Pain And How We Perceive It

Many people suffering chronic pain and fatigue hear far too often the dismissive “it’s all in your head.” Dr. Edelberg has written frequently on the destructive nature of this statement, which places all the blame on the patient and none on the physician to dig deeper into the causes.

As Dr. E wrote in a Health Tip last March, remedies such as Chinese Medicine, supplements, nutritional advice, and even prescriptions can be effective in reducing chronic fatigue and chronic pain. Today, let’s take a closer look at the relationship between pain and the mind.

Pain perception
An article published last year in Yoga International looks at a study suggesting that pain perception is more than just a simple warning signal to the brain, a caution not to burn your hand on a hot stove or put weight on a broken foot. Instead, our brains interpret many degrees of stimuli, all of which have an impact on how we perceive pain at that moment. Consider the following scenarios:

• You’re riding your bike along the lakefront when you hit a pothole and fall, badly injuring your knee. Your friends pick you up and help you home in a cab.
• You’re jogging through the woods, training for a marathon, when you trip over an exposed tree root, tearing the meniscus on the same knee you injured five years ago on the bike ride.
• You’re walking home from work late one night when you notice another pedestrian quickly and closely approaching. You start a light jog toward the entrance of your building, roll your ankle in your high heels, but continue jogging even faster.

The pain that each of these injuries produces is very real. However, evidence suggests that the severity, duration, and adrenaline that individuals experience under the same circumstances could be vastly different.

This is true not only for the acute pain in the injury scenarios above, but for also chronic pain. Emotions, outside stressors, and/or memories of past experiences, to name just a few, are all part of our unique perception of pain, and greatly affect how we experience it.

Consider an injury in your own life. Was there someone you trusted to take care of you? Were there events or commitments that needed to be cancelled? Do you have a history of injuring this area, or have you injured it since?

The relationship between stress and pain
In his book Why Zebras Don’t Get Ulcers, neuroendocrinologist Robert M. Sapolsky writes that the brain’s response to pain generates both emotional and contextual interpretations about the pain. Meaning that the degree of the pain as well as how unfortunate or stressful you deem it, are two separate factors influencing the same response.

Without question, the patients I’ve seen who report the highest levels of chronic pain also report the highest levels of stress and trauma. Sometimes the stress is a direct byproduct of the chronic condition: the pain itself, how debilitating it is to their lives, and perhaps the limited support they receive from loved ones. Other times stress and trauma have already existed in various forms throughout their lives, sometimes starting at a young age. Most commonly, it’s some combination of the two.

Sapolsky has also done extensive research on the inner workings of our stress response and on the idea that prolonged stress makes us far more vulnerable to disease. Read a little more about this here.

Your brain and mind-body practices
Research described in this Psychology Today article shows that chronic pain changes the structure of the brain by reducing the volume of gray matter and the connectivity of white matter. Reduced gray matter can lead to impaired memory and cognitive function as well as depression, anxiety, and other emotional issues. The hardwiring of our brain’s white matter to these negative states of mind can have damning effects on pain perception.

The article goes on to postulate that yoga, meditation, and other mind-body practices such as Healing Touch can reverse the effects of chronic pain on the brain, increasing gray matter while maintaining the integrity of white matter. Catherine Bushnell, PhD, and colleagues from the National Institutes of Health discovered that mind-body practices exert a protective effect on gray matter to counteract the effects of chronic pain. In fact, some increases in gray matter in yoga practitioners correspond to the duration of their practice.

Part of the reason for yoga’s pain-relieving effects and changes in brain structure is its tendency to activate the parasympathetic nervous system, a tend-and-befriend mode, even in stressful moments. This versus the more typical fight-or-flight response to stress, which skyrockets cortisol (stress hormone) levels. You can see the difference in the way individuals anticipate and respond to pain.

Yoga and meditation are practices that literally anybody can do, and it isn’t a one-size-fits-all proposition. Even among chronic pain sufferers the practice might look very different. A good yoga therapist will first take in your whole picture with the use of physical, energetic, emotional, and even Ayurvedic assessment tools to determine which practices are best for you. These might include remaining in a chair or reclined on the floor for an entire practice session, gentle breathing and stress reduction techniques, body awareness techniques, or gentle movements if appropriate.

Supplements, medication, and other therapies that are more passive in nature (such as massage and acupuncture) are extremely helpful and have made an enormous difference in my own healing and that of millions of others. A mind-body practice that you can do on your own may be very helpful as well. This doesn’t necessarily mean a graded exercise therapy program of weight lifting or aquatic therapy (unless that works for you), but perhaps a short daily practice that reconnects you to your physical body in a mindful, peaceful way.

Psychotherapy can be an excellent way to manage stress and pain, and also to feel a greater sense of control over thought patterns and emotions.

Yoga is a mind-body practice that provides tools for stress reduction and overall wellness, whatever your condition. Healing Touch can also be a highly effective way to experience the interconnection of mind, body, and spirit, and to discover the root cause of symptoms and ailments.

In two weeks, Katie Oberlin, WholeHealth Chicago’s Healing Touch practitioner, will explore in depth the practice of Healing Touch and its utility in providing chronic pain relief. In the interim, click here for details on the workshop Katie and I will be conducting May 15 and 22, entitled Self Care for Chronic Pain with Yoga Therapy and Healing Touch.

Take good care,
Renee Zambo
1000-hour Certified Yoga Therapist

PS from Dr. E
Join me at 6:30 pm Monday, May 1, at Facets Multimedia (about 200 yards from WholeHealth Chicago) for a screening of Michael Moore’s documentary Sicko. I’ll be leading a Teach-In after the film, which examines and compares approaches to health care in the US, Canada, Great Britain, and Cuba and looks at the involvement of the pharmaceutical industry and medical establishment. Often witty and ironic, Sicko is nevertheless remarkably distanced in offering a perspective on what is possible in countries that put the health of their citizens first.  Click here to register and reserve your place.

It’s part of a series we’re doing at Facets and it’s free (with a suggested donation $10 if you are able).