Who is turning the volume up?

Some mechanisms of pain to consider.

I mentioned in the last blog, a little bit about the meaning of pain, and I guess I wanted to explore this further. How does thing get in the way, hold us back, and make us feel not like ourselves. It’s amazing to me, that something that is so universally experienced, is so poorly understood. So I’m hoping that my over-zealous engagement in pain science can be translated here, so that after reading, your understanding of pain has improved, and as a result, it is maybe just a little bit less scary.

So you can’t talk about pain with out mentioning the big boys. Ron Melzak and Patrick Wall. In the 1960’s, they made the biggest discovery and theoretical contribution to the field of pain science – the “Gate Control Theory”. The basic premise of their theory was that pain is not a predetermined response to an input, and it most certainly is not proportionate. What does this mean? A cut on a finger, a broken bone, a sprained ankle, a burn or a head knock, won’t equal the same amount of pain for each person. There is no way to predict what a particular input will feel like or how much pain will be experienced. In other words X does not equal Y.

Instead, due to the way our nervous system is wired, an incoming “danger” signal from our tissues, or an outgoing “pain” signal from our brains, will actually be morphed, modified, increased or decreased in our spinal cord before the message gets sent up to the brain to be interpreted.

It’s pretty phenomenal actually. On the way up from the site of input to the brain, these “pain” signals are changed. There’s a whole bunch of tiny little chemical messengers known as neurotransmitters, that can excite (make bigger) or inhibit (make smaller) a pain signal. I’m sure most of you reading this will have heard of things like adrenaline, serotonin, opioids, GABA and glutamate, these are all different types of neurotransmitters which basically communicate with our “pain” signals. I like to imagine these little guys fighting over a volume knob, some winding it up to ear blowing levels, others saying “shh shh” quieten down. They tell them to get louder or softer, and therefore have a major impact on the final intensity of pain we will experience.

There is a normal amount of modulation that should occur even with the most ‘basic’ of injuries or pain signals, but unfortunately when someone has experienced pain for a long time, this ability for modulation becomes more and more a part of the problem. Chronic pain states often go hand in hand with something called central sensitisation; a phenomenon where those chemical messengers can be ramping up the signals too much, are unable to dampen down the signals, or the signals themselves are coming at a faster, more intense rate. Additionally, sometimes non-threatening signals get confused with “danger” signals leading to ordinarily comfortable or even pleasurable signals being experienced as painful.

The thing that interests me most, and the reason why psychological support is so vital in managing your chronic pain, is that this “modulation of our pain signals” is massively influenced by our thoughts, feelings, and general psychological state. I’ve just described how in the spinal cord different messages communicate with each other to increase or decrease our pain experience. Our brain has direct connections up and down the spinal cord, so it makes sense that whatever is going on in our brain, what we are thinking, feeling, remembering, will in real time communicate with the signals in the spinal cord to also change the intensity of our experience. I know for a fact, that if I stack it walking away from a fight with my husband that the pain I feel will be way larger, then the pain I would feel if I fell over on the dance floor while rocking out to my favourite Kygo song. Our thoughts and feelings have unimaginable power in making our pain experience better or worse. Understanding this, reflecting on this, and observing this in real time is where psychotherapy treatment can be absolutely key to your recovery journey, particularly if you’ve been experiencing pain for a really long time.

So just to reiterate, X does not equal Y, and this little known fact is the key to your pain management program. If we can understand all the factors around your pain experience that are ramping up your ‘danger’ signals we can then understand the best ways in which to approach them - and hopefully gain some control over that volume knob to turn your pain levels off.

As always, please reach out should you have any questions about the above.

Warm and hope filled regards,

Gina