• Pain from any body part is a protective danger signal that guides our behavior and physical responses to avoid danger and remain safe.
• This system is called the nociceptive system, which guides behaviors to not exceed the limits of a given structure.
• Feedback from internal organs is called interoception, and the nervous system maintains a delicate balance through hormones, inflammatory responses, neurotransmitters, and metabolism (fuel consumption).
• Unpleasant mental input is perceived in similar regions of the brain as physical pain, but there is no automatic withdrawal or avoidance response. Suppression increases the intensity. We have no protection from mental pain.

Although humans are programmed to avoid or resolve physical threats, we do not have inherent mechanisms to deal with mental threats.

Staying Alive

Every living creature, from single-celled organisms to mammals, has two biological mandates. The first is to survive, and the second is to pass their genes to the next generation.

In order to avoid danger, seek safety, and stay alive, data is gathered through sensors located on every cell in your body. All this information continually interpreted by your nervous system to assess whether the situation is safe or dangerous. Signals are then sent out from the nervous system to regulate and control your body’s next actions to optimize survival. So, a major point is that the nervous system is necessary to interpret the intensity and type of input from the pain sensors. Otherwise, pain would not exist.

There are many different pain signals such as hot/cold, loud/soft, sharp/ dull, pressure, light touch, and position. When these pain receptors send messages to the brain that a given structure in the body is at risk for danger, the brain sends out automatic signals to withdraw from the dangerous situation. Pain is protective and we cannot survive without it. It is a gift.

This unconscious protective system is called the nociceptive pain system. What you may not realise is that this system is focused on guiding our actions and behaviours in order to avoid pain and we can get on with our lives safely. So, we are not aware of its role most of the time. It is only when the limits of a given bodily structure are approximated or exceeded that your brain receivesan intensity of signals that it interprets as, “danger!” These signals have evolved to be so unpleasant so as to compel action. It is how living creatures evolved and survive. It is also the reason why when the finely tuned protective pain system becomes unbalanced and suffering from chronic pain is so tragic.

Protective responses

There are four levels of responses to input from your external environment and internal organs. The variables are intensity and duration.

1. None/protective: Your body is guided to remain safe.
2. Withdrawal: Any physically perceived threat is met with a quick response.
3. Symptoms/Illnesses: Prolonged threat – diminishes/resolves with a lower threat load.
4. Diseases: Sustained threat – your body breaks down, causing structural damage.

There are rare instances where people are born without pain fibers. Since they lack protective sensation, their tissues and joints break down, become deformed, and infected. They live only 10-15 years and usually die from infection. There are also diseases that destroy protective sensation such as leprosy and diabetes. Again, the limits of the tissues are regularly exceeded, and they break down. Often a joint will become a “bag of bones.” Survival depends on your brain accurately processing sensory input, detecting threats, and sending out signals to take protective actions.

Uniquely human

In addition to input from your eyes, ears, nose, mouth, skin, and internal organs, humans also receive input in the form of threatening thoughts. Unpleasant thoughts are processed in similar regions of the brain as physical pain¹, which creates a flight or fight response. Hence the phrase, “You hurt my feelings.”

The brain generates survival signals that are intended to be so unpleasant that the organism is compelled to respond in a way to resolve the threat. Once the problem is solved, your body returns to its baseline. Whenever a given response doesn’t solve real or perceived danger, the body’s physiology remains in an activated threat state. Sustained threat causes symptoms, illness, and disease.

Many, if not most, people have stresses that are not solvable, and avoiding stress becomes its own stress. As your body kicks in more of a stress response, you’ll feel angry. The longer and more intensely you feel trapped, the greater the effects on your body.

There are many ways of minimizing the impact of stress. However, a universal problem is the inability to escape from unpleasant thoughts. This may be a powerful force in driving chronic disease with sustained threat physiology keeping your body in overdrive.

