This is part of the Nervous System Foundations series, focused on helping you understand how your nervous system functions. In this session, we explore how pain works, the difference between acute and chronic pain, and how the nervous system can become sensitized.
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Kamloops, BC, Canada
Transcript
We're going to touch on pain in this video and we'll start with a brief overview of what pain is, How it works. So to begin with, What is pain? Pain is a sensory experience that is typically designed to give us a warning that something. . . Not so great is happening. We can experience pain as a warning or when there is actually an injury or tissue damage. If I, You know, If I reach out and I touch something hot. So the receptors in my hand, If that's what I'm using to touch the hot surface, There might be some dull pain, Some sharp pain, Some heat receptors that are going to pick up on the message that I'm touching something that is potentially a tissue threat. They're going to send an action potential and a response all the way up to my spinal cord and my brain. My brain is going to process this message that it's getting and decide what it wants to do about it. In this case, Very likely, It's going to say withdraw your hand. Take your hand away from that hot stimulus because you are at risk of burning your skin. And as long as I haven't created any tissue damage, Typically that pain response will go away. That sensation that I'm experiencing will go away as soon as I remove my hand from the stimulus and all is well and good. Everything comes back to baseline. Totally normal. Now, What happens is if I don't remove my hand in time and I end up with an actual burn or an injury or tissue damage to my hand, I can experience something that's called acute pain. An acute pain is something that I'm experiencing in the moment. As well as while any actual tissue damage is healing. So, You know, If I end up with that burn on my hand, That is probably going to hurt for a while and it's going to hurt until that tissue is totally healed because it's going to be more sensitive. There's going to be inflammation here. There's going to be, You know, More complex stuff happening at the actual location of injury. It's going to be giving me much higher warning signals. Now, You know, I might touch something that is like, Not any particular temperature. It's totally neutral and I touch it and I might get a warning bell or a pain signal go off because I am at risk of further tissue damage. So during that healing phase, That is a phase where we're going to continue to experience that acute pain that we might feel while the actual stimulus is present. Traditionally, As we've learned about the body and healing, What should happen is that once that tissue is healed, Everything should come back down to baseline. No more acute pain. Things settle out. Everything goes back to factory settings. When we transition into chronic pain, Chronic pain, The, You know, Kind of more. . . Simplistic definition of chronic pain is pain that persists beyond three to six months is what they say. Or beyond any lasting tissue damage. Once the tissue is healed, Pain should theoretically go away. So if pain is persisting beyond tissue healing, Then that is what we would consider chronic pain. Chronic pain is something that we experience when our nervous system hasn't quite got the update that the threat is gone. And so as a result, It will learn new behavior patterns and it'll learn, You know, Even different movement patterns or will behave differently so as to completely avoid having that experience again to protect us and protect our nervous system, Protect our tissue, Protect our body and so on and so forth. This change in behavior pattern is part of what can contribute to the sensitization of the nervous system. An analogy that I'll give you is that of a car alarm. If we have, You know, OK, So we buy a brand new car. Let's say I get the newest, Latest, Greatest Tesla. If someone, You know, Tries to break into my Tesla, The alarm bells are going to go off. Someone smashes the windows. It's going to honk. It's going to make all sorts of weird and wonderful noises. And it's going to alert someone that alarm is going off, That something bad has happened. Someone has damaged it. Someone's broken in. The alarm bells go off. And that's what we would hope for, Right? We pay a lot of money for these things. So if there is a sensitization process, What happens is it's almost like the dial, The threshold for that alarm going off gets totally cranked up. And now. . . What might happen is that alarm might go off to rain touching the Tesla. You know, It might not be that it needs someone smashing the window. It could very well be that it's just wind has brushed by it or yes, Rain is falling on it. And now all of a sudden these alarm bells are going off to something that's actually not going to damage it. The same thing happens in the body. Now, You know, If I touch something really, Really hot that potentially damages my skin. What might happen is now if I touch something, Tissues totally healed, If I touch something that. . . You know, Just feel slightly warm, That same alarm bell might go off and give me that warning in my brain when in fact it's totally harmless to touch said object, The more lukewarm one. There's a really great TED Talk by a very famous pain scientist in Australia, Dr. Laura Mosley, And he talks about an experience that he had. He was hiking in the bush in Australia and while he was walking, He felt something, You know, Hurt