Special Topics
Pain
Is it all the Brain
A couple of years ago I went on a course run by NOI (Neuro-Orthopaedic Institute). I had heard about their research into the nervous system and how they were developing methods to help people with long term pain.
I found the information fascinating and straight away started sharing the techniques with some of my patients who were very impressed with the results. On the course we discussed some of the latest ideas on the nature of pain and that is what I am going to share here.
At its simplest we can define pain as the experience we have when the brain gets too much information coming in through the sensory nerves. This obviously has survival value. If your body is injured or under attack the brain needs to know about this urgently so that it can activate survival programs.
Imagine you are listening to some quiet background music while going about your daily routine. Suddenly the familiar music sounds different, your attention shifts to it and you may turn up the volume while you try to work out what is different. Maybe this is how part of the brain works, listening to the "background music" of the sensory nerves. When something changes it turns up the volume to "listen" more closely and this is what we experience as increased sensitivity or pain.
The things most likely to cause you harm are mechanical injury, poison or infection. Looking at things from an evolutionary perspective, what are the best responses to defend yourself? If you are poisoned because of eating or drinking something harmful your body wants to eliminate the contents of the stomach and gut quickly. If there is a physical injury you need to minimise movement and minimise bleeding. If there is infection you want to minimise movement and generate inflammation to heat the area and bring in a strong immune response. Most adults will have had first hand experience of each of those three types of defence mechanism. And since you are reading this explanation the defences have obviously succeeded in keeping you alive.
But what if the information is corrupted, what if part of the brain thinks there is something wrong when there isn't really a problem. What if the alarm is raised and the body goes into defence mode unnecessarily? The pain stops you moving, the inflammation adds to the pain and if it gets too bad you might be sick for good measure. What if the defence mechanism actually perpetuates the problem and instead of getting better quickly you end up with chronic pain and disability?
This is exactly what we think happens. The system designed to monitor the health of your body can be fooled into thinking there is a serious life threatening problem when there isn't one. One of the ways the brain monitors health is by watching how easily the nerves move. Every time you move your nerves slide, stretch and glide inside your body. The brain constantly gets feedback from the nervous system; even the big nerves have smaller nerves to report on what they are doing. If the brain notices that a nerve is not moving normally it either increases the sensitivity or sounds the alarm. So you have pain and possibly inflammation.
Traditionally we treat the symptoms. Anti inflammatories and painkillers are dispensed routinely and can be helpful but what we really need to do is get the nerves gliding freely again, then the brain can be reassured that there is no further need of pain or inflammation.
In practice this often means developing individual exercises for patients to restore nerve mobility and for simple chronic injuries this works well.
The latest research is looking to expand our understanding of "regional pain syndromes" where patients suffer pain in many areas simultaneously. There is a possibility that this is connected to brain patterning, rather like being left or right handed and experiments are under way to try to find out more.
If you would like to take part in a useful experiment to understand more about how the brain sees the world please click on this link (http://research.noigroup.com) and join the online survey, decide which way the heads are turned - the aim is to have 1000 participants for this piece of research. |