Your brain on fire

A significant percentage of your brain is intertwined with the immune system, and signaling molecules (cytokines) fire up an inflammatory response. Your brain is not only hyperreactive but also inflamed. So, thoughts fire up the nervous system, and then your brain fires off disruptive thoughts.

SciePro/ AdobeStock

Your thoughts, concepts, and behavioral reactions eventually become permanently embedded (memorized) in your brain and are unresponsive to rational interventions.² They become your “demons” that strengthen over time. Essentially, all humans have some level of annoying, undesirable thoughts that aren’t problematic. Many experience them at a level that interferes with their enjoyment of life but doesn’t affect their capacity to function. Others are greatly affected without carrying a diagnosis of OCD (obsessive-compulsive disorder). Coping behaviors include suppressing thoughts, rigid thinking, binge eating, eating disorders, skin picking, nail biting, hair pulling, “worrying,” hyper-focusing on appearance, body image issues, and addictions.

Repetitive Unpleasant Thoughts (RUTs) are worsened when trying to fight or control them³. Attempts at mental control drive them much harder, as more attention reinforces them. Suppressing them is even worse. Then, feeling trapped creates intense angry, irrational reactions. The resultant dysfunctional behaviors create a lot of damage to you and others around you, in addition to illness, symptoms, and disease. We do not have an automatic withdrawal response to mental pain – we have no protection at all.

Recap

This inability to protect ourselves from unpleasant thoughts drives threat physiology, creates many dysfunctional behaviors, and causes symptoms, illness, and disease. There are many benefits to human consciousness, but this aspect of it is “the curse of cognitive consciousness.” We have learned to physically survive but have not consistently figured out how to thrive.

References

1. Eisenberger N. “The neural bases of social pain: Evidence for shared representations with physical pain.” Psychosom Med (2012); 74: 126-135.
2. Feldman Barrett, Lisa. How Emotions are Made. Houghton Mifflin Harcourt, New York, NY, 2018.
3. Wegener DM. The Seed of Our Undoing. Psychological Science Agenda (1999)/ 10-11.

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Conceptualizing pain

What is pain? We toss the word around a lot without really understanding what it actually means. A loud noise is uncomfortable. Bitter tastes are unpleasant. Ringing in your ears is more than annoying. What about when someone, “hurts your feelings?”

The way every living species of creatures evolved and survives is by processing multiple types of sensory input and interpreting the sum total of it as safe or dangerous. Then its behavior is directed towards safety and rewards while also avoiding threat. These automatic actions in response to this input keeps us in a neutral zone most of the time so we remain functional and comfortable.

Nociceptive pain

The name for this function of the nervous system is called, “the nociceptive system.” When the limits of safety are exceeded for a given part of the body, your receptors will signal danger and cause you to engage in corrective action. The intensity of the signal will depend on the input from a specific part of the body. For example, a bright spotlight shined in your eye would not be tolerated for very long. Your brain knows your eyes would be damaged quickly and the danger signal is sent out for you to close your eyes or move away from the light. But what if the same light was focused on the bottom of your foot? No problem because there is no threat from light alone to that part of your body. Pain is simply a warning signal that there is potential damage to a specific body part.

So, acute pain is necessary and protective. It is a gift and people who are born without a pain system don’t survive more than 10-15 years. They can’t sense danger. Tissues are destroyed and they die of infection. (1)

A nightmare

But there is nothing useful about chronic pain. A delicately balanced signaling system is out of kilter and it can no longer accurately interpret the environment. You are trapped by incredibly unpleasant sensations without any hope of escape. It may be one of the worst experiences of the human condition.

Based on the last 10 years of neuroscience research, new definitions of chronic pain are being created. Here is one proposed by the IASP.

IASP definitions of chronic pain

For the first time since 1979, the International Association for the Study of Pain (IASP) revised its definition of pain. This was made necessary by the research showing clearly that pain could arise from sources other than physical tissue damage. Although the revision is a relatively small one, it has big implications for appreciating the complexity of pain and expanding our ability to assess and manage pain with multi-disciplinary approaches.

