Pain and the brain – Context is (almost) everything

Pain and the Brain

Me looking particularly pitiful

My older son turned eight three weeks ago. We have a family tradition of breakfast in bed on your birthday, so after a particularly fun 5:30 a.m. workout, I went to their dad’s house to participate in the early morning birthday festivities. After helping deliver his chosen breakfast of Lucky Charms and biscuits (Don’t judge – he only gets sugary cereal once a year!) I climbed out of his top bunk, stepped on a toy and twisted my ankle.

I heard and felt a “pop” and went to the ground. I had immediate, sharp pain in my ankle and foot, along with nausea and lightheadedness.

What is pain?

The International Association for the Study of Pain defines pain as: “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”

Think about that … pain is an emotional experience associated with “actual or potential tissue damage.”

An injury is only as “simple” as its environment

Suddenly this “simple ankle sprain” has a lot more to it than just the stretching of ligaments.

As I’m lying on the floor, I’m thinking “What if it’s fractured, what if it has to be immobilized? What if I’m on crutches for two months? What if I need surgery? Who will take care of me? If I can’t walk, I can’t work. Oh shit. I got bills to pay. What about my clients? What about the 14 steep stairs to my bedroom? What about getting Fletcher in and out of the car? I have to take out the garbage tonight, who is going to do that? What if I can’t exercise?”

All those negative thoughts (in this case, catastrophizing thoughts) and emotions associated with them actually increase pain.

The moment I got the x-ray results showing there was no fracture, my pain significantly decreased. Don’t get me wrong, it still hurt. A lot. But the context had changed – I was looking at a few days or a week off my feet, not months and not surgery.

Anyone who has watched professional sports of any kind has seen this in action. When an athlete get hits and goes down writhing on the ground … then moments later pops back up as if nothing happened. In that moment, as he felt that twinge in his knee, he felt the weight of “Oh my God, my career is over, this is it, how will I sustain my lifestyle, how will I pay my bills, what about my whole identity as an athlete?” And then, when the realization sinks in about the lack of actual tissue damage, those emotional contributors fade, and the pain does too.

Stress will increase pain, joy will decrease it

Pain is an emotional experience that can be facilitated (increased) by stress, fear and anger. Conversely pain can be inhibited (decreased) by movement, social interaction and joy.

If you want to increase the pain associated with an injury, get angry at the person or situation that caused the injury, ruminate over the causes and catastrophize about what’s going to happen next. If you want to decrease the pain, get moving, get social and direct your mind away from blame and anger and toward your plan for healing.

Be well y’all!

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