Hey! Did you know that all pain is all in your head? It doesn’t mean you don’t have real pain when something to cause pain happens, or that chronic pain is not real. Feelings of pain are very real and are initiated by the brain for a very important basic reason…to keep you safe.
The study of the neuroscience of pain has changed considerably in the past 10 years. It is now believed that the sensation of pain is a necessary function that warns the body of potential pain or of actual injury. The process starts with the nociceptor detecting a potentially painful stimulus from the skin or an internal organ. Neurotransmitters (chemical messengers) transmit the signals through the nervous system and spinal cord to the brain. In essence, how the brain processes the signals causes an appropriate or inappropriate pain response.
One example is a child falling and skinning his knees. He gets up and continues to play as if nothing happened. Then another child or adult reacts to the blood running down his legs, he looks, his brain responds differently to the neurological stimulus, and suddenly there is pain. Initially the brain did not register the experience as painful, however the next time the child falls, he will probably immediately register the skinned knees as painful. Experience plays a role in the pain response.
The pain response can also be overridden by the brain in circumstances that are life threatening. For example, a soldier who runs to safety with a serious gun-shot wound. The brain, due to past experience, can conversely register the event as much more painful or life threatening than necessary. For example, someone who was bitten by a poisonous snake may brush it off as being scratched by a stick, until they realize they have a life-threatening injury. But the next time they get scratched by a stick, they may respond as if they were bitten by a poisonous snake.
According to Elliot Krane in his Ted Talk “The Mystery of Chronic Pain,” after an injury or surgery, the nervous system can sometimes get what is going on wrong. Approximately ten percent of the time, the nerves and glial cells (play a vital role in modulation, amplification, and distortion of sensory experiences) that interact in the pain response develop into a feedback loop that can become distorted. This altered feedback can make chronic pain become its own disease.
Dr. Maria Sykorova-Pritz in her course “Application of Water Exercise for Pain Management” describes how chronic pain is not simple, but very complicated. The body, mind, emotions, and behavior can become entwined in the chronic pain cycle. Pain medication is often prescribed for chronic pain. Rampant prescription of pain medication is believed to play a large role in the opioid epidemic in the United States. Although pain medication is often prescribed for chronic pain, it does nothing to unravel the combination of physical, emotional, and behavioral factors that are now believed to cause chronic pain.
There is growing evidence that chronic pain is caused by multiple factors including cognitive, physiological, and behavioral factors. If you are working with clients or interacting with a family member with chronic pain, it is important to understand that it is not just simply a physiological response to pain. It is important to effectively influence a client’s attitude, cultural background and belief system-which influences social norms and perceived behavioral control. To achieve the highest positive health/fitness results among the chronic pain population, it is important to know and understand your client as a whole person.
As we start to look for alternative ways to deal with chronic pain and its aftermath, a combination of physical therapy/exercise and emotional/behavioral counseling is emerging as the tools of choice. Using the practice of yoga and water therapy/exercise to relieve and even cure chronic pain are proving to be viable and more effective alternatives than pain medication. Statistics from the Institute of Medicine indicate that more than 100 million Americans suffer with chronic pain, thus creating a viable niche for those wishing to work with clients with chronic pain. Now that more is known about chronic pain, its potential causes, the chronic pain cycle, and how to treat it effectively, education is key to working with this population in need. Proper treatment and compassion for chronic pain sufferers can help end the opioid crisis and help people beat chronic pain to live pain free lives without addiction and suffering.
For more information about the psychology and treatment of chronic pain management, see Dr. Maria Sykorova-Pritz’s continuing education course “Application of Water Exercise for Pain Management.”
Compiled by June Chewning. June M. Chewning BS, MA has been in the fitness industry since 1978 serving as a physical education teacher, group fitness instructor, personal trainer, gym owner, master trainer, adjunct college professor, curriculum formatter and developer, and education consultant. She is the education specialist at Fitness Learning Systems, a continuing education company.
- The Mystery of Chronic Pain. Elliot Krane. Accesses 8/2018. https://www.ted.com/talks/elliot_krane_the_mystery_of_chronic_pain
- Sykrorova-Pritz M. 2018. Application of Water Exercise for Pain Management. Fitness Learning Systems. FitnessLearningSystems.com