The Scrutinizer
Welcome to “Illuminate”, our Blog Newsletter that comes out around the first week of every month. The purpose of this newsletter is to shed light on topics that we find essential in achieving true health and wellness. Knowledge is power. When it comes to healing, the more we know and understand about our bodies, the more effective we can be.
In our past three Illuminate newsletters we have been focusing on the topic of pain. In February we discussed the labyrinth that we can get lost in as we desperately attempt to rid ourselves of the pain we are experiencing. March emphasized the importance of truly getting to know your pain as a persona in and of itself and understanding that pain is not all of you, only a part of you. Most recently April covered the process of injury and tissue healing and how our intuitive thought pattern, when it comes
In the 17th century, René Descartes was one of the first Western philosophers to describe a detailed somatosensory pathway in humans known as the Cartesian Model of Pain. He stated that pain was a perception that occured in the brain based on a painful stimulus (nociception) of the tissue and that the perception of pain would only be perceived in the brain when there was a significant enough sensory cue.
The intensity of this sensory cue provided the information to the brain about the intensity and quality of the pain. Sound familiar?
Ronald Melzack and Charles Patrick Wall later proposed the Gate Control Theory of Pain in 1965 that further developed the physiological pathway of pain. Melzack and Wall accepted that there were nociceptors (pain receptors) and touch fibers and proposed that signals produced from stimulation of the skin were transmitted by these fibers to the spinal cord. They proposed that there are neurological gates in the spinal cord that modulate the transmission of incoming sensory information to the brain. When painful stimulation reached a certain threshold it would “open the gate” and allow those signals to travel onward to the brain. This would in turn activate pathways that would lead to the experience of pain and its related behaviors.
These two major pain theories adequately describe a series of actions about the nociceptive system and pain perception and can be very accurate in many acute pain scenarios. However, these models do not adequately account for the complexity of the pain system. Nor are they applicable when treating chronic pain conditions. Melzak and Wall's gate theory came at a time when the medical world was ready to dive deeper into the understanding of pain. It is said to have been an influencer and initiator to the neuroscience research and theories that have followed. As you learn about these theories you can begin to see how each builds off of the other. None of them are wrong per se, we just need to see the bigger picture and how each part of us is interwoven with every other part.
It is now clear that peripheral and central adaptation (plasticity) can arise following repeated nociceptive stimulation in healthy subjects and in chronic pain. An example of this is when acute injuries or symptoms are left untreated or are treated inappropriately. Let’s return to the spinal cord, where the nociceptive sensory data comes in. When this data arrives it causes a release of chemicals and a chain reaction that sends the danger message to the brain. If the data keeps arriving it will cause an adaptive increase in sensitivity of the spinal cord. The spinal cord essentially gets better at sending the danger messages to the brain and becomes more disposed to finding stimulus painful. This means that things now hurt more than they used to and that things that didn’t hurt before now hurt. As a result your brain is getting tricked as it operates on faulty information.
This brings us to our next pain model, The Neuromatrix Theory, developed by Ronald Melzack in the 1990s and considered an extension of the Gate Control Theory. The Neuromatrix Theory of pain proposed that pain is produced by characteristic patterns of nerve impulses that occur within our brain. Everyone has their own distinct Neuromatrix, created through genetics and modified over time through their sensory experience and memory. It is important to note that there is not just one center or location for pain in the brain. There are many areas of the brain that are involved in one pain experience. These interconnected areas that are involved are often referred to as ignition nodes. The particular pattern in which ignition nodes light up to create the perception of each pain experience is called a “neurotag”.
Butler and Moseley, authors of Explain Pain, use the analogy of an orchestra to explain the overall process. You can think of the ignition nodes like musicians in an orchestra. A good orchestra can play many compositions (neurotags) and can easily learn new ones. However, in the case of chronic pain, when the orchestra plays the same song over and over again it becomes a problem. Adaptation doesn’t stop at the spinal cord. It can happen in the brain as well. In chronic pain, when the same song is played, pain ignition nodes become hypersensitive. These sensitized patterns of nerve impulses can be triggered more easily by a painful stimulus, such as an injury or illness; however, they can also be triggered by other factors such as emotions, thoughts, and beliefs.
The Biopsychosocial Pain Model, developed by Drs. George Engel and John Romano in the 1970’s, has been identified as the most successful pain model to date. This model uses physical, psychological, social, cognitive, affective and behavioral measures—along with their interactions—to effectively assess each individual’s unique pain condition. This model understands and appreciates that emotions and beliefs are nerve impulses too. For example, as humans we are fortunate to have the ability to recognize situations as dangerous. This is what helps us to avoid pain in many instances. However, when the system becomes sensitized (as in chronic pain), inputs unrelated to tissue damage but judged by our brain to be dangerous, can be enough to activate a neurotag and cause a pain perception. An example of this form of input would be emotion - fear that something is going to hurt. Another is belief - belief that something is going to cause you harm. This could all occur on the subconscious level. You won’t know that it is your brain that has made the decision that something is painful. You might not even be consciously aware that you have these emotions or beliefs. All you will know is that you have pain. Butler and Moseley referred to thought processes that are powerful enough to produce and maintain a state of pain as "thought viruses".
“I’m in pain so there must be something harmful happening to my body”
“I’m so afraid of injuring my back again that I’m not doing anything.”
“I used to do sports and was in great shape. Now I can’t do anything.”
“My doctor says it’s bone on bone. Surgery is the only way to fix it.”
“Even the MRI couldn’t find it. It must be bad.”
“They said it’s just a part of getting older.”
“I have arthritis throughout my entire body.”
“My back goes out all of the time.”
“My knees are shot.”
The key point in all of this is that pain depends on many different factors and it is the brain that decides whether something hurts or not. This is true all of the time without exceptions. In 1998, Louis Gifford created The Mature Organism Model (MOM) as a teaching tool to help clinicians and patients to see pain as an integrated phenomenon and ultimately manage it better. It draws us away from thinking that pain either has to be coming from the physical body OR from the mind. Instead it brings the mind and body together as one. The MOM places equal emphasis on all the components of the nervous system (sympathetic and parasympathetic) and introduced the interaction between the nervous system and all other systems of the body (ex: endocrine and immune) when it comes to the perception of pain. In Gifford’s model, the brain is seen as a ‘Scrutinizing Center’. This means the brain assesses signals provided from the body’s systems and tissue. This assessment also takes into account environmental factors, pain beliefs, past experiences, and fear of pain to create, sensitize, and increase the perception of pain. After modulating the pain, the brain then decides on an action or ‘output’ which can be physiological or behavioral.
When the brain is satisfied that all is well, that we have achieved homeostasis, it will stop creating the experience of pain. It is our job to understand ALL of the influencing factors to the brain so that we can effectively take action and eliminate that which doesn’t serve us. Willingness to learn, explore, question, and challenge will be the first step to healing. Clients often want to downplay their past experiences, challenges, emotions, and beliefs. They have a hard time understanding how family beliefs, culture, relationships, or work environments could be related to their pain. In the medical world we tend to separate each body part and each body system from the other. We need to start embracing and connecting all of these things, our complete life, in order to effectively heal our complete self.
The next Illuminate newsletter will discuss where to go from here. We will discuss current treatment approaches that are effective in the management of chronic pain. I hope that you have enjoyed this journey into the past to understand our present and to better influence our future. As always, please feel free to reach out and share your own thoughts and feelings as you read these emails. We love hearing from you and talking with you. Be well and enjoy the day!
Shellie
