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Turning pain down and off: Part III

In the last two blogs Dr Francis showed how tissue damage to the discs of the spine can rarely account for chronic back pain. Instead, other ‘cues’ which the brain perceives as a threat to safety are often the culprit of persistent back and other bodily pains. In particular, emotional pain and hurt can often act as danger cues to the brain, particularly in those individuals who have experience adverse childhood experiences. In this final blog Dr Francis discusses how psychological treatments focussing on reducing the brain’s perception of emotions as threats can help reduce, and in some cases eliminate, chronic pain.

Turning pain down and off

We know from much research that pain can be ‘turned on’ or ‘turned up’ by anything that gives sufficient evidence to the brain that the body is in danger and needs protecting. Moseley (2007) found that participants reported more pain when a cold metal bar was pressed against their hands when a red light was shown than when a blue light was shown. In both conditions the temperature of the metal was the same, and all that was different was the colour of the light. The light clearly had no impact on the tissues of the participant's hand, but it did have an impact on participant’s expectations of pain. After all, red lights are associated with heat, warnings and danger! Given that such cues associated with danger can increase pain, it follows that pain can be ‘turned down’ or ‘turned off’ in some cases by giving credible evidence to the brain that such cues are safe and the body is not in danger.

Relating this idea to feeling and emotions, there is a deceptively simple solution to reducing chronic back pain: we need to help the brain perceive feelings as non-threatening. Put differently, by turning your back on pain and facing your feelings, we can change how dangerous such feelings are perceived to be.

Of course in practice this is much easier said than done, as avoiding painful feelings is likely to have become a habit for chronic pain suffered that they unaware of. As a Clinical Psychologist I encounter patients who consciously and unconsciously hide their feelings from themselves and those close to them. They are often terrified of their emotions and try their best to ignore them. As a result, they have much difficulty recognising their feelings or recognising the specific stressful life events which are triggering them. Their early experiences have taught them that feelings and desire for closeness with others is dangerous and should be avoided at all costs. It is no wonder that their fear of emotional pain channels into physical pain. As Sir Henry Maudsley, a pioneering British Psychiatrist, once said: ‘sorrow that finds no vent in tears may make other organs weep’.

Feelings key to psychological and physical wellbeing

The ability to experience rather than block feelings has been shown to be vital for physical as well as psychological wellbeing (Pennebaker, 1990; Malan & Coughlin Della Selva, 2006). Whilst this idea has been a cornerstone of addressing psychological problems, there has been less acceptance of this principle in physical health services, where medical interventions alone seem to dominate the treatment of bodily complaints, even when a medical cause cannot be found. Arguably this may be legacy dating back to the 17th Century, when Rene Descartes proposed that the mind (or soul) and body are separate entities. This division can present a real problem for chronic pain sufferers and those experiencing ‘medically unexplained symptoms’ such as fibromyalgia and Irritable Bowel Syndrome, where emotional difficulties rather than physical diseases can be at the heart of the problem.Interestingly however, even Descartes did consider a link between the mind and body when it came to pain:

“Nature also teaches me, by the sensations of pain, hunger, thirst and so on, that I am not merely present in my body as a pilot in his ship, but that I am very closely joined and, as it were, intermingled with it, so that I and the body form a unit. If this were not so, I, who am nothing but a thinking thing, would not feel pain when the body was hurt, but would perceive the damage purely by the intellect, just as a sailor perceives by sight if anything in his ship is broken.” (Dicker, 2013)

Given that the most ardent proponent of dualism can conceive of a relationship between the brain and body, particularly in regards to pain, then it should not be so difficult to so in today’s society with the added benefit of neuroscience research to support this idea. Panksepp and Biven (2012) capture this point beautifully:

“As soon as we recognise that affects emerge from emotional systems that are fuelled by brain chemicals that can exert eventual effect on the functioning of the brain and the body, then the division between emotional and physical disorders narrows to the point of extinction”

There are many ways of helping people face rather than avoid their feelings, ranging from more simple approaches such as expressive writing (see Pennebaker & Chung, 2011) to more complex approaches such as psychotherapy. In the next blog I'll speak more about these different treatment interventions, with a particular focus on a method of treatment that I used in my clinical practice with patients experiencing chronic pain and medically unexplained symptoms - Intensive Short-Term Dynamic Psychotherapy (ISTDP).

Hope for the future?

Although chronic back pain is no doubt excruciating and unpleasant, it is important to know that the pain is rarely a sign of damage to the body. Rather, pain is a sign of the brain’s perception of danger and attempts to protect the body. Although we often think that this danger is related to physical damage, as is the case in acute pain, in chronic pain the danger is often of an emotional nature. By facing rather than avoiding feelings there is hope of reducing pain as the brain comes to see feelings as safe and even helpful to leading a more fulfilling life.

Recommended resources for understanding chronic pain further

The following resources are recommended for patients and clinicians wanting to understand some of the ideas I have presented within this blog about chronic pain.

● Dr Howard Schubiner’s video Explaining Chronic Pain: The role that stress plays in and the creation of learned neural pathways

● Professor Lorimer Moseley’s TedX Talk on Why Things Hurt

● Professor Lorimer Moseley’s website contains many helpful resources:

● Dr John Sarno’s book Healing Back Pain is considered a classic text within the field and introduces the idea of repressed emotions being at the core of chronic pain.

References for this blog are available upon request.

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