Pain research has progressed over the years while pain treatment really hasn’t adapted to that new research. Pain treatment is very biomedical but research has long suggested a much more multidisciplinary and multimodal methodology.
Hell, even I, as a pain patient have really thought a multidisciplinary approach is quite fundamental but not really focused on that much. We all know that pain is complex and the treatment, likewise, is complex and very individual.
This latter approach considers the biological, psychological and social factors that affect the patient’s perception of danger. Evidence-based treatment includes a combination of pharmacological and non-pharmacological techniques, including pain education, physiotherapy management and mental health support.Cosmos
A lot of the research has been around for quite some time. But not a lot of treatment has picked up to match it. Sometimes you get a little bit in there but not to the recommended level or extent that researchers suggest. However, when I was at the pain clinic there was pharmacological treatment, pain education, physiotherapy and mental health. I think what lacked was that very few people get to the pain clinic. It took me over 20 years to get into it. Also, it is a short program. And somewhat limited.
I personally think it would have been very valuable to me when I was 20. Not so much when I got that pain education and literally already knew all of that from a) experience and b) doing my own research and c) my own trial and error over 20 years. I don’t think that is acceptable that most pain patients have to do what I did. I think most patients should have access, proper pain management right away. Because, man, that would seriously help them cope and not do things the really hard way like I did.
Maybe pain is even More complex
It suggests that pain in the brain at onset is a lot more complex than was originally thought. Or even recently thought where they knew emotion centers were involved in pain processing.
There were experiments done on the specifics of pain signals with a psychological context that showed that that context could affect results. And anyone with chronic pain could confirm these things do in fact affect pain levels.
Namely: how much attention you pay to the pain, or conversely, how much distraction from it; the level of anxiety level the person has which can affect pain level in some experiments likely because, again, it affects attention; and expectation, of either pain increasing or pain decreasing definitely can affect our perception of pain. Basically showing that influences are variable but it can affect the perception of pain.
Another fact about pain we are all aware of is that the longer it persists the more sensitive the system gets to it resulting in: hyperalgesia (formerly painful stimuli become more painful) and allodynia (formerly nonpainful stimuli become painful).
The neuromatrix theory suggests that pain is produced by patterns of nerve impulses. These impulses come from a neural network in the brain known as the “body-self neuromatrix.” Everybody has their own distinct neuromatrix created through genetics and modified over time through sensory experience and memory. The neuromatrix determines how pain is experienced.Painscale
These patterns of impulses can be developed by a lot of things. Certainly, injury and illness can do it. But so can chronic stress. So a lot of factors can go into how we perceive pain. And basically, this theory is saying pain is developed from an active brain process taken from sensory data and then forming a subjective experience.
I suppose, in a way it makes sense. When I read a book on some of the things our brain can do, split-second, without our conscious awareness it was pretty amazing. In that sense, it is constantly taking in crapton of sense data and making split-second decisions and judgments to help us understand the world that we are not actually even aware of… sometimes making mistakes.
And it makes sense that once the brain gets the input of the pain, trauma, chronic illness of some sort that it then processes this rapidly in many ways based on past experiences and information. And that determines what sort of Output it is going to give… in our case a crapton of pain.
the neuromatrix theory (see Melzack55 for a contextual review), which conceptualises pain as one output of the central nervous system that occurs when the organism perceives tissue to be under threat. There are two important components of this conceptualisation. First, there are other central nervous system outputs that occur when tissue is perceived to be under threat, and second, that it is the implicit perception of threat that determines the outputs, not the state of the tissues, nor the actual threat to the tissues (Fig. 1).Physical Therapy Reviews 2007; 12: 169–178
The second important component of the neuromatrix theory is that pain depends on the perceived degree of threat. This means that pain can be conceptualised as the conscious correlate of the implicit perception of threat to body tissues. That psychosocial factors are very important in most chronic pain states is well established.This paper argues that the mass of data regarding psychosocial factors can be gathered within the proposed conceptualisation that pain is one output of the central nervous system that occurs when the organism perceives tissue to be under threat. The conceptualisation has limitations and strengths. One limitation is that it does not attempt to describe the biology of implicit evaluation of threat, nor of how this might emerge into consciousness. In this sense it adds little to theories first proposed decades ago (see, for example, Hebb66). However, a strength of this conceptualisation is that it can easily be integrated into a clinical context where making sense of the influence of factors from across somatic, psychological and social domains is valuable.
This is an intriguing theory of pain in the brain and I can see how this model is predominant now with chronic pain management. Even though it seems mostly theoretical. Obviously, with fibromyalgia I am very aware I have no injury in the body, there is no pain In the Body (in the overall studies-not all. But when you look at pain processing and FM it is the brain that is malfunctioning there) and it is a pain process issue. But clearly, something triggered that whole process. And how and why some people develop chronic pain after an injury and others do not is puzzling.
