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.

If you’re interested in learning more about this, please browse the articles or hope over to my Facebook page to see some of the live sessions at https://www.facebook.com/drjuliagover/.

What happens when I’m stressed?

When you are in a stressful situation, your body releases two stress hormones, adrenaline and cortisol. These bring about changes in your body which are referred to as the Fight or Flight Response – they prepare your body to either run and hide, or defend yourself from danger.

This response is designed to protect you from short term danger, such as moving out of the way if a car is about to hit you. However, when a person is stressed for a prolonged period, such as being excessively busy at work for several months at a time, or caring for a sick family member for many years, these hormones will be released continuously and will have a more pronounced effect on the body. Below is a table showing the different effects on short term and long term stress, and how it causes problems in the body.

 

Short-term Stress Long-Term Stress
1. Increased heart rate High blood pressure
2. Increased production of blood sugar Diabetes
3. Up regulated nervous system Lower pain threshold
4. Blood moves away from digestive system Digestive problems such as IBS and indigestion
5. Blood away from reproductive system Stress-related infertility
6. Blood clots more easily DVT, strokes and heart attacks
7. Reduced effectiveness of immune system Frequent infections and allergic responses
8. Increased muscle tension Muscle and joint pain

 

Back to Sleep, Baby

The Back to Sleep Programme encourages new parents to place their baby in a safe position to sleep at night. New mothers are offered a wide range of help and support to get babies sleeping happily on their back, rather than their front or side. But what exactly are the benefits of putting babies to sleep on their backs, and how much time should babies spend on their backs when they’re awake?

Benefits

Since the introduction of the Back to Sleep Programme in 1992, infant cot death has reduced by an incredible 50%. A study conducted in 2012 found that there were two main types of risk factor:

  1. a vulnerable infant (a baby that is premature, or who is exposed to tobacco from parents who smoke)
  2. risks from the sleeping environment (sharing a bed with parents or another baby, or babies who sleep on their front or with their face covered).

This study also found that changing sleeping position from front to back halved the risk of cot death.

Drawbacks

Whilst a drop in cot death is, of course, very worthwhile, the Back to Sleep Campaign has had some interesting and unintended consequences on infant health. Since 1992, health care professionals have seen an increase in “plagiocephaly”, or “positional head deformity” (PHD). This is an asymmetry of the baby’s head, usually flattening at the back of the head and bulging out at the front. Why does this happen?

When babies are born, their skull bones are soft and the joints between them are loose. This helps them pass through the birth canal during labour smoothly. After the baby is born, the skull bones take a little while to harden and remain relatively soft for about 5 months. This means if a baby spends a long time in one position, the skull will mould and change shape to match. Babies who sleep on their back, and then spend a lot of time during the day lying on their back or sitting in a car seat, can end up with flattened areas on the back of their skull, causing the front to bulge outwards.

It has also been noticed that babies who spend a lot of time on their back often have a delay in learning how to lift the head, push themselves up on their arms, rolling over and crawling, which are important skills to learn in the development of the nervous system.

Tips for preventing PHD:

1) Tummy time! This reduces time spent on the back, but also encourages baby to learn new motor skills and develop the nervous system. Begin with 15 minutes per day and increase by 1 minute per week.

If your baby does not initially like being on their front, try the following tips to get them used to it:

  • Place blanket roll under the chest so baby can see beyond the floor and then decrease the thickness over time as the infant’s skills progress.
  • A parent can lie on the floor on their back, then place the baby on their chest to allow some interaction.
  • Put interesting objects (e.g., toys, pictures, or even goldfish in a bowl) where baby can see them. Remember that the most interesting object to any baby is mum or dad’s face.

 

2) Throw in some variety by changing sides in some of the following activities

  • Feeding from different sides, or in a different position
  • Change the position of the crib to encourage the infant to look in the opposite direction.
  • Reverse the head-to-toe position of the baby in the crib or change toy, mobile, and crib positions, weekly.

