50 Shades of Pain

Easily turned on with a gentle touch or slight movement are our pain receptors. These receptors are the bane of existence for many. But, have you ever noticed that we all experience pain differently? Why does Ibuprofen work for her but not me? Why does chiropractic work for him but not her? This is because pain is an emotional experience that we each experience differently.

What is pain?

Pain is an emotional experience that is perceived in your brain. What!? My pain is in my brain? How DARE you! Woah. WAIT a second…Before you write off this entire post, please understand that everyone’s pain is in their brain.

This is how pain is made:

Threat stimulus is perceived (light touch, bee sting, etc.)

It activates the nociceptor receptor (your excitable receptor)

This sends a signal to the spinal cord

The spinal cord tells the signal whether to continue or to stop

When continued (if perceived as a threat) it goes up the spinal cord to the Thalamus (the switchboard of the brain)

The Thalamus decides if it continues or stops

When continued (if perceived threat) it travels to multiple areas of the cerebrum (your thinking center)

The Cerebrum says “Hey, this is painful”

OUCH! – you experience pain

This TEDx video by Lorimer Moseley, a physiotherapist with a PhD in neuroscience focusing on pain, does an excellent job describing this concept.

50 Shades of Pain

So now that you kind of understand pain,we can dive into why we all feel pain differently. Pain is partially based off past experience of perceived threats. This has to do with what are called “neuro tags.” Neuro tagging is the process of recording what areas of the brain are activated when there is a stimulus. To make this simple, when pain occurs it activates many areas of your brain based on all your past experiences.

We all experience pain differently due to this. For example, you and I stubbed our toe in the same exact way. That coffee table… Well, my pain experience is an initial sharp pain that disappears 60 seconds later. Your pain however is sharp, stabbing and intense for 5 minutes, and then turns into a throbbing pain for hours after the incident. Come to find out, you broke that same toe years ago by stubbing it.

The same scenario can play out with back pain or neck pain. You develop neck pain and it activates the pathways that were established three years ago when you had sharp radiating pain into your shoulder. This new pain may be perceived as the same pain, but it is completely different. The thing about this pain is that you remember how bad it was before, so now you guard yourself from moving and change habits to avoid any pain.

Don’t get Handcuffed to a Label

I have people tell me quite often how their past chiropractor said their back was out of alignment, or their medical doctor diagnosed them with a bulging disc. These are just labels. Sometimes the way the doctor explains the problem to their patient can make their problem worse. As stated before, when you have a previous encounter or a label it changes the way you think about your pain.

Here is why labels are not as important as you may want to believe. Many people that are NOT in pain have the same findings or labels when an x-ray or MRI was taken.

Here are the conclusions of a couple recent studies comparing people with low back pain and without low back pain.

  • Degenerative features of the lumbar spine were extremely prevalent in this community-based sample. The only degenerative feature associated with self-reported LBP (low back pain) was spinal stenosis. Other degenerative features appear to be unassociated with LBP. http://www.ncbi.nlm.nih.gov/pubmed/20006557
  • There is a high prevalence of FJ OA (facet joint osteoarthritis) in the community. Prevalence of FJ OA increases with age with the highest prevalence at the L4-L5 spinal level. At low spinal levels women have a higher prevalence of lumbar FJ OA than men. In the present study, we failed to find an association between FJ OA, identified by multidetector CT, at any spinal level and LBP in a community-based study population. http://www.ncbi.nlm.nih.gov/pubmed/18923337

Here is another on patients that had NO hip pain.

  • Magnetic resonance images of asymptomatic participants revealed abnormalities in 73% of hips, with labral tears being identified in 69% of the joints. A strong correlation was seen between participant age and early markers of cartilage degeneration such as cartilage defects and subchondral cysts. http://www.ncbi.nlm.nih.gov/pubmed/23104610

This article from the Journal of Occupational Medicine explains how earlier MRI in work-related acute low back pain actually resulted in more disability, increased medical costs and surgery “unrelated to severity” of the injury. http://www.ncbi.nlm.nih.gov/pubmed/20798647

Here is another on how psychosocial variables matter more than structural findings on advanced imaging. http://www.ncbi.nlm.nih.gov/pubmed/15653082

Have no Fear

My point is, you cannot see pain on an x-ray, CT, or MRI. It can only be experienced. 

Short and simple. Don’t fear your pain. When your pain is concerning, get checked by a doctor whether that is a medical doctor, chiropractor, or physical therapist. Explain your symptoms and any past pain experiences that you believe may be contributing to this pain.

Joshua Thorp, D.C.