The Brain and Pain – how your thinking affects your feeling

For most of us, our understanding of how pain works goes something like this:

  1. You get an injury, which causes pain in the area
  2. Pain signals travel from the area to your brain
  3. You become aware of the pain and respond appropriately

But, if we thought about it a little more, we might come up with a few problems with this model of pain. For example, have you ever been doing some DIY and suddenly realised you were bleeding from a small cut? You’ve had an injury with no pain. Or those cases you hear of when someone has been in a bad car accident, and managed to get themselves out of the car and run a safe distance away before they realise they’ve broken their leg? There’s a serious injury with no pain. I’ve seen things like that before at rugby matches whilst doing pitch-side first aid.Or what about Phantom Limb Pain? This is a condition where a patient has a limb amputated, but the limb still feels present and is in pain. We might even look at something like pain threshold, where people’s tolerance to pain can differ hugely when exposed to the same painful stimulus. All of these things would give us a clue that pain might be more complicated than our 3 step model above.

From what we know from the best available pain science, the mechanism of pain actually looks more like this:

  1. There’s an injury (or not), and receptors in the area are stimulated, providing information about pressure, heat and chemicals in the area
  2. This information is taken to the spinal cord, which decides to amplify or decrease the information
  3. This information travels to the brain which assesses it by comparing it to previous experience
  4. The brain creates an experience of pain and assigns it a meaning, which we then chose how to respond to.

Each of these points is a brief summary of a huge amount of research and pain data, but if we wanted to look at it a bit more simply, it might be helpful to think of your pain mechanism like a fire alarm.

Fire alarms don’t actually respond to fire. They respond to clues that a fire might be happening, such as heat and smoke. In the same way your brain doesn’t respond to pain, it responds to clues about an injury, such as pressure and heat. Fire alarms will usually tolerate a little puff of smoke without sounding the alarm, but if the smoke cloud is big enough and persistent enough, the fire alarm will sound. In the same way, your nervous system has a low level background “”hum” of activity, but if it reaches a particular threshold of activity, it will sound the alarm by creating the experience of pain.

As I’ve mentioned before, the neurology and neuro-anatomy behind these concepts is something we don’t have the time or space to dig down into  here. But the main point I’d like you to understand from reading this is that pain is an experience created by your brain. Why? To protect you from harm.

Perhaps you’ve been told “your pain is in your head!”. Well, in a way, ALL pain is in your head. Pain does not exist in the body, it is an output of the brain. BUT another important thing to recognise is that your pain is still very REAL. The painful experience created by your brain is not a fake one, it’s how all pain works.

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