Fun With Stress 2.7
Pain & Chronic Stress
Reading time: 10 minutes
Pain is our alarm system that warns us in case of damage to the tissues our body’s made up of.
In this chapter we’ll discuss:
how pain is produced;
different factors influencing our experience of pain;
when pain becomes a problem;
the role of chronic stress on feeling pain;
the loneliness of chronic pain – and how to counter it.
Pain is our alarm system that warns us in case of damage to any body tissues. Image: Hans.
How the feeling of pain is produced
Alarm sensors in our skin, muscles, organs etc., pick up danger signals (a.k.a. pain signals) from all over and inside our body when it’s being damaged by heat or cold, pressure (like a fall on the ground, or a cut in the skin), or toxins.
If we touch a pan that contains boiling hot water, heat sensors respond to the excessive heat by sending that information via sensory nerves (nociceptors) to our spinal cord and up to our brain. However, until that information reaches our brain, we do not consciously experience, or feel, pain. As we have seen in part 1 chapter 2, the brain needs to assess the information first before it produces an output, for example in the form of feeling pain and changing our behaviour into letting go of the hot pan.
In this insightful and funny Ted talk, professor of clinical neurosciences and physiotherapy Lorimer Moseley explains, that the feeling of pain is always produced by the brain. He explains how the brain determines whether or not, and how much, pain is produced, after it has received a danger signal from the alarm sensors.
Moreover, he also points out how the brain can decide to produce pain without any danger signals coming from the alarm sensors, and how it can decide to produce no pain even though alarm sensors are relentlessly sending danger signals. This latter case nearly got Moseley killed, because his brain decided “in all its wisdom” that the bite of a highly venomous eastern brown snake was merely a scratch from a twig.
As he aptly explains, the brain will only produce pain when it finds a pain experience meaningful for our protection. Having never been bitten by a venomous snake before, yet having had his leg scratched by twigs in the forest on numerous occasions, his brain perceived no danger and thus disregarded the danger signals caused by the snake’s poison. Subsequently, his brain did not produce pain, so Moseley didn’t pay any attention to it.
Visual image of the pain pathways. Alarm sensors in the broken skin send danger signals via the spine up to the brain, where the signals are processed. If the brain decides that pain is meaningful for our protection, it will make us feel pain in the wounded area. Image lady: Yamu_Jay. Image brain: b0red. Pain pathways and edit: Erik Stout.
Factors influencing our feeling of pain
However, the next time Moseley had his leg scratched by a twig while walking in the forest, his brain produced so much pain to make him scream in agony. That was because there was now a new experience of a stimulus that resembled the scratch of a twig, but in actuality nearly got him killed. Therefore, when a similar stimulus activates the alarm sensors to send a danger message to the brain, this time it will produce so much pain that Moseley cannot think of anything else. With the near death experience still fresh in memory, the brain finds it meaningful to produce much pain in order to make sure that swift action is undertaken, by closely examining the location where the danger signals come from.
To stress the importance of meaning to whether or not our brain produces pain, Moseley mentions some experiments where it is shown that the brain can produce pain without alarm sensors sending any danger messages.
In one of them, a subject’s hand is being touched with a piece of metal, while at the same time either a red or a blue light turns on. While being touched with exactly the same piece of metal, the people seeing the red light felt more pain than the ones seeing the blue light. According to Moseley, since we are cognitively accustomed to identify red with hot (or danger in general), our brain perceives the metal piece to be red hot and dangerous, and ‘preventively’ produces pain in an attempt to move our arm away from the piece of metal.
Visual image from Moseley’s ‘touching the hand with a metal object’ experiment. Image hand: elkofla. Image sword: rpeppi. Red light, blue light, edit: Erik Stout.
Another influence on our experience of pain is the context in which alarm sensors send danger signals to the brain. When Moseley was bitten by the snake, he was walking in a familiar forest where his leg was scratched by twigs many times before. Therefore his brain felt no need to produce pain, because it judged the context as safe.
