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Pain & the Brain

Last week I explored some new knowledge and ideas in chronic pain. More and more, researchers are proving that persistent pain is a complex brain issue. New generation scanners such as PET/ fMRI are showing that chronic pain causes widespread changes within the brain. Research is beginning to challenge old ideas on pain and will eventually lead to new treatment methods for longstanding pain.

One current explanation for chronic pain compares the pain-flooded brain to a computer with a software virus. If you have ever inadvertently downloaded a virus you know the widespread damage it can do to the computer. Imagine chronic pain in the brain just like a destructive chemical virus in your P.C.

Ongoing pain is partially attributed to changes in chemical concentrations in the brain. These chemicals sensitise the brain to pain messages from any source.

In normal instances, when pain messages arrive from a distant body region, the brain can ‘choose’ to listen to the pain or not. Subconsciously the brain surveys the situation and makes an accurate decision as to the seriousness of the pain in the circumstances. In life-threatening situations such as war, the brain may dampen pain in order to save a life. However this selectivity goes out of kilter in chronic pain. The brain seems to lose this ability to analyse and prioritise pain. Instead all incoming pain messages are given high priority.

A threshold level alters in the brain to decide when and how pain is acknowledged. This threshold is unique to each individual and can go up (so it takes more pain before the brain ‘listens’) or down (the brain becomes more sensitive to a smaller amount of pain). This is thought to explain why people rate apparently similar pain at different levels.

In people experiencing persistent pain researchers believe that the presence of pain over time gradually lowers the threshold at which the brain ‘reads’ both overall levels of pain and any extra pain messages. So despite what you might think, people in pain gradually tolerate less and less pain as they become more sensitised to it.

Knowing this happen offers a huge challenge to those of us who deal with patients in pain. The race is on to develop specific chemical agents, drugs, to reduce pain and raise threshold levels towards those of the painless population. New drugs on the market help some, though one person’s good response may not be the same as the next.

Improved understanding of persistent pain is crucial for pain ridden patients to begin to gain some control of the situation.

Also interesting is the effect of mood and physical fitness. Both low mood and being unfit further lower the brain pain threshold level. Getting fitter can be hugely important tool in the fight to beat persistent pain. Often having chronic pain causes individuals to do less and less, especially as a bout of unaccustomed activity like a long walk or even a house spring clean may result in increased pain afterwards. This is called the pain ‘Boom Bust Cycle’: a ‘boom’ of increased activity is followed by a ‘bust’ of inactivity due to pain.

In turn this can bring on a psychological phenomenon known as ‘Fear Avoidance’. Here, having experienced the Boom Bust Cycle, not surprisingly the person becomes fearful of adding any more pain, so they begin to self-limit their activities in the hope of preventing pain. It starts with maybe one limitation such as not walking for longer than an hour on any single occasion. Then this gets cut to not walking for 40 minutes. Soon no walking is done, to prevent pain. This limiting strategy increasingly seeps into many of life’s daily activities, so that the painful person chooses to do less and less.

Is there any way out of this? The answer is a definite yes. Here’s where professional assistance can really help in terms of improved understanding of how pain works, how to change ‘bad’ movement patterns and activity habits.

Learning how to address fitness in a way that will work for the pain filled individual, breaking down tasks into composite parts and pacing activities are all well proven strategies for improving Quality of Life in this patient group. Chartered Physiotherapists are pain and movement experts and play a vital role in actively addressing how to move better and more. Some physiotherapists have further specialised in the complex area of coping with chronic pain.

If you experience chronic pain, enlist you own multi-disciplinary team of G.P., consultant, Chartered Physiotherapist, pharmacist, psychologist. Make sure they all talk to each other. Go for an active treatment programme is active, not passive.

Make today is the day you draw the line in the sand and start to deal differently with your pain.
Mairead O’Riordan, MSc, MISCP is a senior Chartered Physiotherapist & CEO of TherapyXperts, an allied health network dedicated to clinical excellence.
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