Chronic Pain, Favorites, Fibromyalgia, Pain Science

Understanding pain as your body’s alarm system

pretty fire

In my experience, the key to learning to work with your pain instead of against it is to learn to view pain as your body’s alarm system.

In the developed world, most of us are privileged enough to have very little experience with pain.  As children, we only feel pain when we’re at the doctor’s office getting a shot, or when we fall down and skin our knees.  We come to the conclusion that our bodies are designed for us to come to: that pain means something is wrong. 

The truth is that pain a bit more complicated than that.  What I learned from pain neurophysiology education is that pain is the body’s alarm system.  It not only warns us when something is wrong, but when the body thinks something might go wrong.  To help you better understand this, I’ve collected the following anecdotes:

Pain can stop you from injuring yourself

In his amazing online lectures that I think everyone should watch, Neil Pearson instructs his audience to extend one index finger straight up in the air, and then use the index finger of the other hand to slowly bend the first finger backwards.  It doesn’t take long for this to hurt; however, your finger hasn’t actually been damaged.  The pain is your body’s way of telling you to stop, because if you keep going, it will be damaged.

The body’s protective mechanisms don’t always work perfectly.  Case in point: thirst.

There are many ways that our body can warn us to do something, or not to do something.  Thirst is another example.

Thirst is largely controlled by a part of the brain called the hypothalamus.  This part of the brain has a “thirst center” which measures the ratio of blood cells to water in your blood.  When the percentage of water dips below a certain point, your brain tells you are thirsty.

In his book Painful Yarns, Lorimer Moseley explains how thirst is not as accurate a measure of hydration as we generally believe.  He tells the story of two individuals whose car broke down in the middle of the Australian Outback.  They nearly died of dehydration.  When they were finally rescued, they drank until their stomachs were full of water and then told their rescuers they weren’t thirsty.  In fact, they were still severely dehydrated: most of the water they had consumed was still in their stomachs, not circulating in their bloodstream where it could do them any good.

What had happened is that the act of drinking up all that water had temporarily overridden the thirst signals their brains were sending.  The thirst mechanism is designed to get us to drink, and they had drunk all the water their bodies could handle at that moment.  They were still severely dehydrated, yet they weren’t thirsty.

The essence of what I’m trying to say here is that pain and thirst are mechanisms the body uses to get us to take action in some way.  Neither one is always an accurate indicator of exactly what is happening in the body.  They are a sign that the body wants us to do something.

Your body can block out pain signals when something else is more important.

One last thing to know about the pain alarm system is that your body can override it if your survival is in jeopardy.  If you are caught in a situation where your life is in danger, your nervous system might decide it is more important for you to focus on what’s going on around you than what’s going on inside your body.

Neil Pearson gives a great example of this.  He tells the story of a patient he once treated who had been hit by a drunk driver on the way to work.  He woke up upside down in his burning car, and realized he had lost an arm in the accident.

The man managed to extricate himself from the car, collect his missing arm, and walk back up to the side of the highway all without feeling any pain. 

As Neil explains, it’s not as if the nerves in his arm weren’t sending his brain any signals; they were sending signals like crazy.  But his brain knew there were more important things to focus on: retrieving the arm, getting away from the fire, and getting help as soon as possible.  Once he was safely in the ambulance, his brain knew his immediate survival was no longer in question and pain signals set in with a vengeance.

In Conclusion

Pain is your body’s alarm system.  It is not there to give you accurate readings, at all times, of what is going in your body. Rather, it has been designed by millions of years of evolution to get you to change your course of action if your body thinks you need to do something differently.

In the case of people with fibromyalgia and chronic pain, this alarm system has begun to malfunction.  When the body goes through a painful, traumatic experience, it can change the way the nervous system works.  The pain alarm system can become overactive, and your nerves start sending you pain signals at odd times, or all the time, even when nothing is physically wrong.

This isn’t an intuitive process.  As I discusses earlier, pain signals are designed to make us think something is wrong.  Our biology leads us to believe that the amount of pain we feel is equal to the amount of physical damage we have incurred.  But when you begin to understand, on a conscious level, that pain doesn’t necessarily mean there is anything wrong, you can begin to break the cycle of chronic pain.  (I’ll be talking about how in subsequent posts).

Sources:

Beautiful fire picture courtesy of Loving Earth on Flickr.

