Haims: Treating pain starts with understanding it
Pain has been an evolutionary part of our existence. Not only has it been learned and ingrained in our neural pathways, but it also protects us from danger.
Unfortunately, in a time of history where many people believe that a pill can solve almost anything, too many of us have forgotten that there are other options. It is now possible that one of the easiest ways to treat pain is to increase our understanding of it.
Pain has become a burgeoning field of research and, little by little, it’s finding ways into our daily lives. In an effort to get a better understanding of how we are benefiting from this new research, I have sat with Dr. Elie Sabins, a physical therapist and therapeutic pain specialist at Howard Head Sports Medicine in Vail. This is the second part of a multi-part series on this topic.
Haims: How does our new understanding of pain change our experience with it?
Sabins: We talked in our last article about how pain is a perception, and everyone can perceive things differently. Pain is also a very normal part of life; we all experience it from time to time. It is put in place to protect us from dangers in our environment such as when we are sitting too close to a fire, have a case of appendicitis, or when we get a paper cut. If we combine these two knowns, that pain is a perception and it is designed to protect us, then we can say that pain is a response to a perceived threat.
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Consider someone who has phantom pains even after a limb has been amputated. Or, someone who continues to have pain for years after being told they had a herniated disc — even though we know these often heal in less than a year. There is no injury anymore, tissues have healed, yet the brain still feels threatened.
Our brains use signals from nerves in order to get information about our environment, and our nerves work similarly to a house alarm system. Let’s say that one day your dog runs through your screen door accidentally and sets off the alarm. You get the door fixed, but when the alarm company comes out to reset the alarm, they change settings on it to be more sensitive — to try to deter the dog from going near the door and potentially running through it again. But now, whenever you open the door or someone even walks by it, the alarm goes off. That’s not a true threat to the safety of your house, but the alarm is perceiving them as threats.
We now know that in approximately one in four people, the nervous system stays extra sensitive after that initial alarm goes off. The knowledge that ongoing pain doesn’t necessarily mean there is still something wrong … and that it can be due to an extra sensitive nervous system, can change your outlook on pain significantly. In the last article I mentioned thinking about the “pain dial” in your brain that can either be turned up or down. While our nerves being sensitive and overprotective of us can turn the dial up, our awareness of this can turn it back down.
Haims: How does our interpretation of pain depend on our emotional well-being and state of mind?
Sabins: When the brain decides to create pain, it is factoring other things going on in your life as well. Have you ever seen a bruise on your skin and wondered how it got there? In this case, your tissues were injured but the brain figured that bumping into a counter while laughing with a friend wasn’t very threatening, and that it didn’t need to let you know about it. Things such as your environment when you get hurt, fear of ongoing pain, past experiences, stress, frustration, job issues, family problems, poor sleep, positive or negative attitudes, etcetera, can affect whether your brain feels threatened and thinks you need protection.
An Olympic-hopeful skier who relies on the ability to hold their poles might have a much different experience with pain if they need to get hand surgery versus a snowboarder — either positively or negatively depending on a lot of those things mentioned. Or, your “bad” back may seem a little bit more sore during or after a stressful day at work. Just as increasing our knowledge and understanding of pain itself can adjust our “pain dial,” realizing that these factors can also play into our experiences with pain can change it as well. In the next article we will talk about ways to take more control of pain, and ultimately, your 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.