his skin on his leg and he didn't really think much of it. He's like, Oh, That was kind of uncomfortable. And then next thing you know, He looks down and he's been bitten by a snake and it ends up being this. Very poisonous snake and things go a little crazy and, You know, Lo and behold, He survives. It's totally fine. Fast forward X amount of time in the future. He's hiking again in the bush. And all of a sudden he feels this intense pain in his leg. And he looks down because he's had a very scary previous experience with something similar. He looks down and he's just got a scratch on his leg. It's just a branch that's given him a little scratch. And yet his nervous system gave him this pain response that was far beyond the original pain response he had when he was actually bitten by a snake and it was really, Really dangerous. But what this tells us is that our nervous system learns very quickly and it has this incredible ability to create, I guess you could call it like a mountain out of a molehill. So based on previous experience, If we've had a very, Very dangerous previous experience, Now anything, You know, Minutely a fraction similar to that previous experience is going to be experienced on a much higher pain scale. So those are a couple examples of how the nervous system becomes sensitized and how chronic pain can become this issue when tissue has actually healed and this pain signal is persisting. Another aspect of the sensitization is the increase in the emotional aspect to it as well. So what can happen is when we experience pain, We often have an association of increase in fear. We have an increase in, You know, If things are chronic, Often frustration and resentment and anger and even sadness and grief. These things all get linked into that process. What happens when we have fear and anger about a certain experience is that tends to turn on our autonomic nervous system signals and we end up in a more sympathetic state. And then we end up with these more sensitized systems in the body and it just creates this positive feedback loop where more pain, More fear, More frustration sensitizes everything and makes us more receptive to pain and to that experience of chronic pain. To happen when we're experiencing chronic pain and it becomes more and more and more frustrating. We get more and more fearful of certain movements because they hurt more and more and more and it's a really difficult cycle to break. What we need to know here, Though, Is that This is a cycle we can break. It is possible. The thing that I want to mention is that a lot of the times. . . When being taught this cycle, A lot of practitioners. . . And a lot of people in the medical community will often tell clients or tell people that the pain is in their head without explaining what actually happens. And that can create this complete cycle of invalidation. Increase frustration, And actually create what we call a nocebo effect. So it is really important, A, For breaking the cycle to educate ourselves and us as practitioners to provide good education for our clients about what this cycle is and how sensitization happens. So education is the biggest piece of breaking the chronic pain cycle. Because the pain is actually being interpreted in our head and our brain, But there are actual biological changes happening in the nervous system that are increasing our experience of pain in our head. So understanding that is really helpful because we can hear the pain and then we can decide how we want to respond to it. So taking a moment when we do experience pain to then perhaps have a conversation with it or have a conversation with ourselves and try to figure out if the pain is as a result of a true threat or not. And so that is a big step in the healing process is just for a moment being able to question, Is what I'm feeling appropriate? Sometimes our nervous system, You know, As we talked about, Becomes sensitized and it starts to be a little over the top with the messages that it's sending us. And so being able to step back for a moment and be like, Hey. Is this actually, You know, An appropriate amount of pain? Good healthcare practitioners can really help you with that process because it is really important to actually have structural and tissue sources of pain sorted out. We want to make sure there's nothing red flaggy happening. We want to make sure that there are no, You know, Changes in tissue, No inflammatory processes. Injuries to the tissue or you know other more health concern aspects of this you know. So having a good. . . Physical workup is really, Really important to actually rule out physical sources of pain. That is the first thing you want to do. Once that's been ruled out, Then we can move into this more behavioral change aspect of it. And so, Like we said, Education is a huge, Huge piece of this. Understanding the way pain works in the body is a huge aspect of healing. Exercise is huge. Exercise helps us to begin to foster trust in our body again and helps us to experience positive movements without pain or even with pain. Exercise. Through this process is really, Really big for fostering trust with the body and the nervous system. Along with that, Just all the other stress management tools that we've been exposed to, All the, You know. Eating well, Sleeping well. Meditating, Exercise time in nature, All these things rest super important for just general nervous system health. So all of these in combination can be really, Really powerful tools for managing chronic pain and learning to break the cycle of chronic pain. Thanks a lot for listening.
