caused by psychological issues. These psychological issues for TMS ranged from simply a Type-A personality to a history of prior abuse to depression. Treatment for TMS consists mainly of education, writing/journaling about emotional issues, resumption of a normal lifestyle and possibly psychotherapy. If you’re interested in learning more about Sarno’s works, check out his book The Mindbody Prescription.
Hopefully, you have learned a thing or two about these common pain myths. In short, 1) pain is produced by the brain, 2) pain is not correlated to tissue damage, 3) pain does not necessarily mean harm and 4) pain is related to emotional health and wellbeing. So the next time you experience pain, keep these things in mind and you might very well find yourself recovering faster!
Jeff Remsburg, DC, MS, DACRB, Cert. MDT