Pain is an agonising feeling that can lead to a crisis of psychological well-being in which medical doctors end up over-subscribing medication that does more harm to the bodies systems, often failing to deal with phantom pain and the reduction of real pain. In this paper we will explore the nature of pain with and without injury and its disabilitating effect on everyday functioning and life. We will explore the nature of pain and some simple techniques to manage and even eliminate the chronic pain.
Neuropsychology studies the function and plasticity of the brain and in particular the central nervous system. The pain system of the body itself is quite a complex arrangement of gates and centres with nerves attuned to particular types of pain we might experience. There are different types of pain for example:
Direct stimulation to skin (cut)
From musculo-skeletal system (sprained muscle)
Arising from hollow organs (appendicitis)
Pain also comes by degrees of experiencing a feeling, usually with patients we ask on a scale of 1 to 10 how much pain they are experiencing – such as 1 would be no pain at all to 10 which would feel excruciating and almost unbearable. Words can also help patients describe their experience such as, dull, sharp, nagging and constant etc.
The brain itself interprets these feelings into a cognitive function of experience, for example, we assess the likely cause and damage to our bodies by thinking about the pain and where that pain is coming from. A pain in the stomach could be assessed as indigestion, in the chest, as a heart problem. Neither needs to be true – our cognition is simply rationalizing our experience of pain. In a serious accident where we are severely injured our brain would overload with a fear response so we activate a system of shock in order to minimize the experience of the real pain to the brain at a cognitively acceptable functioning level. If not our brain would be over-whelmed with the pain and create the conditions for example of a stroke. However our central and peripheral nervous system is designed to minimize pain automatically in the event of major physical damage. The spine contains many pain gates connected to our pain receptors in the skin. When damage occurs the pain signal is sent to the spinal nerves to inform the brain that we are hurt in some capacity. If the pain is too extreme (a shock situation) then as the first signals arrive at the brain, opiates are produced that descend from the brain via the raphe nuclei and further descend to the dorsal columns of the spine. Here serotonergic activity excites inhibitory interneurons that block the pain. This happens to make the pain manageable now that we know we are hurt and can take action to fix the situation. (1. Basbaum & Fields 1978). Also remember eye-sight is a powerful indicator to the brain that we are in serious trouble and opiates maybe produced even before the real pain is perceived physically. We can also sustain damage that at first we are not aware of but on seeing the injury immediately experience pain.
Here pain is experienced where no obvious damage to the physiological system is detectable. This may happen after an injury to the muscles (strained shoulder) that has long mended and functioning normally again but we still experience severe pain from the area of injury. Often this type of pain starts in an unguarded moment when we are reminded of the injury through touch or even someone mentioning their own injury we immediately feel the pain as if we are still injured. One theory of this type of pain is memory activated by the habituation of our reflex actions to the original damage to the muscle. For example we dislocate our shoulder, the pain is severe, we cannot stop thinking about it – each movement causes painful spasms – so we stiffen up, move carefully and avoid touching the area. Then we heal, but now that memory of pain is embedded in our cognitive store. The habit of the pain becomes real even when we think about it or are reminded. Our nervous system has become trained to create a pain reaction to an area of our body that actually no longer has any damage at all. (2. Myler 2015). Some research suggests pathological changes to the nervous system become hard-wired to the memory. (3. Reichling & Levine 2009). Others feel that glial cells in the pain system remember independently of cognition and create hyperactivity of the neural pain pathways. (4. Fields 2009) A good example of the this phenomenon is of the phantom limb – where the arm or leg has been surgically removed but continues to cause a pain reaction even though it no longer exists. Pain medication has little of no effect for neuropathic pain and actually damages other organs though often high doses being prescribed by general practitioners who are at a loss of how to deal with a distressed patient in pain that they cannot manage. Having understood the brains reaction to pain we should also remind ourselves that pain is a function of the nervous system that tells us information about our well-being and while we perceive pain in a negative way it is a positive mechanism for our survival.
Managing Pain: Pharmacologically
The most common nonsteroidal anti-inflammatory drug (NSAID) for pain is ibuprofen. This drug helps to relax muscle and reduces swelling also it is easy to buy directly from any pharmacy. The most common brands are Advil, Nuprin and Pamprin IB. The best pain relief is often offered by one of the oldest drugs know – the simple Asprin. However there is a long list of drugs by prescription only, most having dubious effectiveness as to the side effects being high with damage to the organs of the body by long usage.
diclofenac sodium (Voltaren, Voltaren-XR, Cataflam)
indomethacin (Indocin, Indocin-SR)
mefenamic acid (Ponstel)
The main side effect of these types of medicines is that they can cause bleeding and irritation in the stomach. This bleeding usually occurs after long-term use but can also occur with short-term use. Long-term use can also affect the kidneys. Generally, the pain-relieving effect does not increase with higher doses; thus, 400 mg of Motrin has just as much pain relief as 800 mg of Motrin. A person is more likely to suffer a significant stomach problem with the higher dose. (5. John P. Cunha, DO, FACOEP 2015). The message here is clearly avoid medication if at all possible especially long term usage.
