Have you wondered if you’re crazy and your Doctor wants you to see a psychiatrist for your pain? It’s taking over your life, drugs aren’t working and your life is spiraling out of control? Pain is taking over, and the obvious conclusions must be that something seriously wrong to have such a profound effect on your life. For the vast majority of the millions affected by persisting pain, the thing that has gone wrong is the brain and the nervous system.

You’re really going to hate me if I tell you your pain is all in your head. Perhaps others have said something similar and that you’re imagining your pain, that you’re overreacting, that you’re making it up and that you’re gaining something by staying sick. It hurts right (no pun intended!)? Pain Science research continues to add significantly to what we know about pain, but it doesn’t necessarily translate to how we treat it.

I hate to be the bearer of bad news, but it IS all in your head. But not in the way you might have been lead to believe. ALL pain comes from your brain — even if you break your leg or get shot — your brain creates the pain. In this vein, be reassured that whatever you feel is REAL, is actually happening and is a response to the decisions your brain is making about your body and they can happen without any damage to your physical self at all! To really understand this, and help you better manage pain and reclaim your life, we need to dive in to the way your brain and body work together to make sense of the environment.

Surgery Doesn’t Fix Pain

Let’s dispel some myths first. There is no pain “pathway” and no pain centre in the brain. There is nothing to cut or remove to not feel pain. There is no surgery to fix persisting pain. Even if an MRI shows a bulging disc or a physical change that might be the source of your symptoms, if you’ve had long term pain there are other changes that have happened that may be greater factors in causing you to hurt than that structure. For every successful surgery (of which there are many, and there are specific indicators for a good outcome), many other surgeries have been ineffective, or resulted in worse conditions.

Pain 101

Pain is a survival mechanism designed to protect the body by motivating you to do something to get out of danger. When a body part is damaged, receptors detect changes and nerve endings send a signal to the brain containing information about the nature of the damage. No pain is felt until the brain interprets this information and decides that pain would be a good way to encourage you to take action that will help protect and heal the damage. The brain considers a huge amount of factors in making this decision and no two brains will decide the same thing. Many different parts of the brain help process the pain response, including areas that govern emotions, past memories, and future intentions. Therefore, pain is not an accurate measurement of the amount of tissue damage in an area, it is a signal encouraging action. When a professional violinist hurts his hand, his brain might consider very different responses than a soccer player with the same injury, given the meaning of an injury to the part of the body that sustains their livelihood.

Sentinels of Safety

There are many sensation and danger receptors throughout your body. They’re a network of sentinels designed to keep you safe — they detect changes to pressure, vibration, noxious chemicals, stretch, heat — all the things that can hurt your tissue and risk your health. These receptors are located all throughout your body and connected to nerves. When stimulated, they send an impulse through a nerve to the spinal cord, where they synapse with other nerves that talk to the brain.

The message that the brain receives is “danger in right elbow” or other body part. The sentinel is making a local decision based on the information it is receiving — and transmitting that to the brain — where it is processed though many areas of the brain to add layers of meaning. These layers of memory, contextual information and other sensory input such as sight and sound add to the full spectrum of information the brain uses to make its decisions . The sum total of those inputs will determine whether the brain thinks you’re in danger- and if pain is an appropriate response. Pain may be inappropriate if you need to escape from a situation where your life might be at risk — there are many war stories of catastrophe and people who are able to walk on broken limbs to survive deadly situations.

Your Brain Learns to Hurt

Pain is an integrated body and mind experience — once we understand that, it seems almost silly to think that we will control and address a pain condition with a pill alone. It is an adaptive and adaptable response with the only goal to keep you safe. Unfortunately, it gets it wrong a lot of the time, and mechanisms designed to keep our ancestors safe from sabre tooth tigers don’t work well in the modern world. The brain and nervous system has mechanisms to become more sensitive and respond faster to stimuli over time and become increasingly protective (ie- causing more pain) in the same situation. For instance, if you’ve developed pain from sitting at a computer or from lifting heavy boxes, your brain can learn to create pain simply when you’re in that environment, to act as an early warning system. This was very useful to protect us in our evolutionary past, but in our modern world, we have very different threats and predators which makes it very easy for our brain to get mixed up.

Emotional states such as anger, depression, and anxiety have been shown to reduce tolerance to pain. Although it is hard to believe, research provides strong evidence that a significant portion of chronic back pain is caused more by emotional and social factors than actual physical damage to tissues. You may have noticed that when you return to a place you haven’t been for many years, you quickly fall back into old patterns of speech, posture or behavior that you thought you had left behind permanently. Pain can be the same way, getting triggered or recalled by certain social contexts, feelings or thoughts that are associated with the pain. Ever notice that your pain went away when you went on vacation and came back when you returned?