Is your pain all in your head?

Image by John Hain from Pixabay

Do you know where pain comes from?  In this fourth article on how you can be “Stronger over 40”, Dr. Terry Gebhardt will help you understand exactly where your pain comes from and better yet, how you can relieve it.  This is especially important as we tend to have more aches and pains as we age. If you have low back pain for example, perhaps you think your pain comes from your back. If you have knee pain and have been told you have knee arthritis you may think your pain is coming from your knee.  The truth is all pain comes from your brain. This does not mean pain is all in your head and it is not real! All pain is real. However, feeling pain does not always mean you are causing damage. Think about pain as an alarm signal. The alarm sounds when your brain senses potential danger or a threat.  However, in some cases your alarm won’t sound even if there is damage. For example, if you are running across the street and sprain your ankle you may not feel ankle pain because a car is fast approaching. Your brain will prioritize not getting hit by the car over feeling the pain of an ankle sprain. Once you make it safely to the other side, you will likely feel the pain from your ankle sprain.  The key point is your brain decided the threat of getting hit by a car was a greater threat than your ankle pain.

Many people think a pain signal comes from the damaged tissue.  In the example above, a pain signal would come from your ankle. However, that is not the case.  The nerve signal that travels from your ankle to your brain is only a warning signal. Your brain decides if there is a threat and if it should sound the alarm causing pain.  There are many other factors your brain takes into account before deciding if it should “sound the alarm”. It is very common to have tissue damage and never experience pain. For example, many people with arthritis, herniated discs, or degenerative disc disease never experience pain despite having tissue damage.  Dr. Tim Flynn refers to these as “wrinkles on the inside”. Arthritis and degenerative discs are examples of common, normal changes with age that don’t need to cause pain. Despite what many in the medical community may have you think, “damage” seen on an x-ray or MRI does not always mean that is the cause of your pain.  

The normal aging changes seen on x-ray or MRI can contribute to your pain, but there are many other factors that determine whether or not you will feel pain.  Your past experience with pain, your thoughts, expectations and understanding about pain will influence whether or not you feel pain. For example, if you are told you “have bone on bone arthritis” or “the spine of an 80 year old (and your only 55)”, you are more likely to experience pain.  Increased stress and anxiety due to your pain or other life factors also make it more likely for you to experience pain. Furthermore, research has shown the longer someone has pain the more sensitive their “alarm system” becomes. This means you are more likely to experience pain even if you are not causing damage.  Your alarm system is being hypersensitive in its effort to protect you.

The best way to treat your pain is to address all contributing factors, not just the ones seen on an x-ray or MRI.  A great place to start is to get moving! Exercise is one of the best “drugs” to treat your pain. It’s cheaper and has fewer side effects than any drug you can take.  If your pain is more persistent, it is important to gradually progress your exercise so your “alarm system” has time to adapt and dial down. Your physical therapist can help you determine the best way for you to progress your exercises.

We experience pain when our brain perceives danger or a threat.  A key part of reducing your pain is decreasing any perceived danger.  A great place to start is understanding the many factors that influence pain and realizing your pain is caused by much more than damaged tissue.  If you have been told you have arthritis or degenerative disc disease, don’t let those words scare you. Most of us over the age of 40 have these normal changes and don’t have pain.  We know tissue heals. We also know our bodies are remarkably adaptable. Many people have arthritis on an x-ray, but have good strength and mobility so they never experience pain. The longer pain persists, the more likely pain is due to a ramped up alarm system instead of tissue damage.  Remember, all pain is real. Pain a wonderful thing and is necessary to protect you from causing damage. However, sometimes our alarm system can become too sensitive and trigger the alarm (pain) even when we are not causing damage. Check out the “Persistent Pain Education” videos here to help you better understand pain.  

Another powerful tool you have to decrease your pain is your breath.  Simply slowing down your breath will help dial down your alarm system making it less likely you will experience pain.  Pain, stress, anxiety all contribute to rapid, shallow breathing. This breathing pattern makes it more likely you will experience pain.  There are many mindful breathing techniques and tools you can use so choose what works best for you. I recommend having a simple trigger throughout the day to cue you to take a few slow, deep breaths.  For example, every time you wash your hands or come to a stop light slowly inhale through your nose and slowly exhale either through your nose or mouth. This won’t just to help you relax. It changes your physiology in ways that not only decreases your pain, but has many other health benefits.

Take control of your health and don’t allow yourself to be labelled with scary terms like degenerative discs and bone on bone arthritis.  Accept these for what they are…normal changes with aging…and move forward controlling the things you can control: your understanding of pain, exercise, and your breathing!

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