Haims: Hurt doesn’t necessarily equal harm
Pain is more than just an unpleasant feeling that can be irritating or even self-debilitating. Pain can have emotional and psychological effects as well. By understanding how the nervous system functions, in some cases, we may be able to moderate how our central nervous system responds to the warning signals of pain.
In this third installment of columns addressing pain, I will speak with Dr. Elie Sabins, a physical therapist and therapeutic pain specialist at Howard Head Sports Medicine to learn about how our understanding of pain can help rehabilitation.
Haims: What advice would you give someone who feels like their pain impedes them from doing the things they enjoy like walking, hiking, skiing, etc.?
Sabins: If someone has persistent pain that is impacting their ability to do the things they love, there is still hope that this can change. When we remember that persistent pain may not be due to tissue damage but rather an extra-sensitive and protective nervous system, we can begin to make changes in our bodies. It is possible to be sore and safe. Hurt doesn’t necessarily equal harm.
Let’s say when watching the Olympics this year, curling looked like fun so you decided to try it. But how are you going to learn? You can’t expect to get good by just watching others curl. You need to find some curling shoes and start trying yourself. Your first few times may make you very sore and tired, but over time as you keep working at it, it gets easier. Our nerves work the same way. As we begin to get back to doing activities, by nudging the pain, we can slowly desensitize those nerves and calm them back down. But in order to get there, we must be OK with feeling a little bit of discomfort, knowing that it will get better eventually.
Conversely, if you were going to go and start curling for the first time, you probably wouldn’t participate in an all-day tournament on Day 1. It takes time to train and let your body adapt to different activities. Not surprisingly, our nerves react similarly. If we crash through the pain and go from 0 to 100, your nervous system will most likely react in a way to protect you even more. This can contribute to people needing multiple recovery days after doing something like curling and not having the best experience with it. So we need to respect the pain, but not fear it. Touch it, nudge it, and then back off. And remember — you can be sore but safe, and hurt doesn’t equal harm.
Haims: Other than just inhibiting physical movement, what are other ways pain affects people?
Sabins: One of the reasons it is so important for us to understand pain is because when we experience it all the time, it can affect every single part of our lives. Have you ever listened to a song and it immediately conjured a memory for you? Maybe “Time after Time” brings you back to your high school prom and you can see your outfit, re-enact those great dance moves, and maybe even smell your date’s too-strong cologne. Or “Brown Eyed Girl” transports you back to a Fourth of July picnic growing up. You can almost taste that hot dog and you may feel a little nostalgic for those carefree days.
We now know during this process, all different centers of our brain are used in conjunction to give you that experience. The parts that deal with emotions, memory, smell, taste, movement, etc. are all being used together. And I’m sure you can guess where I’m going with this, but pain works similarly. While we are experiencing pain, all parts of our brain are involved in processing it. When the brain is constantly bombarded with pain, from past experiences and beliefs surrounding pain, it has less and less room for other things in life.
So, you may be on an emotional rollercoaster, you start forgetting things, concentrating is difficult, or you might even get hot flashes because your body temperature center is also distracted. This is how pain trickles to all parts of your life — your work, play, mood, and relationships.
But the good news is, this can change. With more understanding, your nervous system and brain can become less concerned. As the perceived threat reduces, pain can ease, and all the parts of your brain that were taken up processing the pain can go back to their normal tasks. Then they can dedicate 100% back to what they were meant to do. In our last and final piece of this series, we will talk more about where you can go from here in order to lead your most fulfilled, meaningful life.
For the past couple of months, Judson Haims, the owner of Visiting Angels, has sat with physical therapists Doug Emerson and Elie Sabins to learn about how new pain research is being integrated into the physical therapy practices at Howard Head Sports Medicine.