We are used to thinking that it is a purely biological and mechanical phenomenon and we treat it as such. Instead it is much more and the answer lies in our brain
In 2007 the Journal of Psychosomatic Medicine described two cases that have proved emblematic for the scientific understanding of pain. They concern two masons and are in some ways opposites. The first one of a 29-year-old construction worker who jumped from a platform on a construction site landing on a nail of 15 centimeters. The nail passed through his boot, popping up on the other side, and the young man immediately felt excruciating pain. In the emergency room he was so bad that the doctors administered him a fentanyl drip
(one of the very potent opiates at the center of the drug addiction debate in the United States). Then they took off his work boots and discovered that the foot was intact: the nail had passed through the crack between his fingers and the mason didn’t even have a scratch. Yet he was in excruciating pain.
The other case concerns a carpenter who was using a nail gun. The gun accidentally fired, ricocheted back and hit him in the jaw. The man took the blow but continued to work. Which he also did for the next six days. He had a slight headache and a slight toothache and at the end of the week he decided to go to the dentist, who took an X-ray. To his great surprise he discovered he had a four-centimeter nail driven into the jaw.
The nature of the pain
The two anecdotes, far from being an oddity, are fundamental to understanding the nature of pain. And in particular of the chronic paina problem that afflicts 21.7% of the population in our country alone, around 13 million people, according to Istat. Whether it’s the cervical that ailment – a BBC journalist joked years ago – from which only Italians suffer; or recurring back painwho resists drugs, or operations to resolve hernias or musculoskeletal problems, or even fibromyalgiapersistent, widespread pain in muscles and joints. We are used to thinking that pain is a purely biological and mechanical phenomenon, a purely physical sensation, and we treat it as such. Often it is not enough. Because pain is more than just a bodily affliction, as the stories of the two masons demonstrate.
Not just body
Our body-limited way of conceiving painexplains the pain psychologist at the University of California at San Francisco Rachel Zoffnesshas enormous consequences: it causes us to neglect environmental, social and psychological factors which are crucial to cure it. Zoffness, author of The Pain Management Workbook, in a long interview for the New York Times podcast Ezra Klein Show, tells how a different consideration of pain – based on data now acquired by medical and scientific research – can instead help us to treat it better. To understand this, we need to start from a premise: the function of pain. Pain indeed a kind of body alarm system, a danger detection mechanism whose task is to prevent us from doing something – for example walking with a broken leg – that could harm us: hurt us, in fact. This is why people who are born with a pain threshold high enough that they don’t feel it usually don’t live very long.
Mirror therapy
The cry of alarm constituted by pain, explains Zoffness, is not the simple result of damage received by the body, but its mental equivalent: it is not found “in the body”, but produced by the brain. This means, for example, that we can try the so-called phantom limb painis the phenomenon whereby those who have undergone a limb amputation feel severe pain in a part of their body that they no longer have. It depends on how our brain works, which – simplifying – has an automatic map of our body and keeps it intact even if the body changes. One of the treatments for phantom limb pain is therefore the so-called mirror therapy, which consists of show the patient the amputated limb: serves to re-educate the brain so that it updates its automatic map of the body and understands that its alarm messages (pain) are no longer needed.
Unimaginable pain
It doesn’t mean that the pain is imaginary. For people suffering from pain, if a particular pathology cannot be found or there is pain of unknown etiology, it is often said: only in your head. Historically, this mostly happened to women. If they experienced pain or strong emotions they were diagnosed with hysteria and told their problems were only in their heads. But the pain we feel is always real – he says in the Zoffness podcast -. It is one of the most important things that we need to talk about when we are talking about effective pain treatment that you can not only work on your back or knee, you have to work on your brain as well. The brain uses all the information available at any given moment to decide whether to produce pain and how much, because this is his job. So – Zoffness explains again – use information from past experiences. Use where you are and who you are with. Use emotions, how you feel. It naturally incorporates sensory messages from the body, from all five senses.
