The Pain in your Brain
When patient’s first come to see me, they often tell me precisely how their pain began…an awkward lift, an unexpected movement, a fall. But it is the unexplained pain that is the most concerning, especially when the pain keeps coming back. “What did I do?” We have been taught that injury equals pain, and we are desperate to know what we did to cause the injury so that we never do it again.
In his TEDx talk “Why Things Hurt,” Australian clinical scientist Dr. Lorimer Mosely, turns that idea on its head. He tells a very funny story to illustrate how the brain literally creates the experience of pain in order to protect us from danger. It is the brain’s job to create meaning out of sensory stimuli to determine if there is a present danger and then, to alert you to that danger. Dr. Mosely likes to call the brain, your “amazing Protectometer.”
In his story, Dr. Mosley tells of his experience of feeling a scratch on his leg when out walking in the bush. At the time, he thought nothing of it. After all, he had experienced scratches on his leg from brushing up against twigs many times before. He recalls getting into the river and back out and that is the last thing he remembers having been bitten by a highly venomous eastern brown snake. Obviously, he survived the bite. Six months later, he was again out walking in the bush. Suddenly he felt a sharp, searing pain in his leg. He was writhing in pain for several minutes until his friend determined that he had been scratched by a twig! The difference this time was that his brain interpreted the sensory stimuli in the context of a prior dangerous experience. This pain was totally different because of meaning.
Patients and doctors tend to focus on what we think is the cause of the pain. Doctors take a thorough history and perform tests to determine which tissues are injured. Then we can appropriately treat that injured joint, muscle or nerve to relieve your pain. And while this is important, it is not entirely helpful on its own. By putting the focus on the injured tissues, patients often become fearful of doing that thing that caused the injury in the first place. They may avoid bending or lifting, and begin a downward spiral of becoming weaker, stiffer and less confident in their ability to perform simple daily activities.
By helping patients understand that pain is a construct of the brain created to alert you to danger, we put pain in its proper context. Your pain is completely real even though the tissue may not be in danger. Pain does not necessarily equate to injury. And the intensity of pain can be disproportionate to the stimulus.
When we understand this, we can reintroduce safe movements and activities to build strength, flexibility and most importantly, confidence. We learn that it is okay to feel a little bit of pain at times. That’s just your brain alerting you to potential danger and it’s being a little overprotective just now. Over time, the brain can turn down the volume on the danger message so that we are alerted to danger when it is present and can focus on living our lives when it is not. What an “amazing Protectometer!”