What is pain?
What is pain? This simple question has a seemingly obvious answer- pain is anything that hurts!
But asking ourselves that question can lead to some surprises, which bring empowering solutions.
The latest clinical definition of pain as described by the IASP (The International Association of the Study of Pain, of which I am a member) is as follows-
“Pain is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”
There are a few categories of pain- generally speaking, acute pain means recent, and chronic pain is defined as anything persisting for 3 months or more. (I prefer the term ‘persisting’ as ‘chronic’ sounds like its implying there will never be an end- which is entirely untrue- but I will use the word ‘chronic’ as its how the literature generally refers to this type.)
There are subgroups of chronic pain- secondary pain is is due to underlying disease such as cancer, and primary pain is arguably a disease in its own right, because its the sole symptom and complaint.
(I work with people experiencing chronic pain, who have ruled out underlying tissue damage, because I’m a therapist not a nurse or medic, and I will always make sure people have had appropriate medical treatment first.)
There are also 4 broad types of pain, which can overlap and cross over- nociceptive (caused by tissue damage) inflammatory (caused by inflammation) neuropathic (caused by nerves) and neuroplastic (caused by changes in the brain.)
All this sounds quite depressing and well, painful! But- there is hope, and lots of it- so please read on!
Chronic pain, lasting 3 months or longer, generally will have an element of neuroplasticity to it. (Neuroplasticity = your brain’s ability to change).
This is GOOD NEWS! Because it means if your brain has changed to be a certain way, it can change back again, given the right inputs. I’ll go into some of those inputs soon. But first I’d like to go back to the official definition of pain.
“Pain is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”
Let’s unpack that a little bit here. The first part is- its unpleasant. That much is clear. Pain is a warning that something needs to change. In this respect, its an excellent protective mechanism.
Some people are born without the ability to feel pain- they sadly usually don’t live very long. There is nothing to prevent them from injuring themselves over and over again. So actually, its appropriate to be thankful for the ability to feel pain, as weird as that sounds.
The next part of that sentence to highlight is that its a ‘sensory and emotional experience’. So the most scientifically proven and up to date definition of pain recognises that it ALWAYS has an emotional component. This is important- because if we change our emotions associated with pain, we change our experience.
This change can come in many forms- creating new neural pathways by having hypnotherapy for anxiety or hypnotherapy for trauma for example, or making positive new brain connections by expanding our knowledge with Pain Neuroscience Education. I also find that Buteyko Breathing is super helpful for letting go of stress held in the body, as is TRE (Trauma and Tension Release Exercises).
Whichever way you address it, understanding your emotional response and finding ways to soften fear and anxiety around the pain is a vital part of releasing pain.
Lets look at another part of that official definition- ‘actual or potential tissue damage’. Basically what this acknowledges is that there doesn’t need to be actual damage for pain to be present.
This is where the neuroplastic element comes in.
One way of saying this is that PERCEPTION IS YOUR INTERPRETATION OF SENSATION.
The way that you interpret incoming sensations- on a spectrum from ‘safe’, through ‘neutral’, to ‘dangerous’ - will inform how you perceive that sensation. Change the interpretation, and your perception changes.
In fact there is only a weak correlation between perceived pain and tissue damage.
This is demonstrated through the peculiar and well documented case of a man who showed up at a hospital in unbearable agony, having accidentally shot a nail gun through his work boot. Because thats going to hurt, right?
But when the doctors cut his boot off, everybody was surprised to see that the nail had merely gone between his toes, causing zero damage to his foot. And yet the pain that the man had experienced was very, very real.
His brain had made a mistake in its calculations- by expecting there to be a nail penetrating his foot, it had predicted tissue damage which warranted extreme pain, and therefore created the alarm signals that needed to happen to protect his foot from further ‘damage’- which was to cause pain. But his foot was 100% fine!
He had interpreted a neutral sensation as dangerous, causing pain perception.
Another way of saying this is that PAIN IS YOUR BRAIN’S ASSESSMENT OF HOW MUCH DANGER YOU ARE IN.
And your brain, helpful though it may be trying to be, can get that assessment wrong. In fact, its protectiveness may be the problem- because in the absence of tissue damage, that protectiveness is misplaced. Its a bit like a dog who bites the postman’s hand- the dog thinks he’s helping, but now the postman is considering suing you- creating a big problem that wouldn’t be there if the dog wasn’t so overprotective. He thinks he’s doing his job, but is driven by fear.
And so the brain can get stuck in a feedback loop, called the pain/fear cycle. Pain triggers feelings of fear. The fear puts the brain on high alert, with increases pain perception. This leads to more fear. Which leads to more pain. Its a downward spiral.
So what can we do?
In fact, there are many, many things we can do.
Soothe the inner guard dog, for a start.
Break the pain/ fear cycle.
Change the interpretation of sensation.
Identify and challenge limiting beliefs around pain with the intention to update them.
Increase safety cues so that there is no need for alarm.
Dial down the stress hormones cortisol and adrenaline that ramp up pain perception.
Utilise the body’s own painkilling hormones and neurotransmitters- endorphins and endocannabinoids- to bring the body back to ease.
Create new neural pathways with hypnotherapy for pain relief.
Use visualisations to bring to mind a different way of relation to your body.
Learning about pain is in itself a treatment for pain. We have learnt more about pain in the last 15 years than in all of the preceding history of recorded time- and this new knowledge is empowering!
And this is just addressing the psychological aspect! The other aspects involved- biological and social- well thats a whole other blog post.
As you can probably tell, I’m a little bit excited to help people out of persisting pain. Because I know, with the right inputs, your perception of pain can change. Its my job, but not just my job- its my passion, to find those inputs and share them with you.
If you need help with putting pain behind you there are a few ways I can help-
Sign up to my monthly newsletter to receive valuable cutting edge insights into the psychology and reversal of chronic pain
Take the Persistent Pain beliefs evaluation questionnaire attached to the link on my contact page or IG to find out how much of your pain is being driven by your thoughts
Follow me on IG for regular pain busting tools and techniques
Get on the list for my next group program Releasing Chronic Pain, a 6 week course combining Pain Neuroscience Education, Cognitive Hypnotherapy, Trauma Release Exercises and Buteyko Breathing to help you put pain in the past. These are conducted via zoom, and are small groups, to heal in community. Email me for more info
Book a free, no obligation 30 minute phone call to find out more about working 1 to 1 with me, either online or in my therapy room in Hastings
Check out the resources page on my website for free hypnotherapy recordings, and book recommendations.
Until then, I hope you have found this interesting and helpful. To your good health,
Ella
