Is Pain Really All In Your Head?
by: Manny Aragon
A number of studies have been coming out lately that ask one of the questions that few everyday folks ponder but which have been intriguing healthcare professionals for eons: What is pain? This has certainly been a focus of my practice for some years as folks will come in, having been to various doctors, physical therapists, and the like, completely frustrated that the doc, unable to elicit progress in the patient, has thrown up their hands and told the patient that the “pain is all in your head”.
Now, I don’t know about you, but if I was experiencing chronic, debilitating, pain and a doc basically invalidated my experience by telling me that I was a head case, I would be pretty pissed off and on the hunt for someone who understood what was going on with me a little better… And, so, in my practice, I have always been of the mind that if you are experiencing pain, it is real and your experience is valid and real. So when I saw this video on YouTube explaining the latest understanding of the neurobiology of pain, many things started to make more sense to me.
Essentially what Lorimer Moseley, a clinical and research physiotherapist and Chair in Physiotherapy at the University of South Australia, explains is that the old model of pain, the Descartes Pain Pathway, described by French philosopher and mathematician, Renee Descartes in his 1664 book Treatise of Man , and further developed into the Specificity Theory in the 1800s, is only part of the story. Pain is contextual and the body, brain, and nervous system will regulate the expression of the pain response relative to many factors including past experience, current mood, the presence of nervous system conditions such as anxiety, depression, and past trauma.
Professor Ronald Melzak, one of the 20th century’s primer pain researchers explains this concept in this Pain Theory Video. A more detailed description of the chemical and cellular cascades that occur in the nervous system, brain, and body tissues that result in pain and the body’s response, is explained by Jon Lieff M.D., a practicing psychiatrist specializing in geriatric psychiatry and neuropsychiatry, in his article, “ Chronic Pain Is A Result Of Conversation By Immune And Brain Cells”
The upshot of all of this is that pain is a simple representation of actual damage in body tissue (as described by Descartes) except for when its not (most of the time). Rather, pain is a conditioned and contextual response to the physical and mental state of the individual who is experiencing the pain.
So, in my book, that begs the question: When chronic pain is not the direct result of current tissue damage (most of the time IME), what factors do we have control of to get a reduction in the level of pain experienced by the client?
Interestingly, in a clinical study of 1574 subjects participating in The Netherlands Study of Depression and Anxiety, the conclusions were telling: “Lower parasympathetic activity is associated with higher pain intensity in subjects with chronic pain” In other words, subjects who were biased towards sympathetic nervous system dominance (ie. fight or flight response or “stressed out, obsessive, worriers, depressed, overly focused on their condition, etc.”) experienced greater levels of pain than those who had a more balanced (sympathetic fight or flight and parasympathetic rest and rebuild) nervous system.
This helps to explain why using methods to calm the nervous system and bring it towards balance like Structural Integration, Cranial Sacral Technique, KST Chiropractic, ERT, calming natural nutritional supplements such as minerals and the like, are so successful in producing the positive neuro_chemical cascades that reduce and even eliminate pain.
So, when the doctors are throwing up their hands and exclaiming that the “Pain is all in your head” – they’re often times partly right- the brain does play a central role in the experience of pain- but there is much more to it as you can see. That they blame the patient rather than offer effective solutions is testimony to their lack of understanding of the problem and to their lack of tools.
There are effective tools and processes for dealing with chronic pain (see the list above) and they don’t include blaming the patient.