It is said that one in five Australians live with chronic pain, and yet it remains the most negated and misunderstood phenomenon world-wide. So, what if rethinking pain, or rather understanding the mind-body connection of pain more comprehensively could assist in the management and treatment of chronic pain? Or any type of pain for that matter.
I do believe understanding pain is the most important step you can take in choosing to live pain free, in fact there are three most critical points to consider when understanding pain. That pain is a culturally dependant concept, that pain is strongly founded in perception, and finally that the sensation of pain itself can be changed through meditation and the evidence that surrounds cortical mapping and re-mapping.
The Pain of Culture Dependant Perception
It is overtly evident that the culture in which we are raised in affects the way that we perceive and thus act in this world. Nothing is more true than of the concept of pain. Indeed, our cultural understanding of pain makes a vast difference as to how we perceive it within ourselves and thus experience it. Historian Joanna Bouke has found that not only has the perception of pain changed over the course of time, so too that there are many differing perceptions of the cause of pain. To name a few:
- Pain is Karma, people who are in pain deserve it;
- Pain has been inflicted by God;
- Suffering is God’s plan, and the use of anaesthetics only teach people to be soft and wimpy;
- Pain is shameful – Best to censor or be quiet about pain so as not to inflict it on others;
- The poorer you are, the more you suffer with less sympathy and less help.
These beliefs highlight that there is a distinct link between the physical and psychological aspects of pain and as Bouke suggests, one cannot exist without the other. Indeed, the psychological truth of the perception of pain, as discussed by neuroscientist, Dr Sylvia Gustin, has shown that chronic pain has a high comorbidity and association with anxiety and depression, due to falling levels of the neurotransmitter Gamma Amino Butyric Acid (GABA) in the brain’s thalamus. When someone is experiencing pain, depression, and / or anxiety, there is a disruptive processing of afferent signals from the body combined with reduced emotional control in the prefrontal cortex; indeed, in chronic and ongoing pain it has been shown that there is a decreased volume within the thalamus and the cortex, which ultimately creates a perpetual cycle between the perception of pain and the physicality of pain. And while yoga postures have been shown to increase thalamic GABA levels and meditation proven to increase the size and activity of the thalamus and prefrontal cortex, it is important to understand a little more deeply the interconnectedness between stress and pain, as it relates to how meditation for pain works.
Australian Professor and pain researcher Dr Lorimer Moseley:
Stress can contribute to nerve sensitivity or pain system sensitivity. Stress lives in the brain, and therefore the experience of people with chronic pain… often is that their pain increases as they become more stressed.
Mosely further comments on the perception of pain as modulated by subconscious and neuroceptively detected evidence of implied danger. Thus, any perceived stressor contributes to nerve and pain system sensitivity, perpetuating the pain perception.
Pain comes into consciousness. The brain doesn’t produce pain, the human does and the amount of pain you experience does not necessarily relate to the amount of tissue damage you have sustained. The exact amount or type of pain depends on many things. One way to understand this is to consider that once a danger message arrives at the brain, it has to answer a very important question: “How dangerous is this really?” In order to respond, the brain draws on every piece of credible information – previous exposure, cultural influences, knowledge, other sensory cues – the list is endless.
Dr. Lorimer Moseley, PhD
The question is how is the brain changing acute pain into chronic pain even when the tissue damage has healed?
The Amalgamation of Pain from Acute to Chronic
When tissues are injured there is both a sensory and motor reaction that moves between the peripheral nervous system (cranial nerves and spinal nerves) and is controlled by the central nervous system (brain and spine). A person who is experiencing what we know as pain is biologically perceiving an immune response to an injury –this is a response that takes sensory stimulus to the brain, the brain the interprets it and creates a biologically appropriate reaction to the stimulus – such reaction is based in many levels of past experience (as aforementioned by Moseley). Often, when pain persists over a duration of time the brain begins remapping perceptions and appropriate reactions in order to best protect the area of damage. Someone who experiences an injury over a longer duration of time, or someone who finds themselves perceiving the pain as an endless encounter will actually switch an acute response to damage to a prolonged reactive response, which in turn actually moves and spreads the perception of pain throughout the body. Indeed, studies of people in chronic pain have shown that their brain is actually unable to interpret or determine accuracy in pain signals – they are unable to distinguish blunt versus sharp pain, nor determine exact points of contact – i.e. whether the stimulus is where they are touched between two close, but different, points on the body. Their mind-body maps and the brain’s homunculus have been adapted, if not possibly stolen, and they continually register pain. This is the theory of competitive negative neuroplasticity – as the mind-body connection weakens, the perception of pain takes over and subtle changes in the brain begin to occur, physiologically, biochemically, and functionally.
Interestingly, and somewhat paradoxically, this same sensory adaptation of the perception of pain is true in what we understand as the placebo effect. It is important to note here that a placebo is understood as “an inert or innocuous substance” (Merrian-Webster) and its ability to reduce pain is referred to as placebo analgesia. Research shows that there are many factors affecting the efficacy of treatment in both acute and chronic pain. However, there are two main theories:
- The placebo initiates the release of natural painkillers called endorphins.
- The placebo changes the individual’s perception of the pain.
