Pain and the Brain Pt. 2: More than just a physical injury

 

 

My last blog focused on the role that the brain plays in determining the amount of pain we feel in the body.  Researchers have likened the brain to acting like a “gate” that influences how pain stimuli are interpreted by an individual.  This “Gate Control Theory of Pain” asserts that certain factors can have the ability to “close the gates” to painful input, preventing pain sensations from travelling to the central nervous system and on to the brain for interpretation.  Closed “gates” can also inhibit pain signals from being sent from the brain to regions of the body that have been injured.  This helps to explain why we may not feel pain immediately after a serious injury.  As we discussed, things like distraction and heightened emotions are factors that can have a large impact on the amount of pain one feels. 

 

When one thinks of things we can do to reduce pain levels, we typically think about those “physical factors” that can make us feel better….rub the area in pain, apply heat or ice, reduce activity, or utilize a pain medication to combat the pain we feel.  When you think about it, this is quite natural….when we sustain a physical injury, we turn to physical interventions to solve the problem.  Let’s take some time to review these physical factors that can “close” the gates and reduce our pain perception after an injury. 

 

  1. Medication (over the counter [OTC] medications, topical creams, muscle relaxers, opioids) 

    • The most common types of OTC pain relievers are acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) which include Asprin, Ibuprofen, and Naproxen. 

    • Both acetaminophen and NSAIDs can be used successfully to treat mild pain.  NSAIDs also reduce inflammation and swelling. 

    • Topical creams are often used to relieve pain associated with arthritis and muscle aches. 

    • Opioids, such as Codeine, Hydromorphone, Oxycodone, Morphine, etc. can be used to treat more severe cases of chronic pain.  However, long term use of these medications to treat chronic pain is controversial.  Close monitoring of doses and usage should be provided by physicians. 

  2. Stimulation (heat, massage, acupuncture, TENS) 

    • Many individuals dealing with chronic pain find relief by applying heating pads, taking a hot shower, or applying warming creams.  Cold weather/stimuli tend to worsen chronic pain levels. 

    • Massage therapy can be beneficial in reducing muscle tension that can contribute to our pain levels.  Focus on releasing “trigger points” in the muscles, through massage or acupuncture, can also provide relief in some individuals 

  3. Surgery (eg. fusing of vertebrae, severing nerve fibers, etc.) 

    • Surgeries to release pressure on the nerves or procedures to sever the nerves that send pain signals can offer relief.  However, these interventions are typically “last resorts” and the complications that may arise can be detrimental. 

  4. Reduced muscle tension or arousal (stretching, Yoga, progressive muscle relaxation, inactivity, proper body mechanics, pacing of activities, etc.) 

    • Regular stretching routines and activities such as Yoga can help to relieve pain from stiff musculature. 

    • Maintaining proper posture and body mechanics helps reduce guarding as well as compensation/overuse that can occur when we are dealing with pain in one side/region of the body. 

    • Pacing of activities and reducing overall activity levels (in the short term) allows the body to relax after incidents of overexertion 

A number of these physical factors will be covered more in future blog posts, but naturally, each factor is important in itself and can definitely help to provide us with some short term pain relief.  However, it is important to realize that the utilization of physical factors alone will not combat your pain problem completely… 

 

Over the years, we have come to learn that one’s attention to the non-physical factors that influence our pain experience play a major role in how we feel.  Although physical factors still have a significant role in pain perception, research has shown that our fears, beliefs, and emotions are actually MORE important in explaining our suffering and the intensity of the pain we experience.  Along with this, the further you are from the time of injury or onset of pain, the more important the role of these “psychosocial factors” become in helping explain why we hurt and how we cope.  As pain becomes more chronic in nature, physical factors in pain management typically take a back seat…focus must be shifted to addressing the mental and emotional factors that could be contributing to our pain.  Therefore, future blog posts will also begin to focus on these psycho-social factors that can help reduce our pain levels and overall quality of life. 

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