Understanding your pain to get better!

The experience of pain is characterized by large differences between individuals. It is influenced by multiple factors: age, sex, environment, biological variables, emotional state or also stress. Al these factors interact with each other to influence positively or negatively the experience of pain.

Awareness and comprehension on the part of the individual suffering from all these factors, is therefore of crucial importance for his pain being taken care of and for his wellfare.[1]

Our brain remembers painful experiences

Chronic pain is one of the costliest forms of care in the world and one of the principal causes of invalidity. That is to say just how much taking charge of pain in our present society is of the utmost importance. [1

All along our life, the experiences of pain we live are imprinted in our body and our brain. The latter keeps track of these past experiences in order to protect itself from any new painful episode. Thus if you fell while skiing on a bumpy slope and broke your arm, your brain will most likely remember it and next time you pass by a bump you will most likely ride round it.

And to this, there are also the messages we keep reading and listening to on social media, on television ...that contribute to emphasizing negative ideas about pain and give ground to pessimism and catastrophism ( this being a mental attitude that makes us foresee the worst in front of a situation and in return, catastrophism makes us grow sensitive and so increases the feeling of pain). [4,5,6]

"Don't bend over when you lift that parcel, you will hurt your back!" , "If you keep reading your SMS in that position, you will get yourself a sore neck" and many other common thoughts that we have all heard of one day or another.

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Our beliefs influence our behaviour

Beliefs are numerous and all of them influence, in a greater or lesser way, the experience of pain and our behaviour towards it.

We will thus find, with certain people, behaviours of avoidance (remember the story about the ski slope with bumps), kinesiophobia (which is fear of movement, for example I twist my back turning around, I will then feel a certain apprehension for executing that same movement for fear to trigger the pain) or even catastrophim. Initially, these behaviours are useful to protect one's self, but if they become persistent even when the danger for the body is over, this is when the situation becomes an issue.

Fear of pain and/or movement can then increase our sensitiveness and amplify the pain signal, the alarm will ring sooner. We have then reached a state beyond the point where pain was useful and protective.

Our beliefs influence our pain

Negative beliefs that we carry about our body and our pains play an important part in the behavioural and emotioanl responses favoring / giving way to incapacities and handicap. [2

Studies show that when we have negative expectatons and we are convinced that pain is going to get worse, we secrete more cholecystokinin, a substance that facilitates the transmissoin of pain. So, the more gloomy thoughts we have about our pain, the more pain will take over, quickly and durably. [3] 

John Vlaegn describes a fear-avoidance vicious circle phenomenon. According to him, there would be two behavioural responses in the face of pain: confrontation or avoidance.

According to studies, avoidance and hypervigilance in the face of pain could find their roots in catastrophic thoughts which subsequently activate restricting attitudes that accentuate handicap and pain. In other words, if we perceive pain as a danger and associate it with negative thoughts, and if we avoid all situations in which pain may occur, we then develop inadapted behaviours and imagine all sorts of things that are not really related to the pain experienced. [7]

On the other hand, as shown by John Vlayden, if our thoughts concerning our pain are positive and if we confront our pain rather than submitting to it, we are more likely to recover. [8]

Did you know? Where back-ache is concerned, studies show that avoidance beliefs and fear are predictive of bad recovery and a transition to chronicity. It has also been demonstrated that psychosocial factors of catastrophization of pain are linked to the length of sick-leave and to the handicap brought up by low-back pain disorders. [7,9,10,11,12]

In short, the more negative you will be towards your pains, the more you will feel inconvenienced and you will be away from work for a longer time.

The attitude of caregivers, essential to limit false beliefs

We know that false beliefs can be altered, they are therefore an important target for the treatment of of pain-related disabilities, in order to favour recovery and limit a transition to chronicity. Concerning low-back conditions, most studies reveal an improvement in the evolution of pain when fears, beliefs and avoidance attitudes are taken into account in the treatment. [9,10

Therefore even if many clinicians still carry negative beliefs about pain, their role in therapeutic education is essential for the patient.

Their discourse can influence the patient's beliefs in a positive way and encourage behaviours that may bring a decrease in pain and lead to healing.

But one has to be careful not to convey false beliefs and subsequently reinforce fears and avoidance behaviours. [13,14]

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Let's remember that:

  • - Pain is influenced by numerous factors: biological, physiological, environmental.
    - Our body and our brain keep in memory painful experiences.
    - Our beliefs, whether positive or negative have an influence on painful experiences.
    - False beliefs may be modulated and are therefore a target in pain management.
    - Caregivers play a key role in the message to be conveyed to patients.
    - Undestanding one's pain helps to get better.

SOURCES

[1]  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5350021/

[2] https://www.sciencedirect.com/science/article/abs/pii/S141335552030407X?via%3Dihub

[3] https://pubmed.ncbi.nlm.nih.gov/17873596/

[4] https://journals.lww.com/clinicalpain/Fulltext/2001/03000/Bias__Effects_in_Three_Common_Self_Report_Pain.8.aspx

[5] https://www.sciencedirect.com/science/article/abs/pii/S1521694209001570?via%3Dihub

[6] https://link.springer.com/article/10.1007%2Fs12529-016-9600-9

[7] https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0242994

[8] https://journals.lww.com/pain/Fulltext/2016/08000/The_fear_avoidance_model_of_pain.5.aspx

[9] https://linkinghub.elsevier.com/retrieve/pii/S1529-9430(13)01576-3

[10] https://www.em-consulte.com/article/877702

[11] https://www.sjweh.fi/show_abstract.php?abstract_id=1360

[12] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6278039/

[13] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4845348/[14] https://www.sciencedirect.com/science/article/abs/pii/S1779012317304886

 

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