Pain and Stress: A domino effect

"The back carries the weight of the world" as a counselling, osteopathic lecturer of mine once said. I would not go quite that far but I do approve with the general principle that what we feel can manifest in our physical body, almost as if the brain does not want to deal with certain emotions and consequently, will create a physical pain. That is not to say the pain is not real, it is but there may be no obvious physical or physiological changes to be seen in painful area.

But to admit that pain is being caused by mental suffering seems to many people to be a massively taboo area, as  if it labels them as shirkers or making it up. This is most certainly not the case and it is imperative for people to realise that mental suffering, stress and so on are very real and that our brains have a host of ways of dealing with them, one being getting rid of and ‘off-loading’ onto the musculoskeletal system. Addressing both parts is a really key component of the treatment but the client must be open to the concept that some of their pain is being created by the brain.

Recent clinical research, as mentioned in Talk Back Magazine, the journal of the charity BackCare suggests that our ability to cope with stressors in life has a direct connection with the amount of pain we experience. Stress can worsen pain and conversely pain can lead to more stress. The symptoms may occur together, they do not necessarily always cause one another, they do though, share a common origin.

The connection in the brain is between the area of the brain that processes emotional responses and the parts of the brain that relate to the glandular, endocrine (hormone) and immune systems. The hormones released into the bloodstream affect every system of the body and for every type of receptor in the brain there is an equivalent in the body. This is the mind/body connection that as a term is regrettably associated with the more esoteric and obscure types of healing therapies but it is a s real as you can get!

One obvious response to pain or stress is the fight or flight response. Like a dark cloud hanging over us, stress or pain can change our biochemistry. Increased production of stress chemicals, such as cortisol are can affect sleep cycles, disturbing the rejuvenating deep sleep that is essential to our well-being. This can lead to decreased energy levels and an increased fatigue. The pain can be enough of a disruption to cause increased irritability, low mood, poor dietary choices and so on. The pain can lead to feelings of depression and relationships can become strained. Brain studies in people with persistent pain shows a rearrangement in those parts of the brain involved in understanding and perception. In other words, long term pain sufferers are inclined to think, feel and act like a long-standing sufferer.

Evidence from studies exploring the link between personality and long-term pain proves that long-term pain is preceded by the creation of predictable behaviours. So how we respond to pain can be understood as a consequence of many aspects including personality, how we manage our feelings and past experiences.

Osteopaths are taught the very basics of psychology and one significant reasons why I have invested a lot of time and energy on my own further development in this area, is to empower me in practice to help people explore the ‘other story’ behind their pain/ suffering. Recognising the factors that may intensify the symptom(s) of pain can really help one cope, deal with and finally and find peace with the issues, past or present.

An introduction to Pain, explained…

In this article osteopath and clinic director James Clapham shares his insight and expertise on pain in this snapshot introduction to explain pain.

Pain

Pain, it’s something that everyone can suffer with at some point in their life, possibly daily maybe rarely. Whatever the case it is an inevitable actuality of being a human being.

Of the 7 billion of us living in the world, at any one-time pain is felt by as many as 1 in 5 people on the entire planet!

Pain is a very, very complex phenomenon which can be hard to understand. There are a multitude of reasons why pain occurs, some of which may even be unrelated to physical factors. So how does pain work? Why does one person have a totally different experience of pain from the next, even if they have exactly the same injury? Someone may suffer with chronic pain which lasts for 3 months or more whilst others could be experiencing acute pain from an injury that has just occurred.

What is pain?

Pain is a product of danger, it is how your body alerts you to the fact that you are harmed, hurt or injured and is the safety barometer to avert further risk of worsening injury. When your brain interprets a situation as dangerous, it lets you know by triggering a warning in the form of the sensory stimulus that you feel as pain – however small the threat to your wellbeing it may be. The pain your body feels is not always proportional to the damage being caused, take for example a ‘paper-cut’ it’s not going to kill you but it can really hurt! Some problems such as CRPS (Complex Regional Pain Syndrome) one of the most sensitive pain based conditions can cause the patient to feel excruciating pain from the lightest touch, even wind, water, cotton wool can cause a great deal of pain to be elicited in their body. On the other end of the spectrum life threatening diseases such as Cancer can be ‘silent’ in that there are no painful symptoms until very late in its progression or maybe in a traumatic injury such as a car crash, there have been reports of people with horrific damage to their body that don’t feel pain as they are in ‘shock’ - a mental state related to our body’s fight of flight response.

It’s not that simple though…

However, we cannot just simply dismiss pain as purely being an output from the brain in response to danger, there are numerous other sources and every individual suffering with pain, especially those suffering for months and years can involve a story, life situations, emotional stress, trauma, all play their part.

Pain can be imprinted in our brain as a memory, let’s say you hit our head badly on a cupboard door or slipping whilst running on a wet swimming pool floor, or whatever it may be, certain experiences in our lifetime that cause pain can act as a mental trigger to prevent us doing the same thing again in the future.

Lower back pain is a very interesting example, many differing degrees of suffering from person to person can make it somewhat of an enigmatic condition to diagnose. Even with ‘black and white’ information from an MRI scan, highly detailed imagery of the spine, surrounding soft tissues may shed light on significant injury to the intervertebral discs, showing apparent ‘trapped nerves’ however in two separate scans in two different people may show the same level of disease in the spinal discs, one person may be in agony with horrendous sciatica but the other may have no symptoms whatsoever.

Behind the scenes and the context of pain

When we delve a little deeper, pain levels can be broken down further more when putting things into context, based on the perspective situation of the person in pain. Let’s say you suffer a minor injury to your finger, the pain experienced will mean vastly different things to a pianist when compared to a footballer. A pianist who relies heavily on his fingers will be more concerned by this and will be likely to pay more attention to this injury which in turn can cause more suffering. Our brains score things in order of severity based on the areas of our bodies we use more in day to day life and therefore these areas will appear to be more sensitive and as a result, in an attempt to self-preserve we will want to protect those parts as a matter of urgency.

A huge area that has another significant effect on pain is mental emotion and mood, in simple cases having a bad can make a headache feel a lot worse or in other cases of mental health disorders such as low mood, anxiety, depression can all be linked to worsening painful symptoms and vice versa.

It is also clinically proven that lack of knowledge and understanding regarding one’s pain can actually increase the level of suffering someone may experience, so if you have a clear picture as to why it is you are in pain you will actually suffer less, which is why as Osteopaths we always like to make sure our patients have a clear understanding as to why they are in pain. Severity can also be affected by the onset and progression of the pain, something that builds up slowly over the months will not register as acutely painful as say a sudden break or fracture to a bone, in such incidences like a trauma causing a broken leg.

James and Pain

Pain is an area of interest that as an Osteopath of almost 10 years now I have encountered in many different forms and severities, and whilst Osteopathy is amazing at helping people who are in pain one area I have become particularly interested in is the type of pain that won’t respond to hands on therapy alone.

I am currently back at college, studying the mind-body connection and learning to help coach people through mind based causes of physical conditions, sensations and symptoms. The study is based on the work of the 6 times bestselling author Sandy C Newbigging and brings together clinically proven science fact and more holistic mind-body approaches in the form of modern day meditation techniques and the teachings around it, which are growing all the more popular with recent the success of ‘Mindfulness’ and its associated patient education.

I will very much be looking forward to sharing this in my practice alongside my work as an Osteopath in the near future, so watch this space...

References
 

·          NOI group – Explain Pain

·          Wall-Pain, the science of suffering, 1999

·          Moseley, Hodges, Nicholas. A randomised control trial of intensive neurophysiology education in chronic low back pain.

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