To illuminate the importance of context on the production of pain even more, we can refer to an often used observation made by Dr. Henry Beecher, who served as a military doctor during World War II in North Africa, Italy, and France.[1] He observed that soldiers wounded in battle needed less analgesic than civilians suffering from similar injuries.
When soldiers go into war, there is a firm realization of entering dangerous situations that might get them killed. Therefore, when injuries suffered do not leave them dead, and especially when they can look forward to a flight home, the pain from their injuries might actually feel quite mild. Civilians, however, treated their injuries as major tragedies.
Contrary to soldiers, civilians are usually not aware of (the possibility of) danger, and feel much more in control of their life and life circumstances. So when they are being confronted with adversity that, in their perception, came ‘out of the blue’ and ‘ought not to happen’, they feel their pain much more than the soldiers, and hence need more analgesia.[2]
Following logically from this observation, also emotion plays a major part in whether or not the brain produces pain.
Pleasant emotions never cause pain, and when pain is felt, they usually reduce it because we direct our awareness to that which we perceive as pleasant, and thus away from the pain.
Clown Doctors use gaiety to distract patients temporarily from their pain. Image: wallpaperflare
Unpleasant emotions, when they happen while we are highly aroused, can also reduce pain. Imagine a soldier in a warzone who just got shot in the leg, but discovers that there’s a way out of his predicament. His subsequent stress response is turned on full blast, sending literally all the available energy to the organs that can get him to safety: predominantly the skeletal muscles and brain. All the other systems, including the pain producing system, are temporarily ‘shut down’, hence he won’t feel pain from the bullet wound at that moment. He can thus use all his energy to escape, and only when he has convinced himself that he’s actually safe from being annihilated, will the fear subside and be replaced with the pain from the wound.
Yet, when unpleasant emotions happen while there is not much arousal, i.e. when we are feeling rather dull, or maybe even depressed, anxiety can be evoked and pain enhanced, as we shall see below.[3]
When pain becomes a problem
Pain, like stress, initially protects us from greater harm. However, like stress (and everything else in our body and mind), pain can morph from a help into a hindrance.
When you’re experiencing muscle pain as a result from a great workout, a day of gardening, or an intensive football match, most likely you will describe that painful feeling as ‘good pain’, because it arose from an activity you chose to do, and enjoyed doing. The painful feeling usually subsides within a few days, describing a normal physiological pattern.
Furthermore, the experience of breaking a limb, for instance, causes initial sharp and high intensity pain, and ensures that you will not put any weight or pressure on the location of the fracture. Within anything from a few minutes to, roughly, half an hour, that sharp, high intensity pain will subside and be replaced with a dull, but manageable pain. And as soon as the fracture is treated by medical personnel, usually the pain will become less day by day during the recovery process.
After a broken limb has been treated, pain will diminish every day during a normal physiological recovery process. Illustration: clker-free-vector-images
In contrast, imagine we’ve been involved in a head on collision. A violent ‘head bang’ move with our heads can definitely cause strong muscle spasms or bruises; or cause bruising, tearing, or breaking of other body tissues. However, in case of actual damage to body tissues, the feeling of pain should follow the same pattern as described above; in normal circumstances there will first be a high intensity, sharp pain, which then usually subsides into a more dull and manageable pain. When being treated by medical personnel, it should normally follow a similar pattern as in the recovery of a broken limb.
However, if the pain not only doesn’t subside, but seems to become worse as months go by, there is a good chance that the pain has ceased to carry out its protective function. It can then turn into a problem when it starts to prevent us from doing the things we need and wish to do.
The effect of chronic stress on how we feel, and experience, pain
It is not uncommon that pain becomes one of the side effects when our buttons are relentlessly pushed, multiple times a day, for a longer period of time.
With every stress response, the police and border patrol forces from our general defence system create an inflammation, of which pain is one of its features. And just as our general defence system as a whole, due to chronic stress, can begin to mistake healthy body tissues for criminals, so all the nerves and parts of the brain which form the pain pathways, can become more sensitive and responsive to their relentless stimulation by every new stress response.
