Firstly, I want to start this blog by giving you a bit of insight into how big of a problem pain is and why it is important for people to understand why they feel pain.
Stats on pain:
In 2012, the Canadian Survey of Disability (CSD) reported that of the 13.7% of Canadians on disability, 9.7% identified as having pain-related disabilities.
The Canadian Community Health Survey reported that 1 in 10 Canadians aged 12 to 44 experienced chronic pain. This is an estimated 1.5 million people.
In the United States, the National Health Interview Study did a 3 month survey and reported that 126.1 million people reported having pain, with 25.3 million adults suffering from chronic pain.
This increase in pain is costly on the healthcare system and is connected to the overuse of opiod medications.
With one of the naturopathic principles being, “Doctor as Teacher” I was excited to see that one of the pre-readings included a study where they compared two different types of educational sessions in a group of people who experience low back pain (LBP). One group learned about back anatomy and physiology (the structure of their LBP), while the other group learned about the neurophysiology (the function of the nervous system) of pain. The group that was educated on the nervous system and it’s neural plasticity (the ability for the brain to reorganize it’s connections), rather than the anatomy associated with LBP, experienced less back pain. So although both groups had their “Doctor as a Teacher”, the content and the language used in what they were learning changed their outcome!
Now that I’ve gone over how common and impactful pain is on a society and why it is important to teach people about the neurophysiology of pain, I want to address some common misconceptions that may be stopping a person from changing their pain experience.
Pain and tissue damage don’t have to occur together, one can exist without the other.
There is not just one pain center in the brain. Pain involves many areas in the brain and can be influenced by different things you see, hear, smell, think and this will be different for each person.
The nervous system is “plastic”. It can change overtime and since pain is influenced by the brain, it would make sense that pain can change as well.
Now to expand on this idea that pain involves many areas of the brain. There may be certain beliefs, thoughts, and triggers that bring on a pain experience for a patient. Examples of this could be; if the patient’s identity is focused on their diagnosis, if the patient saw imaging that made it look like their prognosis was worse, or if the patient is going through a stressful time. These beliefs and thoughts affect how a person perceives their pain and these thoughts need to be addressed.
Pain is there to protect us and we will experience it when the brain perceives danger over safety.
The Nervous System & Immune system
The nervous system is very complex! There are over 1 trillion cells in the brain and about 60 trillion synapses (connections between nerves) in the cerebral cortex! 50-80% of the cells in the brain are glial cells (these have immune function) that have a relationship with neurons. Nerves can “talk” to each other through chemicals called neurotransmitters which effect ion channels. These ion channels determine whether or not a nerve will fire or signal a message. When a nerve is in a more “sensitized” state, it will fire more easily. Inflammation and the immune system can also influence how a nerve will fire. The network of nerves that fire when a person is experiencing pain is called a “neurotag”. Over time the neurotag will change by addressing the other factors that are affecting a person to feel pain.
As an ND, we learn the importance of a healthy and balanced immune system, that too little or too great of an immune response is not always ideal. This is also attributed to pain. The immune cells respond to tissue damage by releasing inflammatory substances such as; prostaglandins, histamine, cytokines etc. These all help to heal the tissue! However, this inflammation can also be connected to prolonged pain, if the inflammation doesn’t go away.
Another article we had in our pre-reading was how the immune system is connected to memory. When the immune system is over or under activated it can decrease learning, memory, and neural plasticity! This is another example on the importance of a healthy immune system! Also, this neural plasticity is needed for a change in the person’s pain neurotag.
This idea that experiencing pain comes from nerves that are effected by our thoughts, memories, beliefs, immune system, and systemic inflammation gives the patient an idea into how they can take control over their pain experience!
The endocrine system
Another system that is very connected to the nervous system is the endocrine system. When a person has an injury or perceives a threat they will release CRH (corticotrophin releasing hormone). This communicates to the pituitary gland and tells it to release ACTH which stimulates cortisol release from the adrenal cortex. The adrenal gland can also release adrenaline and noradrenaline. These hormones trigger a person to be in fight or flight mode, but if it keeps the nervous system constantly in overdrive it can feed into chronic pain.
Tying it all together
As you can see, pain is very complex and isn’t only caused by tissue damage. This information can help explain to patients about why they still feel pain after they have healed from an injury or surgery. After this course I learned that the best approach to pain is where a patient can understand how different systems in the body are connected to pain. The practitioner can help them by boosting their immune system, balancing their hormones, and educating them on how and why their body feels pain.
Tips for patient’s experiencing pain:
Learn the connection between your nervous system and your pain experience (knowing how your thoughts, memories, beliefs, immune system, hormones and inflammation can give you hope and control to change your pain).
Get your sleep!
Mindfulness, breath-work, yoga, and meditation are all important for helping you slow down and getting you into a restful state.
A well balanced diet that you both enjoy and it helps promotes your health (think immune boosting and anti-inflammatory foods).
Movement. See someone who can give you the right exercises to get you active.
Are their certain beliefs or thoughts that you feel are holding you back from changing your pain experience? A counsellor is the best person to talk to about this!
Lastly, find a group of practitioners who can help you address these different factors that effect your pain.
Carol A. Courtney, Michael A. O'Hearn, Carla C. Franck; Frida Kahlo: Portrait of Chronic Pain, Physical Therapy, Volume 97, Issue 1, 1 January 2017, Pages 90–96, https://doi.org/10.2522/ptj.20160036
Moseley G., Nicholas M., Hodges P. (2004) A randomized control trial of intensive neurophysiology education in chronic low back pain. Clin J pain: 20(5): 324-330.
Nahin (2015) Estimates of pain prevalence and severity in adults: United States, 2012. J Pain; 16(8): 769-80.
Statistics Canada (2016) Canadian Survey on Disability, 2012. Retrieved from: https://www150.statcan.gc.ca/n1/pub/89-654-x/89-654-x2016007-eng.htm.
Statistics Canada (2015) Chronic pain at ages 12 to 44. Retrieved from: https://www150.statcan.gc.ca/n1/pub/82-003-x/2010004/article/11389-eng.htm.
Yirmiya R., Goshen I. (2010) Immune modulation of learning, memory, neural plasticity, and neurogenesis. Brain Behav Immun: 25(2): 181-213.
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