 

3) Limit the time spent on the back in car seat, infant swing and infant carriers. You might want to try baby wearing instead, in a soft stretchy sling.

 

4) See a chiropractor to ascertain if there’s any underlying cause, such as tension in the neck, jaw or upper back

Tension in the neck, jaw or upper back can be very common in babies because of the mechanics of labour and delivery, and can be especially pronounced in very quick deliveries or deliveries that required intervention (forceps, ventouse, C-section). But even before the birth babies sometimes adopt unusual positions in the uterous (sometimes known as IUC, inter-uterine constraint). This is more common in mothers with low amniotic fluid (oligohydramnios) or in multiple pregnancies (twins, triplets,etc). Paediatric Chiropractors are highly skilled and detecting and treating these conditions.

Summary:

  • Babies should be placed on their backs to sleep, to reduce the risk of cot death
  • During the day, babies should have regular supervised tummy time to reduce the risk of PHD and help the back and shoulder muscles develop so babies learn to sit and roll
  • Vary the position of the cot in the room so your baby is encouraged to look to both sides
  • Visit a chiropractor to correct any underlying neck problems which may be causing the PHD

You can find a Paediatric Chiropractor by searching the Royal College of Chiropractors Paediatric Faculty. Members of this faculty have achieved special recognition for their expertise in treating babies and young children.

Pain During Pregnancy

During pregnancy, lots of extra stress is placed on the back and the pelvis. Mums usually have to adopt a change in posture by leaning backwards to compensate for the growing bump, and the extra weight of the bundle of joy she carries puts extra pressure through the joints of the back, hips and pelvis. Not to mention, that once baby is developed enough to move around and kick, the muscles and the connective tissues in the pelvis have to adapt and stretch to keep baby comfy.

Lots of expecting mothers find that chiropractic care can help with pains during pregnancy. Not only that, but some exciting new research has shown that pregnant ladies who undergo chiropractic care throughout their second and third trimesters have shorter labours, fewer complications and need less pain relief.

Here’s are some common causes of pain in pregnancy explained, how chiropractors would treat them and some tips on how to relieve them yourself.

“Mechanical” Low Back Pain

This is caused by the mother leaning backwards to accommodate a growing bump, and in doing so puts extra body weight through the facet joints. These are the joints that connect the individual bones of the spine, the vertebrae. The extra weight through these joints will cause them to stiffen up, and will also sprain the ligaments that hold them together.

Chiropractic treatment is very effective for this type of pain, and chiropractors treat this condition by “manipulating” or “adjusting” the joint to free it up and keep it moving well. They would also work on the other tissues around the joints to help support them through the pregnancy.

One exercise that may help is The Camel. Start on all fours, with your hands directly under your shoulders and your knees directly under your hips. Make sure your spine is straight, and is not hollowed out in the low back. Pull in your tummy muscles and slowly push your back up into an arch, like the hump of a camel. Hold this for a few seconds, then slowly and in a controlled way bring your back down to a straight position again. When coming down, the back should still not hollow out, but should come down to a neutral position.

Pelvic Girdle Pain (Symphysis Pubis Dysfunction (SPD) and Sacro-Iliac Joint (SIJ) Dysfunction)

The symphysis pubis is a joint at the front of the pelvis, midway between the two hip joints. The SI joints are located at the back of the hips, where the pelvis meets the spine. Because of the change in weight distribution when pregnant, these joints are now carrying a lot more weight than it is used to. Not only that but the joints lose a lots of stability during the last few months of pregnancy because of a hormone called “relaxin”. This causes the joints in the pelvis to become looser and move more in preparation for the birth. This extra movement will help with labour but can cause a lot of pain due to instability in the pelvis while still carrying the baby.

Chiropractors are experts when it comes to joints, and so can use mobilisations and manipulations to get these joints moving as they should, and also work on any associated muscle tension in the area, to provide pain relief and help to get the whole pelvis ready for delivery.

