EXPLAIN PAIN!! THE WHY & HOW.
First of all, I would like to apologize to everyone who is reading this article. I apologize for the fact that you have pain, whether chronic or acute, that may be as a result of unfortunate circumstances or the result of an inadequate health care system. Pain is very misunderstood even in the medical community. Chronic pain sufferers can be stigmatized because of this lack of understanding. Currently, one in four Americans have chronic pain. That’s 75 million people! I want to reassure you that there is an answer. There is a physiological reason WHY you have pain. I want to convince you that the pain you feel may not be coming from where you think and feel it is. You WILL get better. Let me explain your pain!
Anatomically, we are essentially all the same. Each of us has approximately 206 bones, 640 muscles, and 400 nerves in our bodies. Our spine consists of 24 vertebra which are attached via ligaments and muscles to our head at the top and to our sacrum and pelvis at the bottom. Each vertebra is separated from the next via our discs. At each vertebral level, there is a spinal nerve that exits a small hole called a foramen. This nerve is the connection between your spinal cord and the rest of your body. Each spinal nerve sends branches to specific locations in your body. They connect the muscles adjacent to your spine to the small nerves at the ends of your fingers and toes. Think about your spine as the tree and the nerves as all of the branches.
Your nerves respond to any and all types of stimulation such as touch, temperature, pressure, pain and relay a message thru the spinal nerve to your spinal cord and then up to your brain. Impulses and/or commands from your brain are then transmitted back down the spinal cord to the spinal nerve and out to the targeted area. This communication system is active ALL the time. Our brain determines whether we are consciously aware of it or not. For example, if you are running from a lion attack and step on a tack do you think your brain will tell you “Ouch! Stop. You stepped on a tack?” Hopefully not or else “Dinner is Served!” So what happens if something goes wrong with this system? What happens if this system becomes over-sensitive?
As mentioned above, we have 400 nerves in our bodies. That amounts to 45 MILES of nerves! So how does a nerve “talk” to the brain? At rest, a nerve is always “listening”. Every nerve has a certain threshold that, once surpassed, will generate an electrical signal (called an action potential) that will be sent thru the spinal nerve to the spinal cord and up to the brain. If the threshold isn’t reached, then the nerve just continues to “listen”. For example, how long does it take for you to shift your weight while sitting in the movie theater? The threshold of your “buttock nerves” has been surpassed when your brain tells you to shift your weight. This threshold is different for everyone. In the diagram below, you can see that that the resting state of the nerve is at a certain level while it is “listening”. After the action potential occurs, the nerve returns to its previous resting state. However, in certain circumstances, the nerve does NOT return to the previous resting state and the nerve remains in a heightened state. It is essentially MORE sensitive, or hypersensitive, and will fire an impulse much more easily.
After an injury, 1 in 4 people experience this heightened nerve state. Why? The answer has a lot to do with the individual’s response to stress. For example, people that get injured in a stressful environment such as a car accident, playing competitive sports, or a stressful job are 7-8x more likely to develop a chronic pain syndrome. In addition, emotional responses to the injury such as worry, fear, and anxiety perpetuates this stress cycle. To use the lion example above, this fear is like an ongoing emotional lion attack to the nerves of a chronic pain sufferer. The Kendall study found that the biggest predictor of developing chronic pain is FEAR! Fear that your pain will not go away. Fear that your life will never return to normal. All of these responses have one thing in common physiologically, they release both inflammatory chemicals and several stress hormones including one that I am sure you have heard of called ADRENALINE.
