Today we have with us Paul Ingraham – a science writer who spent ten years running a busy massage therapy practice before founding PainScience.com. He’s written for many other websites including ScienceBasedMedicine.org – but primarily for PainScience – where he gets around 25000 visitors a day.
This interview is going to be interesting for a number of reasons.
Firstly, Paul is one of the most well researched writers out there, and he doesn’t shy away from debunking popular remedies when the evidence doesn’t support them.
Secondly, we’re going to explore a subject of great importance to all the listeners on LifeAfterPain.com – namely how your pain system can malfunction – and more importantly – what you can do about it.
In today’s talk you will learn:
How and where is pain felt
What brain modulation (and why it matters for people in pain)
How social circumstances affect the levels of pain you feel
Nociception and its role in chronic pain
‘Mind over pain’ (and whether this really exists)
Biology of Pain
The first thing happening in your body even before you experience pain is the transportation of information on damaged tissues from your nerves up to your brain. What happens next, (and this is usually misunderstood even after decades of research,) is how the brain actually evaluates that information and decides what it is that you are going to feel. This central modulation system is really the key to chronic pain – and yet in genaral we don’t hear nearly enough about it.
All pain is ‘brain tuned,’ meaning we cannot experience anything painful without the brain making some kind of a judgement and decision. Our brain takes all information coming from our tissues seriously but by no means this is the only factor. The brain is constantly evaluating a huge number of sometimes counter-intuitive variables.
For example, research shows that if your hand hurts and you look at it through a magnifying glass it hurts more. Another impressive example is a famous case of a guy who end up with a 2 inches long metal rod completely lodged into his arm after a car accident. Nobody noticed it and the tissues healed around it. The little rod stayed in his arm for 50 years and the guy never experienced any pain. Until – all of the sudden after five decades – his arm started swelling and aching then the x-ray revealed the piece of metal. This case shows clearly that there is no straight forward relationship between tissue damage and pain.
To better understand the modulation process you need to know that your brain and your mind are two separate things. All the pain evaluation process happens in the brain before you become conscious of your experience of pain. One of your brain’s functions is to help you stay away from dangerous situations. Clearly pain is one tool to do just that. It is a signal that you need to take an action and do something.
What’s fascinating is that your brain also decides on the level of pain depending on how dangerous the situation is perceived. A significant observation was made back in the days during World War 2 that severely wounded soldiers often experienced very little pain.
What’s happening here? One explanation is that when you are in a war and you are shot it means you are out of danger – you are going home to a safer place. Your brain is registering that in the modulation process and decides that you only need this little pain. In contrast if you suffer an injury in civilian life, which means some very stressful implications such as losing your job, your brain registers the threat and you feel more pain. These are very basic examples of up modulation and down modulation based on social circumstances, of course these are just one of the many factors taken into account in brain modulation.
The Case of Chronic Pain
What’s interesting about patients with chronic pain is that it might be directly related to damaged tissues. Or it can be completely triggered by your brain. Or it can be a combination of both causes.
It is sometimes really hard to identify what exactly is the case. Paul was diagnosed with chronic pain disorder after a year of throat pain with no evident physical reason. It was then discovered that the pain was actually caused by a tonsil stone stuck into his throat. Tonsil stones are calcified food leftovers glued to your tonsils. They are usually harmless but sometimes can become very hard and edgy and cause severe throat pain.
Another common cause of chronic pain is pain sensitisation. It is the over reaction of pain levels to a fairly moderate tissue problem. The longer you have pain the more sensitised you tend to get. People who suffer from insomnia, depression or anxiety are often on the road to chronic pain sensitisation.
The good news is there are things you can do to deal with sensitisation. One of the most effective steps is to educate yourself about the condition you have and to build confidence as you understand more. Research shows that the more confidence you have the less pain you experience.
Many pain problems are sustained by the nociception that pain isn’t going away. Nociception is the interpretation of tissue damage by the nerve endings. This is not pain yet – it’s nerves reacting to a variety of chemical and other signals and turning this into information that’s delivered to the brain. In other words nociception is the delivery of information to the brain that might indicates tissue damage.
Mind Over Pain
The most important question here to ask is: If pain is an output of the brain to which we are tuned, can we untune it? Can we affect the brain in a way that we eliminate pain? In reality we can influence the factors that the brain takes into consideration rather than influencing the brain itself. As we spoke of before anxiety and depression are factors for the brain modulation. So instead of trying to tell your brain not to take them into account there’s good evidence to support treating anxiety & depression to turn down chronic pain.
Be Kind to Your Nervous System, make yourself feel as safe as possible, seek pleasure, comfort and safety, meditate. Don’t dramatize your pain. A lot of people with chronic pain condition tend to be very creative in describing their pain simply because they are not believed by others and need to exaggerate to make their point.
This however might be a trap. The more you dramatize, the more you cooperate with your brain – your conscious mind send information back to your brain agreeing on the terrible levels of pain. Then what happens is the brain send you more pain. You really want to avoid reinforcing your levels of pain.
I to have MS and am suffering from significant pain. I currently take paracetamol, Celebrix, lyrica Tramadol and hydromorphone (Jurnista) to control it but have started to struggle because the weather has changed. Previously I have found lignocaine infusions helpful for this temperature sensitivity but as this no longer works I am going into hospital this week for a ketamine infusion.
I have previously used ketamine troches orally but found that through a poor understanding of central sensitisation, I’m on my third Pain Specialist, their use although effective resulted in a horrible disassociative state and infact seemed to increase my central sensitisation over the eighteen month period I was prescribed them.
I would completely agree with the idea that knowledge is power and as well as recommending this excellent website I would direct you to the NOI group from Adelade Australia. I have recently obtained all of their written material and this more than anything has given me a greater understanding of the factors affecting the central processing of danger messages.
Today we have with us Paul Ingraham – a science writer who spent ten years running a busy massage therapy practice before founding 