Exercise for the Gluteus medius muscle can also help, as this is the main muscle that stabilises the joints of the pelvis. You can use The Clam exercise. Lying on your right side with your knees bent, make sure your hips are in line with your feet and your knees are in front. Pull in your tummy muscles and slightly tense your pelvic floor and your bum muscles. Keep your feet together and slowly rotate your left leg to bring your knee up towards the ceiling. Make sure you’re not cheating! Your pelvis and hips shouldn’t roll forwards or backwards and your back should stay absolutely still. Only the leg should move, and you should feel the muscle at the top of the left buttock cheek working. Hold the knee up for a few seconds then slowly and in a controlled way lower it down again, and make sure you’re still not cheating! Do 10 and then roll over and do the same on the other side.

Fascial/Connective Tissue Pain and Hip Pain

During pregnancy, a large band of connective tissue (also known as fascia) runs under the bottom of your bump to help support the baby as it grows. This also connects to two muscles at the front of the hip called Iliacus and Psoas. Sometimes, as the baby moves around or kicks, bits of the connective tissue can get bruised or twisted and this causes tension. This can pull on the Iliacus and Psoas muscles or, very occasionally, it can pull on the uterus and affect the space the baby is growing in.

Chiropractors use fascial release techniques to release any tension in the connective tissues, and will also use massage to the muscles around the hips. This loosens of the tension and gives the baby plenty of room to move around. It also helps reduce pain in the hips and pelvis. There is also a technique called KinesioTaping, which uses special tape (similar to that used in sports injuries) to support the bump and help the connective tissue take the strain.

You may be able to relieve some of the tension on the connective tissue by using a gym ball. Sitting on the gym ball you can tilt the pelvis backwards and forwards and roll from side to side to encourage the fascia to unwind and untwist.

 

If you have any more questions, please do not hesitate to discuss these with your chiropractor.

Exciting New Research in the Treatment of Low Back Pain

Back pain is a very common problem in the UK, and is common across all types of people – the young, the old, men, women, children, manual laborers, office workers and even celebrity athletes like Andy Murray! In the UK, one study showed that an estimated 9.3 million working days are lost through musculoskeletal disorders (that is, pain caused by severe stiffness in joints or tightness in muscles) every year. Other research has confirmed that musculoskeletal pain the second most common reason for someone going to see their GP, accounting for up to 30% of GP visits. Low back pain is also a common problem among new parents or parents of toddlers, as a result of carrying their little bundles of joy about with them.

In an exciting study published in the British Medical Journal, doctors and researchers looked for the most effective treatments. Over 740 patients were given either standard hospital care (including painkillers and referral to physiotherapy) or chiropractic care (including massage, joint manipulation, exercises and advice). The results of the study were striking. Patients who had received chiropractic care had less pain than those treated with hospital care, and 66% of patients said that chiropractic had significantly helped their back pain.

In themselves these results are not surprising, as it is well-known that chiropractic care is very effective. However, what the researchers were particularly impressed with was that, when they went back to those same patients 3 years later, all of the chiropractic patients had continued to improve, even when they weren’t having treatment. However, a significant number of the hospital patients had relapsed and were now in pain again.

Chiropractors are specialists in musculoskeletal pain and use their hands to make gentle, specific adjustments (the chiropractic word for manipulation) to improve mobility of the joints, release tension in muscles, improve the state of the nervous system and reduce pain. Chiropractors do not use any drugs or surgery in their treatment. Chiropractors treat a whole range of musculoskeletal conditions, including neck pain, shoulder, knee and hip pain, arthritis, headaches and sport injuries. We also treat low back pain, including low back pain caused by slipped discs, trapped nerves and pregnancy or difficult childbirth.

If you’ve not tried chiropractic care before, and you would like to, you can book in for a consultation at Flourish Chiropractic on 07763 752879.