Why pain and types of pain
- Pain is natural. It tells us when something is wrong.
- It helps us avoid injury – like snatching our finger away when touching a hot iron.
- It protects us after injury by ensuring we know we have hurt ourselves and of the need to take care of our injury, for example not walking on a broken leg.
- It tells us something is wrong inside us – like when we have an infection (e.g., appendicitis) or a disease like arthritis.
There are two sorts of pain: ACUTE or short term pain and CHRONIC or long term pain.
ACUTE pain can be fast or slow pain. Fast pain travels up on nerves that transmit the pain signal to our brains very quickly – this is for when acute pain needs to be responded to very quickly, like after scolding yourself with hot water or when you’ve banged your finger with a hammer. The pain is very localised and you know exactly and instantly where you have hurt yourself.
Slow pain is associated with slow, throbbing pain that we might feel for example a little while after falling over on our knees. The acute pain passes to be followed by a generalised pain. It can come in waves. We sense the general area of our knees as being painful but cannot say it is one particular point of pain. Often rubbing the general area can help to alleviate it a bit by masking the pain with more pleasant sensations.
ACUTE, short term pain goes way as the injury heals its self as there is no useful purpose to the pain anymore.
CHRONIC Pain can go on for weeks, months or even years. CHRONIC pain is usually associated with something going wrong inside us and is called PATHO PHYSIOLGICAL PAIN.
There are three types of PATHO PHYSIOLGICAL PAIN:
NOCI-CEPTIVE PAIN – is caused by damage to our tissues like muscles and joints and is associated with conditions such as rheumatoid arthritis or osteoarthritis.
NEURO-PATHIC PAIN – caused by damage to parts of the nervous system itself and is associated with e.g., types of diabetes and neuralgia.
SENSORY HYPERSENSITIVE PAIN – where pain is experienced in the absence of any identifiable damage to either tissues or nerves and is considered to be a regulatory dysfunction within the nervous system. It is associated with conditions such as Fibro-myalgia.
Chronic pain can also be experienced as BREAKTHROUGH PAIN. This is when pain suddenly increases on its own without any obvious cause and that lasts for short periods before dropping back to the chronic level. It is often experienced by people with phantom limb pain (following amputation) or pain associated with some cancers.
Whatever the cause, the pain stimulus travels from the point of stimulation along nerves up the spinal column and into different regions of our brain along what is called the Pain Pathway. The brain then interprets the pain signal and sends a response that we feel as pain along with any action that may be needed – like taking our hand away from a hot iron.
Let’s look at this Pain Pathway now. It is interesting and it gives us an understanding of how important the brain is in conditioning how we experience pain. The brain can amplify it or turn it down depending on how it perceives the context of the pain. We will see that the old saying ‘mind over matter’ is very true. Hypnotherapy takes advantage of this by working with the mind to change our perception of pain and alleviating our experience of it.
- Stimulus – bangs toe. Fast pain signal travels up fast peripheral nerves to…
- Spinal Column up to the…
- Brain stem and then into the…
- Brain where the Thalamus directs it onto to three different regions:
- Somato-sensory Cortex – deals with our senses and thus the intensity of the pain
- Frontal Cortex – deals with our perceptions and thus the meaning we give to pain
- Limbic systems – deals with emotions and our emotional reaction to pain.
These different regions communicate with each other to condition all factors of intensity, meaning and emotional reaction and ultimately our overall experience of pain.
In this instance on the chart the brain sees we have hurt ourselves but not too badly and sends a signal back to our muscles to hold the toe and rub it. The brain tells us ‘relax, don’t worry, this is not serious, and not to be so silly again.’ As a result, we don’t feel too bad about the experience.
If the damage had been much worse – like we had crushed our foot under a concrete block, then the brain might enhance the pain sensation and send a signal ’this is serious’ and to make us scream for help. Our experience will be pretty awful and one we are likely to remember for a long time.
The brain is very good at conditioning the response to the pain stimulus depending on the circumstance and our emotional reaction to it. For example, we might be hurt in a bad car crash. The pain is acute but the brain tells us ‘get out of the car because it is about to catch fire.’ We can over-ride or ignore the pain if necessary. Equally powerful can be good associations, for example giving birth. The physical discomfort can be over-ridden by a sense of joy and wonder so the pain becomes secondary and lessened by the understanding something good is happening.
In the cases of joy the brain releases natural opiates, or endorphins, that bind to the receptors in the nerves that usually pass on the pain signals thus blocking the pain pathway. Synthetic pain killers like morphine work in the same way by mimicking the natural opiates and blocking the pain pathway.
This ability that we have for our minds to condition our experience and emotional reaction is why hypnotherapy can work so well. Hypnotherapy is a good way of doing this. Hypnotherapy accesses the same parts of the brain when in trance that can help us relax and focus, experience a sense of joy and happiness, and enables us to reframe our relationship to pain so that we can deal with it more easily.
Hypnosis is increasingly being used as an adjunct to other methods of pain control and research has shown the hypnotic pain control is not a placebo but has a psychological action, as just described. For example, PET (Positron emission tomography) scans show clearly that hypnosis directly affects our Cortex involved in how we perceive pain, as shown above in the chart.
How bad is your pain and what effect does it have on your life? Use the chart below to help you describe your experience of pain. I encourage my patients to use this tool as an aid to my understanding of how they feel and in designing therapy best suited to them.