Pain Is In The Brain


I spent a day in the clinic on Friday and it got me thinking about Pain. Probably not that surprising as not many people book a Physiotherapy appointment when they feel tickety boo. Pain is a great motivator, it is intended to cause action to protect us. Did you know that a Pain experience depends on how much danger you think you are in not how much danger you actually are in.



There are many systems designed to get us out of trouble including the sympathetic nervous system, the motor cortex, the immune system and endocrine system (think hormones). Any or all of these systems can play a part in the pain experience. Now consider the interplay between these systems and psychological influences such as cultural learning, past experiences and personality variables put together with societal and environmental factors and ‘voila’ each of us will have our own personal pain experience.


The simplest situation to consider is that of nociceptive pain when sensory nerve endings are ‘excited’ if we trap a finger, touch a hot plate on the cooker or a sprain our ankle. This acute injury initiates the inflammatory response which ultimately helps us to heal.


The nerves in the local area (peripheral neurones) sends quantitative data to the brain; how much injury has been sustained.  The qualitative experience of how it feels however depends largely on the interpretation of this data by the central nervous system. This explains why tissue damage and pain don’t always correlate with one another. Another interesting phenomenon we find is that the longer we experience pain for the better the brain becomes at ‘producing pain’.


All very fascinating but how does this help us when we are in pain?


Studies have demonstrated that educating patients about the neurophysiology of pain can actually increase pain thresholds whilst completing physical tasks (Moseley, Hodges et al, 2004) and improves the outcome of therapeutic approaches such as graded exercise programmes. (Moseley, 2003).


Health professionals can underestimate the ability of lay people to process and understand health information. This Health Literacy is actually one of the strongest predictors of an individual's health status. Information is power after all!


The more understanding we have of the biological and psychological processes which comprise the pain experience the more we shift the central nervous system interpretation from ‘danger’ towards ‘safety’, turning down the alarm system.


This biopsychosocial approach to healthcare acknowledges the brain body connection and ultimately yields better outcomes for patients. People are empowered, more inclined to embrace the therapeutic process and to self manage more effectively.  


So this is why you will hear my varied explanations of nudging boundaries, embracing the sensations we feel as we work muscles and harnessing the power of the breath to calm the mind.


This graded exposure to normal movement and the normal sensations we can expect will turn down this alarm system in the brain and increase the resilience of our muscles, bones, ligaments and tendons.


Combining education and movement will reduce pain, increase our physical capacity, improve sleep and ultimately improve our quality of life.