Old 1979 definition of chronic pain

“An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.”

Revised 2020 Definition

“An unpleasant sensory and emotional experience associated with or resembling that associated with actual or potential tissue damage.”

This definition is expanded by 6 key points

1. Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors
2. Pain and nociception are different phenomena. Pain cannot be inferred solely from activity in sensory neurons.
3. Through their life experiences, individuals learn the concept of pain.
4. A person’s report of an experience as pain should be respected.
5. Although pain usually serves an adaptive role, it may have adverse effects on function and social and psychological well-being.
6. Verbal description is only one of several behaviors to express pain; inability to communicate does not negate the possibility that a human or a nonhuman animal experiences pain.

By adding the words resembling that associated with allows for an expanded understanding and appreciation of pain beyond that which was previously limited to actual tissue damage.

Dropping the phrase “describe” the pain, allows for acceptance of pain from those who may not have the ability to describe their pain whether infants, cognitively impaired individuals, those with communicative disorders, or any other reason that a description of pain may not be possible including nonhuman animals.

Commentary on the six key points

1. It logically has to be personal since each person is genetically different and we are programmed with regards to safety vs threat by our past. If you come from a less than nurturing background, more things in the present will seem dangerous because when you were younger they were dangerous. You will spend a higher percent of your time in a “high alert” and the sustained exposure to stress hormones and inflammation will create physical symptoms and serious diseases.
2. Acute pain is the danger signal that indicates that you have exceeded the safety limit of a given structure of your body. The nociceptive system keeps your behaviors in a range to protect you. Chronic pain happens when the signals have become disconnected from the environment and keep firing even in the presence of safety.
3. Pain being a learned experience is well established in the medical literature. One classic study involved looking at childhood trauma. A scoring system was developed called the ACE score (adverse childhood experiences) looking at 10 factors such as various kinds of abuse, parent(s) in prison, addicted to drugs, or having a mental health diagnosis. There is a marked increase in chronic diseases including chronic pain. (2)
4. Patients in chronic pain are often labeled. They include, “drug addict”, low pain threshold”, “faker”, “drug seeker”, “unmotivated”, and the list is endless. Often the labels are even more disparaging. No one likes being labeled. Once a person has been labeled, you can no longer “see them”. Since physical symptoms are created by the patient’s interaction with his or her environment, it is critical to know them and also their life circumstances. How can you solve any problem without deeply understanding it?
5. There is no usefulness in chronic pain. It is a disaster and it always interferes with function, social interactions, and psychological well-being – ALWAYS.
6. Chronic pain is so disruptive to every aspect of your life that words do not come close to describing the depth of suffering. It has been shown that the impact of chronic pain is greater than that of having terminal cancer. (3) The term that best reflects this condition is, “The Abyss.” It is a really dark place without a way out.

Unfortunately, mainstream medicine has not incorporated the last 20 years of neuroscience research into their treatment approach. It continues to recommend random simplistic treatments for a complex problem. It can’t and doesn’t work.

The new IASP definition is a start and opens the door for a better treatment paradigm. Chronic pain is solvable with an understanding of it and the principles behind the solutions. The starting point is for YOU to better understand it and then solve it with using the medical system as a resource. Once you take charge, it is game on.

1. Yancey, P and Paul Brand. Pain: The Gift Nobody Wants. DIANE Publishing Company (1999).
2. Anda RF, et al. “The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology.” European Archives of Psychiatry and Clinical Neuroscience (2006); 256: 174–186.
3. Fredheim OM, Kaasa S, Fayers P, Saltnes T, Jordhøy M, Bortchgrevink PC. Chronic non-malignant pain patients report as poor health-related quality of life as palliative cancer patients. Acta Anaesthesiol Scand. 2008;52(1):143-148. 

The post Clarifying the New IASP Definition of Chronic Pain first appeared on Back in Control.

The post Clarifying the New IASP Definition of Chronic Pain appeared first on Back in Control.