The Truth About Pain
For the last few hundred years, we have thought about pain in the same way.
The biomechanical model of pain sees us and our bodies as essentially mechanical in nature – muscles/ropes and joints/levers. Stimulus travels to the brain, the brain accepts the information and returns a nerve signal to the area = sensation. We put our hand on a hot plate, it hurts and we learn from the experience – don’t touch hotplates. The biomechanical model holds up pretty well for injuries while they are healing. However, it fails to explain pain that persists after the injury has healed. It also fails to explain injuries without pain – like when we notice a bruise and can’t remember getting it. So what is the truth about pain?
Pain is instructive. We learn from it. Hotplate = caution. People who canʼt feel pain die sooner than those that can.
Pain is also contextual. When we are tired, hungry, cold and sad a stubbed toe REALLY hurts. When we are slept, fed, warm and happy, the same stubbed toe is less of an issue.
Our bodies are really good at repairing themselves. Last time you cut yourself, how long did it take to heal? 2-3 weeks? Broke your arm falling out of a tree? Six to eight weeks in plaster, then a bone as good as new. An Achilles tendon torn off the bone is back on the playing deck and almost as good as new in 12-18 months. So a microscopic bulge in the ligaments surrounding our spine healed in a matter of weeks.
Why do we experience persistent pain if the body has had time to repair itself? Is it because the injury persists or is it a richer tapestry than that?
It is widely accepted that a disc bulge (an injury to the tissues around and within the spine similar to a tendon strain or minor muscle tear) in the lower back equals pain.
However, 68% of adults in their 40ʼs with no back pain have disc bulges when put through an MRI. That’s 70/100 adults in their 40ʼs with NO pain have back injuries.
The MRI – Magnetic Resonance Imaging machine – is really, really good at picking up details inside our bodies. Namely cancer and degenerative abnormalities such as disc protrusions (bulges). As the numbers above show us, however (70/100 pain-free adults have disc bulges) MRI machines are really crap at predicting pain.
So an MRI that proves a disc bulge but does not predict the truth about pain. The truth is that 70% of adults who are pain-free in their 40ʼs DO actually have disc bulges.
Better indicators of chronic pain than a disc bulge are:
• Sleep. If you donʼt get enough or itʼs broken sleep you are more likely to be in persistent pain than if you have a disc bulge.
• Stress. If you feel stressed about work/money/home etc you are more likely to have persistent pain than if you have a disc bulge.
• Exercise. If you do you are more likely to be pain-free and/or recover faster. If you donʼt you won’t.
• Belief. If you believe your back pain will pass, it most likely will. If you believe you are your back pain is with you for good, it most likely is.
This illustration shows the Bio-psychosocial model of pain. Increasingly supported by compelling scientific evidence it shows persistent pain as a result of a more complex web of variables than a simple A+B=C.
It explains why the way we are feeling about ourselves, our lives, our jobs our partners and our kids all have an impact on the severity and duration of persistent pain.
None of this is meant to suggest that pain is not real or that it’s all in our headʼ. Pain is very real. As anyone whoʼs been in pain knows, itʼs hard to ignore it when itʼs there and we tend to forget to do the things we know help when it is upon us. What we are finding is the truth about pain is that itʼs affected very powerfully by many more factors than the injury site.
Solving our persistent pain is more complex than simply getting an operation to remove a bulging disc (that we now know has no bearing on 95% of all lower back pain, AND that people with no pain still have disc bulges). It doesnʼt necessarily work to just go and see your osteopath or physiotherapist and get a back adjustment. There needs to be a shift in our exercise, in our sleep and in what we believe about our bodies and our pain.