Chronic Pain

The Pain Clinic

I once had the opportunity to attend a pain management clinic run by a prestigious rehabilitation hospital in Boston, and it was a total bust.

I recently had a conversation with my neighbor Carolyn about my terrible experience there.  She’s had problems with one of her shoulders for years, and she mentioned that she was currently on the waiting list for the same place.

Judging by the wistful tone in her voice, I could tell Carolyn’s doctor had built up her expectations of the pain clinic just as much as mine had.  She explained how the waiting list was months long, and how she was scared she’d never be able to get in.  Suddenly I understood what my doctor had meant when she said she’d had to pull some strings to get me through the door.

I told Carolyn not to worry if she couldn’t get in; she wouldn’t be missing too much.  She looked confused.  “But my doctor said there’s no other place like it around here,” she said.

“Yes…” I replied, choosing my words carefully.  Apparently I had to be the one to initiate Carolyn into the depressing world of trying to get help for chronic pain.  “The sad thing is, that doesn’t mean this place is any good.”

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Before I go on, I should probably back up and explain a little bit about how I ended up needing to go to a pain clinic.

Two years earlier, I threw my back out.   In a bad way.  I will talk about it more in another post, but suffice it to say, my back was wracked with muscle spasms.  The whole thing hurt, from my neck, to my shoulder blades, to the base of my spine.  Some days I couldn’t even raise my arms above shoulder level.  My doctor called it “glass back syndrome” because I was so fragile I could hardly even stand to be touched.

During the first few months after I hurt my back, I found the best thing I could do for the pain was to take walks.  This was particularly important in the morning: when I first got out of bed, I was so stiff that I could hardly move.  I would stumble out of bed and pace up and down the hallway of my dorm for about five minutes. This got me to the point where I was loosened up enough to put on warm clothes and my coat.  At this point I would head outside for a twenty-minute walk around campus.  Only afterwards would I feel human enough to deal with brushing my teeth, breakfast, and everything else.

I was eventually to get my back pain somewhat under control, through a combination of exercises and medications that dulled the pain enough for me to be able to exercise.   But the pain never completely left me, and I spent the next two years trying to be free of it.  I had MRI’s.  I had trigger point injections.  I tried physical therapy at numerous different facilities.  Nothing seemed to work.

After about two years, my doctor said she wanted to refer me to the pain clinic.  She explained that she had done her residency in pain management at the same hospital, and couldn’t recommend it highly enough.  I was thrilled and agreed optimistically to go.

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I started at the pain clinic in the summer of 2006.  The session was supposed to run for six weeks, four days a week. The day was broken up into 45-minute blocks that were set by a predetermined schedule, and I was one of twelve chronic pain patients who would be doing everything as a group.

On paper, the clinic sounded great: the brochure I found in the lobby said there would be classes on meditation, ergonomics, and pain relief.  Patients would have the opportunity to work out in the gym twice a day under the supervision of physical therapists.  We would be given the chance to try yoga, tai chi, and biofeedback.  And finally, we would also have the opportunity to meet with a physiatrist and a psychologist.  It sounded absolutely amazing.

And how did it go?  Well, most of my experiences there were neutral.  I met with the physiatrist, but he said pretty much the same things as my own doctor.  (This made sense, since he had been one of the doctors to train her).  I met with the psychologist, who didn’t really say anything helpful, but didn’t manage to offend me either.  Anyone who’s read my post on the problems I have with yoga knows how that part turned out.  I did enjoy the tai chi, however.

Biofeedback was sort of interesting, but it doesn’t really accomplish anything when you only try it once for fifteen minutes.  I’ve actually done biofeedback in physical therapy since then, and I feel confident in saying that it takes several 45-minute office visits to really even begin to know what you’re doing.

I actually enjoyed the part about ergonomics, or how to set up your home and workplace to allow you to do things in the proper anatomical position.  That was actually helpful, and I still think about some of that stuff today.  With that being said, any physical therapist can teach you how to set up your workstation.  You don’t need to attend a six-week program.

The best part of the clinic was actually the time I spent hanging out with the other pain patients.  We got each other.  Lunch, when we all sat outside at picnic tables in the sun, was the most fun part of the day.

There was aspect of the clinic, however that was just so horrible that it pretty much overshadowed everything else.

