After a long hiatus from blogging, I’m BACK! It was good to get some time away from reading textbooks and research and just enjoy life for a change!
Earlier this year I attended Greg Lehman’s Reconciling Biomechanics with pain neuroscience course, it was quite an eye opener, actually no it was a big wake up call for me. I realized that I was so biomechanical focused that I was losing site of the biggest reason why patients walk through the door in the first place, and it’s because their in PAIN. For something that we treat 99% of the time, I knew very little about. I always told that pain is subjective and to pretty much throw it out the window, don’t focus on it, and try to find the root cause. Yes, I 100% agree finding the problematic area is important but why is this person experiencing pain? How are you going to get this person pain-free if you have no idea what the heck pain is from a neuroscience perspective? This is not to say go and chase pain, absolutely not, but we should be at least addressing the issue of pain from an injury with a biopsyhosocial model and not ignoring it. Its about integrating biomechanics and pain neuroscience into your treatment to make people move more efficiently.
Anyways, because of Greg’s course (highly recommend) I left with so much information, I took the time to read over and over his materials so that I knew it better. It also struck an interest for me to indulge further into pain neuroscience. Holy did I open a can of worms! Pain is very complex topic, so I started back to the basics with Todd Hargrove’s “A Guide to Better Movement: The Science and Practice of Moving with More Skill and Less Pain”. This book is basically the “Understanding Pain for Dummies”, it’s an oversimplification of pain neuroscience of a very complex topic. I highly recommend this to every clinician that is treating anyone with pain, because it can be very helpful in management of your patient. This book is also a great tool for patient’s to understand why they are in pain and encourage them and equip them with ways to move better. The best $26 CDN I have spent into continuing education and definitely worth every penny!
I’ll highlight important concepts and points from the book. If you really want to get the whole picture, I’ll leave it up to you to actually read the book!
Some highlights of what you need to know about pain…..
– It can be explained by the “neuromatrix” model. It is the patterns of brain activity that creates pain. Pain is a conscious experience created by the brain, not a damage condition of the body.
– Pain is a protective mechanism; it is to protect the body from perceived threat
– Pain is an output not an input
The body will gather information from the body, and interpret it and will act accordingly based on how much of a threat it thinks that it is
– Inputs are noiception, our movements, thoughts, emotions and memories (aka past -experiences)
– We can have pain without nociception, and nociception without pain.
This is not to say that the pain you feel is not real and its all in your head. Pain is a real feeling but does not necessarily reflect real damage in the body.
Pain does NOT equal tissue damage
This has been demonstrated by many studies
Rajeswaran et al. (2014)– Lumbar spine MRI of 98 asympotomatic elite junior tennis players showed some type of pathology on the imaging.
– Facet Joint arthropathy (89.7%), Degenerative Disc Disease (62.2%), Disc Herniation (30.6%), Pars interarticularis abnormalities (29.6%), Spondylolisthesis (5.1%)
Silvis et al. (2011)- 77% of asymptomatic hockey players demonstrated MRI findings of hip or groin pathologic abnormalities
Miniaci et al. (2002)– MRI imaging of the shoulder of asymptomatic professional baseball pitchers revealed that the labrum was abnormal in 79% of the 28 shoulders
You can have pain without damage
The brain does not know what is going on in the body and causes pain in an area that is clearly not under threat. An example of this would be phantom limb pain, where one experiences pain in the limb that no longer exists. Another example is when someone is having a heart attack, they feel pain down their left arm or jaw and at times no chest pain. It’s a miscommunication and the brain thinks that the actual pain is coming from the left arm rather than the heart. This might because the close proximity of nerves that innervate the heart to the nerves coming from the left arm.
Pain is pretty much just an illusion 100% of the time
You can mess with pain without touching the tissues.
Moseley et al. (2007)
-Put a cold piece of metal on the back of the hand of people.
-Then he showed a blue light and then a red light
-Asked how much it hurt after showing each light
-People had more pain with the red light than the blue light
-The stimulus is exactly the same. The only difference is the meaning of the colours
-Red=hot and Blue=Cold
Moseley’s TedTalk from 2011, he gave another example of an experiment that demonstrated that pain is just an illusion.
-Sham simulator put on a persons head and change the intensity knob by increasing it and decreasing it. But the machine is not actually “On” and doesn’t work
-People had more head pain as the intensity knob increased
-The key is that people needed to see the dial for this to happen
When Pain persists the nervous system becomes more sensitive
- Your brain tries to protect your body from something that doesn’t need to be protected.
- You also get pain spreading and changes it quality
- Pain “neurotags” can be activated more easily
We create pain “neurotags” based on past experiences of pain
Pain neurotag= a pattern of neuron activation, which creates a certain output of the brain, such as perception thought, movement or immune system response (Moseley).
Hargrove provides a good example of how neurotags work. Example:
When you hit yourself on the thumb with a hammer there is a certain pain neurotag that creates that special feeling. If you hit yourself on the thumb and for some reason this does not activate a pain neurotag, you will not feel pain in the thumb. And for some reason your thumb pain neurotag is activated, even if you haven’t hit your thumb at all, you will feel pain in the thumb
Failure to inhibit the pain neurotag will cause pain to persist. If “disinhibition” occurs we can get imprecise activation or smudging of the pain neurotag which will cause the pain to spread into other area’s of the body.
Pain neuro tags can become sensitized and can get activated with less and less stimulus
Hopefully this post shared some more insight to your knowledge about pain. Know that pain is more than just noiception and subjectivity. It’s a complex process and understanding pain is just one of many variables to help your patients to full recovery/move more efficiently! What I have provided above is just a tiny splash into pain neuroscience and their are many, many resources out there to help guide you to explain pain.
References
Hargrove, T. (2014). A guide to better movement: The science and practice of moving with more skill and less pain. Seattle, WA: Better Movement.
Silvis, M., Mosher, T., Smetana, B., Chinchilli, V., Flemming, D., Walker, E., & Black, K. (2011). High Prevalence of Pelvic and Hip Magnetic Resonance Imaging Findings in Asymptomatic Collegiate and Professional Hockey Players. The American Journal of Sports Medicine,715-721.
Miniaci, A., Mascia, A., Salonen, D., & Becker, E. (2002). Magnetic resonance imaging of the shoulder in asymptomatic professional baseball pitchers. American Journal of Sports Medicine, 30(1), 66-73.
Dr. Katrina Protopapas 