On The Front Line: A very clever system, but awful when it goes wrong
I’m going to repeat a controversial statement, recently told to me by a professor of neuroscience and pain research, Lorimer Moseley. “Pain is never a marker of tissue damage”.
This might seem crazy, as our usual experience of injury or damage is that it is painful. But research shows that the level of damage does not match pain levels, and it is possible for severe injury to result in no pain. Conversely it is common for us to experience ongoing pain, with no tissue damage. We call this chronic pain, and unfortunately it is surprisingly common. As a GP I see it often, it is difficult to explain and understand.
The key thing to understand is the purpose of pain is to protect us, to teach us how to stay safe. It is our brain’s response to a threat or injury, to help stop us being damaged. Moseley says that if pain is a measure of anything, it is a measure of the brain’s evaluation of how much protection your body needs. Think of it like a protective bubble wrap suit. So pain can be associated with body damage, but damage is not the cause. The root cause of pain is our brain trying to protect us. The brain is sufficiently clever that anything at all that suggests we need protecting (eg fear or anxiety) can turn pain levels up. But the opposite is also true – anything that suggests we are safe can turn pain down. It’s a very clever system. But awful when it goes wrong.
When our pain system is not working properly, we can get stuck in ‘over-protection’ mode. Our pain system tells us to stay still, even when nothing is wrong. Unfortunately not moving is really bad for us. We get weak and the over-protection gets worse.
Lorimer champions pain education. He knows that understanding what is going on in chronic pain is crucial. He says that understanding this fact can be very confronting, but when it ‘clicks’, it can transform our experience. We all need to know the truth. This allows us all to appreciate chronic pain issues differently. We focus on learning how to reprogram our system using the brain, and safely down regulate the over protection, without feeling we are not being believed.
I strongly recommend watching this YouTube clip https://youtu.be/hziwU3eWlL0. As always I welcome comments on social media, using the hashtag #ShareWithDrOllie.