We had two 45-minute sessions in the gym each day.  One was at the beginning of the day at 10 am, the other was at 2 pm.  You were supposed to use one of the sessions for cardiovascular exercise, and one for weight training and other exercises.  I ended up getting into a stand-off with the head physical therapist over the fact that I also wanted to do a short cardiovascular warm-up before I lifted any weights.

Now I might be about to go on a bit of a tangent, but I have a very big problem with the concept of doing any kind of weight-training or other serious exercise without doing a warm-up first.

It’s common knowledge that doing a gentle warm-up at the beginning of your workout both improves performance and reduces the risk of injury.

With this in mind, there was no way I was going to do my exercises at the clinic without a warm-up.  I explained to the physical therapist at the beginning of my “weight-lifting” session why I was walking on the treadmill.  She didn’t really respond so figured it was fine.

A few days later, however, the same person took me aside and demanded to know why I wasn’t doing my strengthening exercises.  She spoke in an angry tone of voice, as if this was some sort of personal conflict between the two of us.  I was completely bewildered.  Her anger was totally out of left field.

I tried my best to smooth things over by explaining what I was doing.  She calmed down slightly when she realized I wasn’t intentionally skipping my exercises, but still tried to talk me into skipping my warm-up. “You won’t have time to get to all of your exercises if you do a warm-up,” she said.  “You have to do all of the exercises on your chart at least once a day.”

This was news to me.  I thought these were just things we were supposed to try.  I didn’t think I was at the point where I was strong enough to do all of those exercises in one day anyway– especially if I wasn’t going to be allowed a warm-up.

Neither one of us wanted to give in, and things were getting more and more awkward by the second.  All of the other patients in the gym had noticed the physical therapist’s angry tone of voice, and were watching.  I wished I could just agree to do what she wanted, but I knew it wasn’t physically possible.

We eventually compromised, agreeing that I would only spend the first five minutes of the weight-lifting session doing my warm-up rather than the ten or fifteen I would have preferred.  I was slightly uncomfortable with this short amount of time but it was close enough, and it wasn’t worth the argument.

But wow.

I had thought a pain clinic was the one place where someone wouldn’t give me a hard time about the things I needed to do for my body.

Every day the staff gave us little lessons on “self-empowerment.”  These were supposed to be about how we could articulate our needs and stand up for ourselves when the people in our lives were pressuring us to do things that would worsen our pain.  And here I was, having to defend my need to do a warm-up before a workout to a member of their staff.

A better approach would have been for her to be flexible, to ask me to tell her more about why I felt walking was so important.  It could have been an opportunity for a conversation in which we could talk about my fears and anxieties regarding exercise. If she thought I had my facts wrong, she could have taken that as a chance to impart valuable information.  I mean, this was a pain clinic; I was there because I had trouble doing things normally.  She should have been trying to understand what caused my pain, not getting into an argument with me about what I did and didn’t feel.

This physical therapist’s lack of personal skills aside, who in their right mind would ask a group of chronic pain patients to skip warming up before exercise?  Many of the other patients were obese, and looked as though they hadn’t exercised in years. If anyone was likely to injure themselves during exercise, it was this group.  Proper exercise protocol shouldn’t have been something I had to beg for; it should have been part of what they were teaching at the clinic.

The next few days were pretty awkward.  I stuck to only using the treadmill for five minutes, but even so the physical therapist would walk over from time to time to check the timer on the treadmill.   I could tell she was just waiting to catch me going over the five minute mark.

Fortunately I didn’t have to deal with this situation for more than a few days.  I went on vacation to Virginia during the third week of the clinic, and while I was down there I got a voicemail from the physical therapist saying I’d been discharged for having missed too many days.  I was a little bit surprised, because I’d given some other staff members the dates for my vacation during my intake appointment and they’d said it wouldn’t be a problem.

I mean, this was a six-week clinic that ran through July and August—what did they expect?  I wondered if maybe they’d forgotten what I told them.

The physical therapist’s message said I could call back if I had any questions.  I interpreted this to mean that if I was really upset about it, I could call back and beg and they would probably let me back in.

I thought about it for a few minutes.  Then I deleted the voicemail.

That was that—sometimes you have to know when to let things go.  No matter how good it looked on paper, that place wasn’t working for me.  I was just relieved to have a graceful way out.