Pain management – Psychologically
One of the most talked about pain management techniques is hypnosis. However the evidence shows it is a popular method but actually mostly fails and is ineffectual. Even if subconsciously you ignore the pain it does not last every long and you are constantly going back for further sessions and of course spending an inordinate amount of money. Today most clinical psychologists use visualisation rather than hypnosis. Visualisation asks the patient to focus on a pleasant painting or photograph and imagine they are in the picture and part of a story – this distraction after a little practice can be repeated internally without the actual picture now being present. You can just see it in you minds eye and focus on continuing the story line. Although there is evidence that hypnosis can reduce or even eliminate pain again it is only short term and so more useful for minor operations where analgesics cannot be used for allergic patients for example. (6. Graham Hill 1998)
Remember that in the brain pain is perceived by the cognitive evaluation of the severity and amount of damage seen. To alter this perception one has to trick the brain into focusing away from the area of pain it perceives. An example would be the Paradox method (7. Myler 2014) here if the pain is in the left shoulder you should tap or rub the right shoulder where no damage was ever experienced. The effect of this paradox is that pain lessons in the right as the nerves are stimulated in the left. The brain switches its focus to the area of stimulation and only perceives a pleasant feeling of massage. This has the effect of also lessoning the habitual memory set up when the shoulder was originally damaged. An everyday example of this can be seen when we bang our knee against the edge of the coffee table – we naturally start to rub our knee and so stimulate all the nerves around the sharp area of damage which then instantly dulls the pain overall. This extra stimulation has the effect on the pain gates in the spine to pass more information about the injury to the brain as being less serious than the original point of contact with the table edge. Another method is the relaxation before you move technique. (8. Myler 2013). If making a movement causes pain to an area of the body then take time to relax before the major movement. This can be achieved through a simple countdown – from 10 to 0 – before you move. As you count down slowly – you relax your body consciously – then move. This technique has in many clinical cases proved again to retrain the body to accept less discomfort when moving, for phantom pain in particular, where the damaged has long healed.
Another paradox method is making the pain happen. Here if your patient suffers from headaches – you can ask the patient to try and have a headache – this is almost an impossible task to complete – and so the patient when feeling a headache coming of actually tries to make it worse and fail. Sound odd that creating a paradox works but in many patients has remarkable effects.
Other Complementary Methods
For physical pain particularly from sports injuries and the spine then physical therapy massage can be very effective in relaxing the painful areas of muscle. In fact physiotherapy is mostly about pain relief for training muscles, after injury, to function effectively again. Chiropractic methods are also effective in cases where pain is being caused by trapped nerves in the spinal column. A shift in the vertebra can cause nerves exiting the spine to the peripheral system to give pain impulses to the brain that are not related to actual injury. The chiropractic doctor (or rehabilitation specialist) can readjust the spine through physical hand manipulation to redress the normal curvature and alignment of the spine and so freeing the trapped nerves and eliminating the pain. (9. B. Diskin 2014). Many patients suffering from stress feel physical pain and so seek chiropractic or physiotherapy to relieve the tension in their necks and lower back. However dealing with the stress itself through psychotherapy may actually be more effective in the long term.
Pain is a disabilitating experience that can have the ability to disable a person’s enjoyment of everyday life through becoming distracted and dysfunctional. In order to tackle the various types of pain and their severity a combination of methodology is required from medical pain relief, complimentary methods and most effectively psychological pain management.
- Basbaum & Fields 1978 – Biopsychology 8th Ed. Pearson Publications pg 182
- Myler 2015 – Case Studies – Sky Clinic Shanghai
- Reichling & Levine 2009 – Biopsychology 8th Ed. Pearson Publications pg 183
- Fields 2009 – Biopsychology 8th Ed. Pearson Publications pg 183
- John P Cunha DO, FACOEP emedicinehealth.com/pain_medications/article_em.htm
- Graham Hill 1998 – Advanced Psychology through Diagrams Oxford University Press.
- Myler 2014 – Case Studies – Shanghai East International Medical Centre Shanghai
- Myler 2013 – Case Studies – Healthway Medical Centre Shanghai
- B. Diskin 2014- Hospital Lectures – St Michaels Hospital Shanghai
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