It's All In Your Head
Chronic pain is complicated for many reasons, but ultimately, it’s all in your head. Before you throw your hands up in frustration, let me explain. Our brain is our computer; it is where all information gets sent, processed, and understood. Understanding that pain is an experience that happens entirely in your brain can actually be helpful in dealing with it. I will do my best to help you get your head around pain.
Pain is in the brain and is separate and distinct from the idea of nociception. Nociception responds in the event of a cut finger while pain is the experience that may happen in your brain because of that cut.
A nociceptor ("pain receptor") is a sensory neuron that responds to damaging or potentially damaging stimuli by sending “possible threat” signals to the spinal cord and the brain. Have you ever looked down to see that you were bleeding but there was no pain? You had nociceptive information coming from the cut to your brain (I promise) but your brain didn’t care and there was no pain experience. The reverse is also possible, you can have pain without any nociception. Patients can experience pain in a hand that has been amputated, how is that? Because an area of your brain is still dedicated to your hand; your brain still has a hand (it's part of what is called a homunculus) and therefore it can be in pain.
Phantom Pain
I have had patients suffering from chronic pain that although agree that people who suffer from “phantom” pain are experiencing pain, argue that their pain must be different because they still have a fully functional hand that is hurting.
When I conduct an examination and have my patient move their painful hand in all sorts of ways and it hurts, but all tests show a normal range of motion, this tells me that there are likely no torn muscles, or ligaments that are no longer connected, which would limit the range of motion.
So, if they have a fully functioning hand that hurts, the same thing is happening for them as those suffering from “phantom” pain. Their pain is in their brain.
Your Brain Has a Mind of Its Own
If you are suffering from chronic pain, your brain has learned that some activities in the past were not safe to do when you were injured. The brain is good at helping us avoid pain. So, when we realize that moving a certain way will hurt, we quickly learn to avoid those motions as much as possible. What happens for most people is that when tissues heal, the brain realizes that those painful positions are no longer aggravating to the injury, and return to normal.
The brains of people who suffer from chronic pain don’t get the memo. As tissues heal, they don’t learn that painful positions are healed. They maintain their firm hold on protecting us from those positions/activities despite those tissues having healed. This explains why these patients were able to complete all tasks without issue with their hand during examination but still experienced pain. The brain has learned and solidified pathways that protect us from problematic motions despite the fact that the tissues have healed. This learning is similar to most types of learning, like learning to ride a bike.
Like Riding a Backward Bike
It is really hard to forget how to ride a bike. It is a phrase we use in society as an example of being unable to forget. “It's like riding a bike.” So, here is the rub; if you have created a learned behavior that isn’t riding a bike, and the learned behavior is pain, now what? We want to forget the pain, but if it is so ingrained in our brain that is unforgettable, what do we do?
I found this video on YouTube of a man who used a backward bike to explain the plasticity of our brains.
All this guy did was change one little thing about the bike.
The wheel went right when you moved the handlebars to the left. That’s it. But it made the bike un-ridable. Yes, he eventually learned how to ride the bike, but it took over 100 days to rewire his brain to be able to do it. Most notably, although he eventually learned to ride the backward bike, when he tried to ride a normal bike, he was no longer able to ride it. In terms of rewiring our brains to deal with chronic pain, this part could be the key.
The backward bike experiment gives us a perfect example of how it is possible to forget something on purpose. Even something as ingrained in our brain as riding a bike. He forgot how to ride a bike! On purpose! This provides hope that we can unlearn, forget, or break the pathways our brain has set up regarding chronic pain.
We can forget something on purpose.
The Process of Unlearning
There are a few steps to the process of unlearning chronic pain. Your body needs to be tested to determine that it has healed as well as it can. Pain needs to have been around longer than 6 weeks, but by the time you get to me, it is likely that it has been much, much longer than that. Finally, you need to understand that your body has healed, that pain is in the brain, and that it can be learned and unlearned. These steps are all required before we start the process of forgetting how to ride the bike called chronic pain.
I find the video of the backward bike is extraordinarily helpful in teaching the concept of neuroplasticity (the scientific term for how our brain learns and unlearns). We CAN change the pain pathways that have been learned and solidified in your brain.
If you are struggling with chronic pain right now, I understand that this could be a difficult post for you to read. Please know that I am on your team. I want you to live pain-free and get back to moving. If there is any chance at all of using brain plasticity to our advantage to help you get there, I want to help. Let me help you guide your brain through the unlearning process.
About the author
Author Dr. Spencer Devenney is a Chilliwack Chiropractor, who graduated in 2009 from the Canadian Memorial Chiropractic College (CMCC) He has a clinical interest in all things mechanical. His motto is: "if it hurts to move it bring it to your chiropractor first."