Know Pain, Know Gain-Part 3

Let’s imagine you are sitting comfortably in your favorite recliner at home watching your favorite show and an African Lion comes into the room.  Are you going to continue to sit there comfortably watching TV, are you going to think about your posture, will you be considering what you are going to do this weekend or what for dinner tonight?  Of course not, you will immediately go into protection mode, you’ll be ready to Fight or Flight.  All your bodies systems will shift to getting ready to run or fight.  With the impending threat, breathing becomes faster and shallower. Digestion of food is slowed down or even put on hold, allowing for all possible energy and blood flow to be allocated to the systems that are in immediate need. Muscle tense in your arms and legs and blood flow is shift from postural muscle to the large muscles of the extremities.  You’re wide awake, libido reduces, heart rate increases and sensitivity to pain increases.

How does this relate to your pain? Everything in your life associated with the struggle of your pain can be bundled together to represent a ‘lion’ or a constant threat in your life.  In order to protect you, your body or, more correctly your brain, will make survival choices and activate systems for your protection just as if a huge, dangerous lion was attacking you.

The list of the threats in your life with chronic pain are long.  For example, no one knows what is causing your pain, life is miserable, you are having a hard time with your work, you try different treatments and nothing works, exercise and movement hurt, nothing helps, you’re losing hope, family and financial issues are arising, you get a lot of different explanations for your pain, what does the future hold?  No one wants to help, constant pain, you develop fear that it will get worse.

Metaphorically, patients who live in pain every day have a massive, roaring African lion following them around each day.  The lion is a metaphor for the constant stress they experience associated with issues such as pain, fear, anxiety, worries about their job, worries about money, failed treatments, etc.  All together theses issues are a threat similar to a lion.  There is widespread reaction to threat by the various bodily systems trying to protect you  which if activated for months, years or longer contribute to various symptoms in addition to pain.

You may start to experience sore muscles, mood swings, appetite changes, weight gain, sensitive nerves, sleep disturbance, posture issues, irritable bowels, low libido, fatigue, difficulty with concentration and depression.  This can manifest as fibromyalgia, chronic fatigue, low back pain, neck pain, headaches, weakness, and many other problems. As you struggle with these issues you become less and less active, you stop doing things you enjoy, you may not be able to continue to work, and gradually you become de-conditioned.  As the years pass of ever-decreasing activity your muscles and tendons are stressed less and less work and exercises.  It’s not surprising that they get sore easily, even with small amounts of activity.  Also, the nerves around these muscles become more sensitive.  You whole nervous system becomes extra-sensitive or awakened and everywhere you poke, push or prod is tender.

People in persistent pain also struggle with “core muscles” and get told their core is weak.  Our deep spine and abdominal muscles allow us to stay upright during the day and protect our spinal column.  The work to protect your spine when you move, lift, push or pull.  When pain persists these muscles weaken because you have a lion in your life and your brain is spending time and energy dealing with the lion not keeping the core strong.  The threat of the lion requires the brain to allocate all available energy to the large muscles of the arms and legs and so as a result your core weakens and your spine suffers.  This is likely a reason why the number one cause of persistent pain is low back pain.

The take home message is this: many body systems are used to protect you. This explains why you may have many different pain issues going on, as well as why you’re dealing with increased fatigue, sensitivity and weakness.  The stress system has been working overtime, you have increased adrenaline and cortisol flowing through your body because of the lion in your life called pain and everything associated with pain that doesn’t resolve as it should.  What is the answer to reverse this downward spiral?  What can you do today to start your recovery?

My next post will talk about 4 things that are proven to help and is consistently done can reverse some or all of these negative effects including pain.

The pictures and information in this post are taken from “Therapuetic Neuroscience Education: Teaching Patients About Pain” by Adriaan Louw and Emilio Puentedura.