I promised you a conversation about pain. I think the most important thing we need to know about Pain is that it is a tool. Pain is a tool that your brain uses to keep you safe.
I promised you a conversation about pain. It’s such a complicated topic I’ve been at a loss as to how to broach it with you. Solid evidence now shows that knowing why we hurt will help us heal – and we talked about this in the last Blog I wrote. I think the most important thing we need to know about Pain is that it is a tool. Pain is a tool that your brain uses to keep you safe.
Pain doesn’t happen at the site of an injury. This may be a weird idea, but it’s true. We know this because of the medications used to help with pain. When pain is severe then things like paracetamol or ibuprofen (which work in molecules in the body involved in inflammation and the like) don’t change the pain a person is feeling or perceiving. With severe pain it is only psychotropic drugs that act on brain function that alter the perception on pain.
If you roll your ankle here’s the kind of flow of events that happen in the body and nervous system:
So that’s what happens with an acute injury to the body. What about long term, or chronic, pain? Chronic pain has a distinct pathology that causes changes throughout the nervous system which can worsen over time.
Anatomically and physiologically all tissues of the body will heal after a certain period of time (given the limitations of matter). So why do we still get pain two months after the injury to the ankle when the ligaments should be healed by six weeks (assuming the sensible behaviour of the person attached to the ankle)?
Let’s say our person has a “weak” ankle after years of injuries playing basketball. They come to a time when the rolled ankle “just doesn’t heal properly” and they’re left with episodic pain in the joint when they challenge it. There may be degenerative changes in the joint. It may “throw a wobbly” (i.e. be perceived as painful) at the least provocation. In this scenario the person has chronic pain.
With chronic pain the brain is in protection mode. It has learnt that those tissues are at risk and it’s the brain’s job to prevent further damage. It stops us from damaging the ankle again by giving us pain, or by making us feel the sensation of pain in the ankle, when it perceives the ankle is at risk of further damage.
Our person with the chronically damaged ankle now actually has hypersensitive nerve endings in their ankle that measure where the joint is in space.
So, now our basketballer is dodging around an opponent and heading for the basket down court…or walking on an uneven footpath:
[Note – the amazing brain can even go so far as to create swelling in the region to deter further action and keep the ankle “safe”…yes, even when there is no damage to the tissues!!]
Sometimes the brain is overprotective, but the great thing about the brain is its adaptability. It has a property called “Neuroplasticity”, which means we can teach it to manage this situation differently. This takes work.
The joint position sensors (proprioceptors) in the chronically damaged ankle are hypersensitive – it is much easier to trigger these receptors than in a normal joint. These nerves are remodelled every few days. If we teach the brain SLOWLY that this ankle can actually do more than the brain thinks it can, without causing damage, these joint position nerves in the ankle will be remodelled with progressively less sensitive receptors. Thus the brain will be less likely to make the person perceive pain at the least provocation (like our chronic ankle being painful at the merest hint of movement in a risky direction). This remodelling of the proprioceptors will also improve the function of the joint.
I repeat, this is a slow process that should be taken on with the help of a professional (chiro, physio). Specific, small, steady, progressive, physical goals are set and the plan is modified along the way as necessary. We aim at optimising function, not restoring the ankle to what it was when the person was seventeen! But it can be done – which is really exciting and just serves to remind me how awesome our wonderful brain is.
So. Pain is a construct of the brain created to keep us safe. That doesn’t mean that pain is all in your mind – it’s very real. It is a very useful tool, but sometimes the brain can overdo it and, even in that situation, there are ways to teach the brain to tone it down. Chronic pain is debilitating and understanding it is the path to finding solutions. If you are interested in the science of pain and pain management there are some great books to read:
As chiropractors we deal with both acute and chronic pain every day. We work with the neuroplasticity of the brain to tone down the brain that’s being overzealously protective and improve its perspective on what is possible. Call the Adelaide Chiropractic Centre today on (08) 8221 6262 to make an appointment and start changing your pain.