But perhaps one of the factors to chronification in the brain is the brain’s perceived threat at the time. Perhaps years of chronic stress, or anxiety, or depression, or existing chronic illness, thoughts and beliefs… or numerous other potential factors that affected our brain’s pattern for how to perceive pain such that when we were in pain it perpetuated the signal because of the perceived threat.
teaching patients about modern pain biology leads to altered beliefs and attitudes about pain and increased pain thresholds during relevant tasks. Moreover, when education about pain biology is incorporated into physiotherapy management of patients with chronic pain, pain and disability are reduced. A key objective of such education is to encourage patients to apply the same principle as that advocated for clinicians, summarised here as ‘what effect might this (factor) have on the implicit perception of threat’, or in patient-appropriate language, ‘how does this affect the answer to the question, how dangerous is this really?’.Physical Therapy Reviews 2007; 12: 169–178
When pain becomes chronic, it is less about physical damage and more about a pain system that has become excessively protective. A physical cause of the pain might never be found in scans, yet the pain people feel is real, says Moseley.Cosmos
And it makes you wonder. As the brain becomes more sensitive to pain it does certainly seem to be screaming ‘Don’t Do That!‘ but we know there is no mark of injury on the body at all. No reason at all that we should not do things. As in there is no injury we have to attend to or be careful of or aware of. No, it is the pain signal itself that is preventing and limiting our behaviour. Which isn’t how the system should work at all. I am quite aware it is a broken pain response. That is pretty obvious. Nevertheless, it is one we actually have to be aware of. And pace ourselves and manage. We know it’s a broken signal but we still have to Live within our Limits. Chronic pain is draining and comes with it a host of its own symptoms. It just means knowledge is power, that is all.
How it came about and my brain got stuck into this feedback loop is the question. It makes a lot of sense that pain would be dependent on the perceived degree of threat since biologically that would be a functional way for the body to help understand how to respond to threatening situations. And we all know how those signals can get messed up… I mean, the flight/fight response is biologically useful but these days can also cause a lot of problems. Likewise, I can see how a system designed to adjust pain to the perceived threat might be faulty because our ‘perceived threat’ system is faulty.
How our brain learns to respond to the environment and stimulus has little to do with our conscious control. Once we establish patterns, well, then we try to consciously change them, sure, but that is always a tricky thing. It is like with belief systems that we develop without thinking that are limiting beliefs… once we become aware of them, we can change them, sure, but we are not even really aware of them or how we developed them in the first place. A lot of our brain is on autopilot and unconscious thinking. All going on in the background really.
And I can see how this process would be the same because it would be how the brain has learned to respond to stresses of all sorts; pain from injury, illness, emotions, environmental stimulus… all sorts and how it has interpreted all that. To a threshold where it decides ‘not-dangerous’ to ‘dangerous and threatening’… time to overload the system!
Treatment of chronic pain
In light of the neuromatrix theory, treatment of pain involves removing chronic stress or other factors that may be triggering the neuromatrix. Treatment focuses on reassurance that the body is not in danger. It also involves exposure to both sensory and non-sensory inputs that trigger the neuromatrix, with the goal of adapting the response of the neuromatrix, reducing or eliminating pain caused by those specific inputs.Painscale
And it does seem a viable clinical theory for pain. As in, it helps clinically to help us with pain management because it promotes a better model for pain management.
“We have developed a four-steps process that brings together all these ideas (drawn from modern pain science),” says Professor Benedict Wand, a pain scientist at the University of Notre Dame. The first, fundamental step of this process, he says, is modern pain neurobiology education, which helps people gain a less threatening understanding of pain.
The second step is helping the person feel safe to move, while the third step includes an active progressive rehabilitation that gradually loads the body so that movement continues to feel safe. Lastly, the focus shifts towards making the body stronger.Cosmos
I think there is nothing wrong with this model on the pain management treatment side. If it is actually Used. Given it is more expensive, not likely used as much as just medication.
On the research side, I think there is still a ways to go in understanding pain and chronic pain. Although, I do like the idea of this model for its complexity… because I do believe pain is a very interpretive neurological experience. One we do not initially have much control of because it is based on historical experiences the brain knows and therefore uses for its interpretation and judgement of what to do with any new pain experience.
Therefore, any pain management has to be consciously taking control over the thought processes and beliefs and behaviours about our pain… in order to tweak the brain’s response. And that takes time, man. And all sorts of methods and treatments are very individual as well. Not even to mention it is a very slow process to do anything with chronic pain. I know that from exercise (took me six months to work up, painfully, to 20 minutes on an exercise bike. And I can’t even do that now with my pain levels because chronic pain changes. So I’d have to start all over again.)
The brain doesn’t just stop its loop but I think we can help shift it somewhat. Certainly, we can somewhat alter our perception of pain, our thoughts and our beliefs. We do have to live with the pain we have though, so that is the damn tricky part. It doesn’t matter where the pain is coming from, frankly, we are the ones that in the end have to live with it, cope with it and manage it. These days, not much help with any of that.