With this in mind, it is also important to note that genuine analgesics have been found to be more effective if a person knows they are actually administered the drug, rather than the drug being given without the person’s knowledge. Remarkably, our pain experience can be determined by what the physician is wearing when they administer the drug, and more interestingly the colouration of the pill taken can cause either a stimulating or tranquilizing effect: “Red, yellow, and orange are associated with a stimulant effect, while blue and green are related to a tranquilizing effect.” (Dr. A. J. de Craen, researcher, BMJ). Further to this some of the researched placebo’s that have been proven to be effective in pain reduction are:
- Choosing injections over a tablet,
- A larger pill over a smaller one,
- Two tablets over just the one,
- Capsules are stronger than tablets,
- The branding of the pill,
- How much you choose to pay for the medication.
Finally, it cannot be negated that, aside from the analgesia effects of medication, whether real or placebo, a clinician’s beliefs and expectations strongly influence pain outcomes. Those that are suffering from pain need understanding and reassurance in combination with treatment strategies that make sense to them and fit within their current lifestyle. Additionally, strategies within a contemporary model of evidence-based pain science are shown to gain higher response and commitment to the treatment plan.
With this in mind, how can we help someone in pain rethink pain?
Move Toward, Not Against
Pain is an opinion on the organism’s state of health rather than a mere reflective response to an injury.
Phantoms in the brain, by VS Ramachandran and Sandra Blakeslee
Pain doesn’t exist until it emerges into consciousness.
Dr. Lorimer Moseley
While the perception of pain is real, quite often there are situations where the level of pain experienced is not congruent with the actual physicality of the injury, or the true danger that the body tissues are experiencing. As highlighted above pain depends on the evaluation of an injury, the perception, reaction, and response – therefore it might be entirely reasonable to fathom that fear of future pain, or thoughts of persistence of pain could actually transform perception and convert sensory input into something it is not – i.e. non-painful stimulus into a painful response.
With this in mind, alongside the knowledge of competitive positive neuroplasticity, we can begin to fathom that if we make the relationship between the pain and the state of the tissues stronger rather than weaker, the pain desists. Thus, our perception and opinion of the pain changes. The mind-body connection becomes stronger and our experience of this “very painful” moment becomes more manageable, if not even somewhat non-existent. Yes, the perception of pain is very real, at the same time we cannot negate its protective purpose, and the ability of our minds to detect what is not truly there (this can be significantly seen in those who suffer from PTSD). When suffering from chronic pain, it is great to be open to the possibility that our perceptions and resultant cortical maps may not be as accurate as we think.
A change of perception might look like an approach that highlights a continual commitment to assessing and rethinking the experience of pain. This in turn can reduce our protect-by-pain strategies, fear of movement, even our pain opinions. We want to try and reduce any benign sensations from ordinary activity that may be misinterpreted as threatening, causing pain to emerge.
The best results I have found for myself when I suffered headaches and for others is moving towards the pain and really looking at the nature of it.
I have a very simple “meditation for pain” on Insight Timer that has helped many people around the World. I get many emails around the World thanking me for the change that it has made in their life, reducing their headaches, if not forever ridding them. It baffles me, I must admit I am still fascinated by the phenomenon of pain, and how simply moving toward can change the overall perception of the experience.
In this particular meditation, I ask meditators to move into the pain – to see if the pain is really there. This movement towards is somewhat based on the simple premise that ‘what we resist, persists’ and also how we perceive and fear pain; this concept helps to remove the suffering around pain, the second arrow that we tend to shoot ourselves with. To stay with the pain sensation, not make too much mental commentary on it, even how much we hate having it. I ask people to explore if the pain really exists for them, because when we sit right in the centre of the pain, sometimes it really shifts and moves, sometimes it appears as if it isn’t even there!
Over time I have come to truly understand that the body is always listening – the way you feel about your limbs alone are intimately related to their immune function and blood flow. This is called psychoneuroimmunology. If we can remove the stress and emotional concern around the pain by accepting it fully and not fearing it, pain can be a wonderful teacher that anchors us fully into the moment, truly changing our perception of life itself.
We can take what we know and understand about pain – neurobiology and brain research, the notions of brain plasticity and bioplasticity (whole body plasticity) and begin to change pain – we can reduce pain if only we allow the brain the correct responses and adapt our perception positively. A brain that is free of chronic pain has a very clear and precise. If we dedicate time to training, not only with meditations that move us into the reality of pain, so too with mindful movement and meditation, the clarity and precision of our mind-body maps and our brain’s homunculus becomes our anchor, our ability to ground our perceptions and thus experience reality as it truly is.
Let’s think about the no pain, no gain road. People talk about pushing through the pain barriers. We don’t support this, although for some people there is no harm in vigorous exercise as long as they understand any pain that is provoked. For example, some discomfort as you rehabilitate stiff joints and tight muscles is probably necessary. But pain is a bit like love, joy or jealousy – have you ever heard of anyone pushing through the love or joy or jealousy barrier? Maybe we should say, ‘know pain, or no gain’.
Dr. Lorimer Moseley
If you are in chronic pain and want to start somewhere, but movement feels limited at this time, visualising movements is proven to work very successfully. You can start by visualising small movements until you reach your threshold. Remember, how you think about your pain changes the way it feels, so do it mindfully and compassionately with a sense of self acceptance and commitment.
Things you can do:
- Understand pain as a protective mechanism
- Commitment helps and be prepared for it to take time. Mind – body – brain training works and it can take up to one year for recovery.
- Move – Movement is king.
- Meditate within the pain, with acceptance and mindfulness.
In meditation teacher training, we go even further and also look at techniques that employ competitive neuroplasticity in the shrink pain maps; using sound, thoughts, imagery, beliefs, movement, vibration and touch.