A Tale of Two Claws: What Changes Pain?

Source: Denver Post Staff/Denver Post Files/Used with permission

Pain is never purely physical

You may believe that pain is a purely biological process and has nothing to do with your thoughts, perceptions, or emotions. This makes sense, given that Western medicine has mistakenly and dangerously divided humans into two separate entities: the mind (“spiritual”) and the body (“physical”).

When it comes to pain, this gulf is not only useless, but wrong.

Thoughts, beliefs, perceptions, emotions, past experiences, background, and input from the body all influences the experience of pain (Edwards et al, 2016). Always, always. To illustrate this point, see A Tale of Two Nails. Everyone, sit down for this one.

Case study 1: Boot nails

In 1995, the British Medical Journal reported on a 29-year-old construction worker who had an accident. After jumping onto the board, a 7-inch nail penetrated the other side of the boot (Fisher et al, 1995). In severe pain, he was rushed to the ER and sedated with opioids. When the doctors took off his boots, they discovered a miracle: the nails had passed. between No need to pierce your toes into the skin! There was no damage to his leg at all, no blood, no puncture wounds, not even a scratch. But don’t get me wrong. Even though I wasn’t hurt, the pain was real. what happened?

Sensory receptors in the man’s body told his brain that there had been an accident and that the nail had penetrated his boot. his brainrecognizes potential threats to his safety and health, uses the situation to determine what happened, and gathers information from his five senses (including the vision of a nail sticking out of his shoe!). ), we have gathered knowledge about hazardous working environments and their hazards. We collected the risks, the fearful faces of our colleagues, and other data to deduce what happened and how we should respond. thoughts, beliefs, feelings etc. panic and fear—starts a cascade of biological and neurochemical processes. His brain put all this information together and decided he was in danger. It was painful to protect him.. In this case, the actual pain occurred overall It was due to factors that had nothing to do with actual tissue damage, but it was just as intense as the sting.

Case Study 2: Hitting the Nail in the Face

Conversely, another construction worker (a dangerous job!) was using a nail gun when it unexpectedly discharged, hitting him in the face (Dimsdale & Dantzer, 2007). Other than a mild toothache and a bruise under my jaw, I thought I had escaped relatively unscathed. After 6 days, eat for 6 days, sleepingAnd going to work—he went to the dentist. To his surprise, an x-ray revealed that he had a 4-inch nail embedded in his head. In fact, the nail had penetrated his cerebral cortex, putting him in potentially grave danger. But because contextual cues failed to put his brain on high alert, his pain system remained silent, even though there was actual damage to his body and required medical intervention. It was (#fail).

What does this tell us about pain?

These claw tails highlight several important points for pain sufferers and healthcare providers (just kidding!). The first is Pain is not an accurate indicator of tissue damage. If there is no physical injury (such as a nail in your shoe but not your foot), you will experience severe pain, but if there is a significant injury (such as a nail in your face), you will experience very little pain. I don’t feel any pain. Just because something hurts doesn’t necessarily mean your body is in danger. “Hurt” and “harm” are not the same.

The second point is that in addition to sensory input from the body, thoughts, cognitions, emotions, and circumstances define the human experience of pain and can amplify or reduce pain (Gatchel et al, 2007 ; Turk et al, 2016). You may have experienced this phenomenon many times. For example, have you ever had so much fun at a soccer game that you didn’t realize your leg was bleeding until it was over? Or maybe you noticed a mysterious black and blue mark on your leg that you couldn’t figure out how it got there? Did you discover? Similarly, potentially painful stimuli, such as being bitten or slapped, can also feel pleasurable during treatment. sex In other situations it can be painful. this is, Cognitive, emotional, and contextual factors Excitement, distraction, pleasure, and attentional processes constantly control the experience of pain.

Dr. Henry Beecher, a wartime anesthesiologist, reported a similar phenomenon in a 1946 paper on wounded soldiers. He found that there was no correlation between the severity of soldiers’ injuries and the amount of pain they experienced. Seventy-five percent of seriously injured soldiers reported little or no pain despite their serious injuries, even though they now feel secure that they can escape combat and return home. Here are the words of this respected doctor: “There is a general idea that wounds are necessarily painful, and there is a further idea that the more extensive the wound, the worse the pain” (Beecher, 1946). This, he observed, was not true.

we know it now pain is a guess: your brain’s best guess about whether and how much your body needs protection (Moseley & Butler, 2015). Context, the sum of all information available from the internal and external environment, is critical to pain processing and always informs the experience of pain. Pain is not purely biological and is caused solely by problems such as tissue damage or anatomical dysfunction. It is also emotional, social and cognitive. It is always influenced by thoughts, perceptions, emotions, and context (Bushnell et al, 2013; Gatchel et al, 2007).

Points to take home (sharp things!)

The message you take away from these cautionary Tales of Nails is:

1. Pain isn’t “all in your head.” However, that teeth—at least in part—in your brain.
2. Pain acts as your body’s warning system, motivating you to take action to ensure your safety. However, since the pain is just a guess, do not have Accurate indicator of tissue damage. “Hurt” and “harm” are not the same.
3. Cognitive, emotional, and situational factors everytime Informs pain processing. Specifically, reliable evidence that the body is in danger can amplify pain, whereas reliable evidence that it is safe can reduce pain (Butler & Moseley, 2013 ). Therefore, changing your thoughts, perceptions, and emotions—what you think, feel, and believe about your body and health—can change the pain you feel. This means you have more control over your pain than you think.
4. Under treatment chronic pain It is not enough to use only biomedical solutions such as pills or treatments. This limited treatment approach is one of the primary causes of the opioid epidemic, and national reports indicate that long-term treatment is ineffective (NIH, 2019; USDHHS, 2019a).
5. Effective pain treatment involves biological, psychological, and Social components of pain. This includes cognitive behavioral therapy, biofeedback, Mindfulness-base stress transition to pain relief (MBSR), graded exercise, and other non-drug, non-surgical interventions for treatment planning (Kerns et al, 2011; Majeed & Sudak, 2017), or integrative pain management clinic. Going to therapy for pain doesn’t mean you’re “crazy.” Such biobehavioral approaches are low risk, have evidence of efficacy (Garland et al, 2019), have no side effects, and are now considered best practice for pain medications (USDHHS, 2019b). You literally have nothing to lose!