“The bane of pain is plainly in the brain.” – Dr Allan Basbaum

Do you believe that people can sustain significant damage yet experience little or no pain?

“In 1943 and 1944, Beecher, who was described by friends as a street fighter in the field of medicine, travelled to the Venafro and Cassino fronts in Italy, where he questioned 215 seriously wounded men who were waiting on the beachfront to be evacuated by boat to hospital. He concluded that the anecdotal evidence was correct: there was no necessary correlation between the seriousness of any wound and men’s expressions of suffering. In fact, three-quarters of wounded soldiers claimed that they weren’t experiencing significant pain and didn’t ask for pain relief, even when offered it. One third claimed to feel no pain at all, while another quarter said they were experiencing only slight pain.”

Pain requires a context.

Taking from the example above, these wounded soldiers were not in the right frame of mind to be conquered by pain. Their lives, their country, what they were fighting for, were at stake. These people were neither worrying about their injury nor paying attention to them. The adrenalin in them was high.

“In contrast, suffering a similar kind of injury in civilian contexts (a car crash, for example) was excruciatingly painful because it heralded “the beginning of disaster”. Beecher confirmed anecdotal evidence that being wounded was viewed as good luck: wounds enabled men to escape “this hell with nothing more perhaps than the loss of half a foot”, as one World War I soldier put it. Emotions and expectations affected physiological sensations.”

cartesian model of pain

“Most war surgeons simply explained the absence of pain as due to the men’s “great excitement”. Agitation, elation, enthusiasm, ideological fervour: all these states of mind diminished (or even eliminated) suffering. Others claimed that the “psychological effect” of the “booming of the guns” was similar to the “continued drumming of the dervish dance” – in other words, the deafening sounds of battle had a hypnotic effect.”

This anecdotal information leads to finding a solution for people suffering from non-cancer chronic pain. In non-cancer chronic pain, usually all dangerous painful medical conditions have been ruled out. The cause behind chronic pain is always unknown but recent evidence shows that treatment that targets specifically at the brain has a better chance at success.

Indeed, current evidence-based best practice guidelines point towards (in no order):

  1. physiotherapy (exercise-based)
  2. cognitive-behavioural therapy (changing one’s perception of pain, changing one’s reaction towards a painful experience)
  3. acceptance and commitment therapy

Why exercise-based treatment for a condition that clearly, is a problem with the perception of pain?

People who suffer from persistent pain usually are more physically deconditioned compared to their counterparts who are not suffering from persistent pain. The main reason is that people who are in pain move and do less due to pain and the fear of re-injury. There is a strong urge to get  these people active in the right way again! There is a huge body of evidence supporting physical exercise for the reduction of pain. In many occasions,  the perception that ‘exercise worsens pain’ is a major barrier for these people to take up regular physical activity in their rehabilitation, most probably due to previous encounters with pain during exercise or an innate belief that exercise provokes injury/pain. These individuals will then require a cognitive-based interview session to break down these beliefs before exercise therapy can start successfully.

Once the barriers towards exercise therapy has been broken down, we can fully concentrate on exercise-based physiotherapy. There are many mechanisms at work behind exercise in reducing physical pain and it is generally called ‘exercise-induced hypoalgesia’ or EIA. In layman terms, it has always been associated with ‘runners high’. However, you don’t necessarily need to run, be a runner or excel in running to get a ‘high’. I shall follow up a post on EIA in time to come.

Indeed, the bane of pain is plainly in the brain.

Reference

http://theconversation.com/emotions-affect-how-pain-feels-as-soldiers-know-only-too-well-25889

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