Throughout the length of our nerves, there are channels or pores that open or close in response to physical or chemical stimulation. They are called ion channels. The amount and type of ion channels are based on our genetic coding as well as what our brain THINKS we need to survive. Ion channels live for only 48 hours so the amount and type is always changing. When the channel is closed the nerve is “listening”. When it is open the nerve is “reacting”. During cold weather we produce more temperature sensitive channels. During times of stress or fear we produce more adrenaline sensitive channels. The more that we focus on the pain, the more that our brains perceive a threat and continue to send inflammatory chemicals and adrenaline into the area. This response is like a constant “knock on the door” of the ion channels. Regular ion channels stay open for milliseconds. Certain adrenaline channels can stay open for up to 5 minutes! As a result, the nervous system up-regulates and becomes much more sensitive. Can you see the physiological link now between your emotions and your nerves? The initial trauma or injury caused your pain, but it is your BRAIN that perpetuates the pain.
Logically, your next question would be “Is that what’s wrong with me” and “How do we know this?” The explanations are based on what we know about nerve science. We know that you have a pain syndrome based on your physical examination and what you have told us about your pain.
Your next question may be “Why did this happen to ME?” As I mentioned earlier, 1 in 4 people after a traumatic event develop chronic pain. The greatest predictor of chronic pain is uncontrolled acute pain from the injury. Medications, icing, rest, bracing are important strategies in the beginning. Our brain determines our pain tolerance and everyone is different in this regard. Having high levels of stress chemicals in our system not only perpetuates the pain cycle, it also leads to chronic fatigue, depression, mood swings, and sleep disorders to name a few.
So then, “What can we do to treat it?” Our objective is to determine what we can physically as well as mentally do to control your pain. The more that you understand your pain, the more control you have over your brain. Studies have been done that demonstrate a significant reduction in perceived pain just by understanding the physiological process. So re-read this article several times until you REALLY get it. Doing this means you are already moving in the right direction! Choosing the right medications is an important part of the healing process as well. Non-steroidal anti-inflammatories (NSAID’s) such as ibuprofen and Aleve may help. Medications such as Cymbalta, Lyrica, and Neurontin(Gabapentin) function by plugging the openings in your ion channels. Narcotics such as morphine can actually make nerve pain worse! As a side note, your brain can produce pain relieving chemicals that are 50x more powerful than any drug that your doctor can prescribe.
So how do we turn on our brains? As I mentioned earlier, education is the key. The more you know, the more you control. Secondly, choose your foods wisely. Tryptophan is an amino acid that cannot be produced by our bodies. It is a powerful precursor to the “happy” hormone our bodies produce called serotonin. High levels of serotonin can also aid in plugging holes in ion channels. Serotonin is also a precursor to melatonin which plays an important role in mood and sleep disorders. Foods with high levels of tryptophan are turkey, bananas, soy products, tofu, almonds, sesame seeds and walnuts. Lastly, the right type of physical activity is key to controlling your pain and normalizing your nervous system. “Move it or lose it!” certainly applies in this case. There is Gold Level evidence in the literature that aerobic activity performed daily for 10 minutes at 50% max effort can reduce chronic pain. Aerobic exercise cleanses our system of inflammatory chemicals and stress hormones. The most important things that our nerves need to heal are proper movement, adequate space to move, and lots of blood! Our nerves constitute 2-3% of our body weight and use 25% of our blood. The circulation to a nerve will be cut off if the nerve is stretched more than 7-8%. It is very important to determine what kind of movement and/or irritability is occurring in the nervous system. We call this nerve movement “neural dynamics”. Stretching a nerve is NOT something that you want to do. A qualified physical therapist will perform a thorough assessment of your neural dynamics and establish an appropriate plan of care to restore proper and painfree nerve mobility. Manual techniques such as soft tissue and joint mobilizations, Primal Reflex Release Techniques and spinal manual traction can also be beneficial. Hands-on techniques can help to retrain your brain and to desensitize the system. Proper diaphragmatic breathing is also key. If you don’t get enough oxygen, how will you feed your healing nerves?
Once again, I apologize to everyone who has read this article. I know that having pain every day must be very difficult and challenging. I want you to know that there is HOPE. Reading my article is only the beginning. Please let me know if we can help you further.