Danger detector
This explains the different reaction between the two masons. In the case of the first mason his brain, i.e. his danger detector, used all available information: memories of past pain experiences, the knowledge of the dangerous work environment, the panic he saw on the faces of his colleagues, the vision of a nail sticking out of his boot. He reworked them and activated his alarm system: so the mason felt pain (real pain, we repeat). To the second mason the opposite happened: when the nail gun discharged, he had the perception that the nail had crossed the room into the wall in front of him. So – says Zoffness – once again, his brain, our danger detector, used all available information to determine whether or not to feel pain and how much. He used the vision of this nail going across the room and information about the experience of a nail gun who hit him in the jaw and concluded that there was no need to feel much pain because his body was ultimately safe. Pain and tissue damage are not the same thing.
Neuroplasticit
All of this has huge consequences for the treatment of pain. The brain in fact changes with time and experience, the so-called neuroplasticity. Brain pathways are like muscles in the body. The more you use them, the bigger and stronger those paths become, explains the psychologist. It also applies negatively. The more pain is experienced the more the pain pathway in the brain (which is not a real way but a series of neuronal connections and with the central nervous system, because there are numerous parts of the brain that are activated in the perception of pain) is strengthened and the stronger the pain becomes. simplifying, chronic pain arises when the brain tuned to pick up sensory messages from the body interprets them as dangerous, amplifying them, even if they are not so dangerous. this is why in many cases, according to Zoffness , chronic pain is self-perpetuating.
If you are a person who lives with pain and believe that it is dangerous to go out and take a walk and that it is dangerous to see friends, you will never heal – he says -. why part of the chronic pain cycle is staying home, staying in bed, and missing out on a lot of life. In some cases unavoidable. But in the case of chronic pain, it turns out that this type of pain cycle is what ultimately amplifies the pain, perpetuates the disability, and impedes healing, says Zoffness.
Reverse the pain cycle
The cycle of pain, for, it can also be interrupted and even reversed. Gradually, over time, we can desensitize a sensitive brain by gradually increasing small bits of physical activity, social exposure, and movement, Zoffness explains. Also why there are many psychosocial factors that regulate the volume of pain: such as stress and anxiety, mood and emotions, or attention and what we focus on. Neuroscience shows that when stress and anxiety are high and our bodies and muscles are tense and our thoughts are preoccupied, the brain increases and amplifies the volume of pain, so the pain feels more, says Zoffness again. Similarly pain gets worse when we experience negative emotions and when we focus on it.
Psychosocial factors
We are usually used to lowering the volume of pain by intervening on its biochemical triggers: pain medications they do this. But in the long run – if there are no more immediate physical causes to treat – it is more effective lower the volume of pain by intervening on psychosocial factors. Zoffness, for example, knows what her recipe for pain is by now, i.e. what are the psychosocial factors that make her more sensitive to pain: insufficient sleep, sitting for too many hours without moving, eating badly without making sure you are taking adequate fruit and vegetables, not exercising, arguing with my partner or family.
These factors can vary from person to person and it is essential to identify your own. If you look at what is in the recipe for pain, you can easily trace a recipe for little pain explains the psychologist. In my case – she adds – I know that if I don’t take care of my sleep, I don’t take care of my pain. I know I have to take care of my emotional health. I know I have to take care of exercise. I know I have to make time to get out and walk in the sun, even if it’s just 20 minutes a day.
The personal recipe for little pain
To get rid of the most disabling chronic pain, it is therefore essential to look for your own recipe for little pain and do it gradually. You don’t go out and run a marathon the next day. You choose an activity, whatever it is, and it’s usually best to pick the favorite hobby or activity you’ve given up, whether it’s cooking or playing football, and chart a course of what it would take to get back. to that activity. And you can only start by standing in your kitchen for three minutes, which is where you start. Graduality means taking your favorite activity and breaking it down into small, manageable chunks. And gradually return to that activity – says Zoffness -. I can’t tell you how many patients I’ve had who had an impossible goal, like going back to playing football, and ended up going back to playing football.
February 25, 2023 (change February 25, 2023 | 2:26 pm)
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