Four hundred years ago, renowned mathematician, scientist and philosopher René Descartes theorized that pain was a one-way message from the tissues in our bodies up to the brain. And that assumption has persisted even through today. However, in the last four centuries, we have learned a significant amount of information about the how the body and brain work, so our understanding of pain has grown exponentially.
The old assumption was that tissue damage—a torn muscle, ripped tendon, arthritic joint or bulging disc—directly caused pain. This is simply not the case, as is proven again and again through imaging studies and sham surgery trials. The medical field has taken MRIs of people who are not complaining of shoulder pain and have found that one out of three people over the age of 30 have rotator cuff damage while experiencing no pain. That goes up to two out of three people over 70 years old with rotator cuff tears and zero pain. There are similar statistics for neck and back arthritis, hip joints, knee joints, and bulging discs.
Useful research studies include sham surgeries. During one of these procedures, participants are prepped for surgery, put to sleep, and given a nick in the skin with a scalpel. However, no actually surgery is performed. Study participants getting these sham back and knee surgeries report just as much relief as patients who get the actual surgery, despite their tissue issues not being addressed at all.
What we have learned in modern times through studying the body and the brain, is that the body does not directly produce pain. Rather, the body is simply sending data to the brain for the brain to process. It works the same with all our senses. Our eyes don’t do the seeing, but rather they send signals to the brain where they get processed as vision. Our eyes can be tricked, as visual illusions demonstrate so well. Likewise, our ears don’t actually hear, but rather send sound waves to the brain where they get processed and interpreted. Our brain can be tricked there as well, as shown in auditory illusions.
The tissues in our body send information to our brain, in the form of temperature, pressure, chemical irritation, torsion or shear forces. Our brain processes this data, along with details from our surroundings, context, mental state, current mood, cultural interpretations, and a vast history of experiences. All that information processed together causes the brain to determine what to make our bodies feel. And in cases of chronic pain, just as with visual or auditory illusions, our brains can be “tricked” and start thinking that even the lightest touch or simplest movement is a threatening, dangerous sensation. The brain can cause us to feel pain while attempting to protect us, acting like a hovering, overly-protective mother.
Pain is always real, and it is felt in the body despite being determined by the brain. So, what does this mean for healing? By only working on the body, we are not getting to the root of the problem when it comes to persistent pain. For an acute injury—a recent ankle sprain or pulled muscle—using ice, compression, physical therapy, acupuncture, massage therapy and the like is helpful and important. But when pain has persisted past the tissue's normal time for healing, working on the body through adjustments, balms, therapies, injections, and surgeries is often not enough to truly solve the problem.
A more holistic, mind-body approach is needed. We need to address the brain’s role in creating our sensations—in this case pain—and figure out why the pain has stuck around. This can be different for every person. There is a strong link between chronic pain and trauma, with traumatic injuries—such as a car accident, work injury or abuse—being eight times more likely to cause chronic pain. Modalities such as Cognitive Behavioral Therapy can be fantastic in getting to the root issues to assist with healing.
Physical therapy is another great, non-invasive way to find relief. A skilled physical therapist can provide a full examination to rule out any potentially missed tissue injuries or red flags. They are also able to educate patients on pain mechanisms and provide guidance on moving the body again in a safe, comfortable, progressive way. Addressing the nervous system through relaxation techniques, proper breathing, sleep hygiene, mindfulness and meditation will help to calm down the now overly helpful protective mechanism of the brain.
We have learned a lot in the last 400 years. Our understanding of our bodies and our brains continues to grow. The main message coming from the field of neuroscience is that our brains are always changing and always adaptable—even into old age. That is great news, because now we know that there is always hope.Dr. Sarah Hayward is the owner of Flourish Physical Therapy & Wellness, located at 3418 S. Grand Blvd., in Spokane. She specializes in vestibular rehab (vertigo) and customized pain programs and offers 60-minute, one-on-one appointments. For more information or to get a free consultation, call 509-385-2823 or visit FlourishPhysicalTherapyAndWellness.com.