When that happens, pain can become an end in itself. For even though it has lost its protective function, it nonetheless keeps recurring.
A brain that keeps producing pain, even though there is no tissue damage, has made pain into an end in itself. Illustration: 1tamara2
The loneliness of chronic pain – and how to counter it
By now, it has hopefully become clear that the experience of pain is highly subjective. I can try to be empathetic with the suffering you endure because of your pain, but I cannot feel your pain, and nor can you feel mine or anyone else’s.
Moreover, in the clinical setting it became obvious to me that the longer we suffer from chronic pain, the smaller our social circle can become. It’s relatively easy to feel empathy for someone with a broken leg. We see the impairment to ones moving abilities from the cast, and we can try to imagine how the moment of the actual fracturing of the bone must have felt.
But when you cannot see anything out of the ordinary in someone, yet they become more and more immobile and inactive due to chronic pain, many of us lose empathy, interest, or compassion with the sufferer, if not worse.
When pain is invisible from the outside, misunderstanding, frustration, and isolation might be lurking around the corner. Image: geralt
Therefore, I would like to end this article with some ideas for action, both for you if you’re suffering from chronic pain, and for you if a loved one or someone near you suffers from it.
If you’re suffering from chronic pain, it might be positive to know that you’re not the only one. Thankfully there are many support groups for chronic pain, so whenever you have enough energy, do a Google search on ‘chronic pain support groups near me’, and begin by sharing your story with people who will surely understand yours.
Second, there is always a possibility that biological factors contribute to your chronic pain. Therefore, learn about chronic pain related illnesses like fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, and whiplash associated disorders. Research their possible biological causes, and then talk to your doctor or general practitioner to have those tested. If a test comes up positive, then there’s often some treatment available.
Yet if, thirdly, no test comes up positive, then at least you have ruled out the possibility that organs and tissues by themselves are malfunctioning. In that case, you have now good reason to begin investigating your current life circumstances, and how you feel mentally and emotionally. Thankfully, more and more initiatives are being initiated to assist and help people suffering from chronic pain. So reach out and find a caregiver or group you feel completely comfortable and safe with. Then devise a plan that you feel positive about, and go from there.
As a fourth, and last point to you with chronic pain: whatever you do, don’t rush, or don’t let yourself be rushed. Every human being has their own pace of living, just like no two trees grow with the same speed. I realize that society can be very persuasive in pressing us faster and faster, but that has quite literally never helped anyone. So, find out about your own pace, and stick to it – and this advice is not just for those of us who are dealing with illness.
Finally, to you who has a loved one or someone near who is suffering from chronic pain, please understand that they feel their pain as real as others do when they cut their finger. However, empathy in this case can prove to be counterproductive, since empathy usually means ‘sympathising by feeling the other’s pain and suffering’. Feeling another’s pain and suffering when it’s continuously there, might deplete your own energy at some point. Therefore, in this case, to have – or cultivate – compassion might be more effective and productive, both for you and the other, because that means that you ‘really want what’s best for the other person’.[5]
An important feature of recovery in chronic pain, is knowing that you have people who’ll support you through thick and thin. Illustration: lavnatalia
In sincerely wanting what’s best for the other person, you hopefully become curious as to what that would be at the moment you’re with them. Maybe they would actually like to watch a funny movie, or take a walk in the park. Whatever it is, let them know that you’re there for them, that you believe them, and assist where you can in finding both the right assessments and/or treatments for them. For as dark as life can get, the feeling of not being alone can move mountains.
Loving greetings,
Erik Stout
[1] https://qualitysafety.bmj.com/content/19/5/466
[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC4795524/#sec6
[3] ibid.
[4] In this informative article, two other examples are given where the brain produced pain without tissue damage signals being sent, and conversely, despite obvious tissue damage, the brain didn’t produce any pain.
[5] From The Book Of Joy by His Holiness the Dalai Lama and the late Archbishop Desmond Tutu.
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