Acute pain and chronic pain
As humans we can experience acute pain and chronic pain. Acute pain is the pain that we feel in response to an injury. After a while, the pain subsides and we return to normal. Having the pain encourages us to stop, rest, heal and get better.
Into survival mode
Chronic pain can last for months or years and is more complex. People with chronic pain often experience disturbed sleep. When this goes on, night after night, it leads to increased stress, depression and anxiety. These symptoms, in turn, contribute to even worse sleep. General daily functioning in compromised, the symptoms get worse and the sufferer moves into ‘survival mode’ – just trying to get through each day rather than live life.
In survival mode, everything feels more dangerous. We perceive threat everywhere and we become hyper alert, seeing danger where perhaps there is none. This means, of course, that we are also hyper alert to the pain that started all of this, and what we previously experienced as a slight twinge becomes shooting agony.
Cortisol
In amongst all this is Cortisol. The hormone cortisol regulates processes such as metabolism and the immune response, and also helps the body to deal with stress. When stressed, cortisol is released, but too much cortisol is bad for us and can cause inflammation and muscle weakness. This adds to the pain. If you have inflammation, the old injury that started the pain might not be the only cause of continued pain – have you noticed that it gets worse during times of high stress? That’s the cortisol.
Sufferers of chronic pain are often high achievers. They work hard, they are always on the go and consequently they have a lot of stress, adrenaline and cortisol in their lives. Often, they push through when the body wants them to rest. Our bodies are remarkable machines and can come up with ways to force us to slow down and take a break, for example irritable bowel syndrome. IBS is often a response to stress – the body is saying “If you’re not going to do it, I’ll make you stay at home so that you can get the rest you need”
All in the head…?
In previous blog posts I’ve spoken about habits forming in the brain. The hippocampus holds patterns of behaviour, responses and memories. After a period of time, it also starts to hold the experience of pain as a response that it is familiar with and will go back to. It can be very dismissive to be told, “It’s all in your head – just relax!” but I’m going to demonstrate to you the science behind that statement.
Think of a motorway. It has three lanes: the slow lane where the heavy lorries are chugging along, slow and steady; the middle lane where you might find the family cars, overtaking the lorries; and it has the fast lane, where the fastest cars are zoom past everything else.
- The slow lane equates to the C fibres sensation pathway to the brain, and this pathway is responsive to heat and pain.
- The middle lane is the A delta fibres sensation pathway to the brain, which is responsive to cold and pain.
- The fast lane is the A beta fibres sensation pathway to the brain. This pathway is responsive to touch, pressure and vibration
Pain gate theory
These sensation pathways include a gate into the brain. Only one signal can get through the gate at a time, and the fast lane always takes precedence, with the slow lane last in line. You may not realise, but you already know this. Imagine you have a small accident while chopping vegetables, and slice into your finger. You will grab your finger with your other hand and squeeze, applying the pressure of the A beta fibres. These have precedence at the pain gate so reduce or eliminate the experience of the acute pain from your injury. Or, when you feel cold, do you huddle into yourself and rub your arms? The pressure of the arm rub overrides the sensation of cold. TENS machines use the pain gate theory to work. They supply a strong vibration to the body, greatly reducing the experience of pain as the brain receives the signal from the vibration over the pain that it experiences.
Laughter
Here, I must mention laughter. I will write a longer blog post on laughter at some point, but laughter is a natural pain reliever. Part of that is the vibrational aspect of it. When we laugh – that is to say, when we laugh properly, when we have a prolonged belly laugh – our whole body shakes up and down. That ho ho ho or the ha ha ha or the squawking, sniggering, guffawing sounds that we create send a vibration that starts in our windpipe and takes over our whole body. Find things to laugh about or, if you cannot, laugh anyway (fake laughter has the same physiological effects and often transmutes into real laughter) and allow that laughter to continue. Make the choice to abandon yourself to your laughter. Laugh for as long as you can and see how you feel afterwards. Hint: you’ll feel much, much better than you did before.
Serotonin
And of course we must not forget serotonin. Serotonin: the mood stabilising, pain killing hormone. We can encourage its release through positive actions, positive interactions, and positive thoughts. Happy memories, a walk in the woods, a conversation with friends, paddling at the beach, having a massage, reading a good book, making plans, completing a task, making a baby laugh, standing outside and taking a deep breath – there are so many things stimulate the production of serotonin. If we return to the motorway analogy, there is a fourth vehicle – the motorbike. Serotonin is like a motorbike, weaving in and out of the traffic and getting to the destination quickest.
Rebecca Bartholomew, 24 April 2022
