Pain and the brain: How perception, mindfulness and personal experience all play a critical role in managing pain
About the Author
Nicole Vandehurst, NMT, CSCS, MA, is a Mental Performance Consultant who works with local athletes, and helps clients with stress and pain management. She is also a Neuromuscular Therapist at Elevate Wellness. If you are interested in setting up an initial consultation with Nicole please contact Elevate Wellness Center at 530-541-9355.
The human experience and pain are symbiotic; pain is universal, yet highly individualized. We need to feel pain to navigate and survive in our environments. Our reaction to pain is formed at an evolutionary level, meaning our primitive brain reacts and starts a cascade of physiological events. However, pain is a complex phenomenon, in that each person experiences it differently making the experience subjective, with no specific diagnostic tools to accurately capture the full capacity of the situation.
A New Way of Viewing Pain and Treatment
By prioritizing direct, effective ways to manage pain, a constellation of biological, psychological, and social factors, must be taken into account. Through the Biopsychosocial Model for chronic pain, a multidisciplinary perspective is used to treat the complexity of chronic pain. The following is an example of the different factors:
Biological — the extent of an illness or injury and whether the person has other illnesses, is under stress, or has specific genes or predisposing factors that affect pain tolerance or thresholds;
Psychological — anxiety, fear, guilt, anger, depression, and thinking the pain represents something worse than it does and that the person is helpless to manage it. (Ochsner et al., 2006)
Social—the response of significant others to the pain—whether support, criticism, enabling behavior, or withdrawal—the demands of the work environment, access to medical care, culture, and family attitudes and beliefs (Tsang).
An Individualized Approach to Pain Management
As we can see, there are many factors to consider when assembling a treatment plan to manage one’s pain. By understanding all the different aspects that contribute to acute and chronic pain, a person that finds themselves experiencing pain can now have more power to overcome it. Pain encompasses much more than direct tissue damage: our perceptions, emotions and social situations can enhance and prolong pain.
Until the 1950s the medical stance on the brain’s involvement in pain was a passive one. Empirical findings through research has shown that the brain plays a dynamic, central role in pain processing and perception (Brennan). Current research is using functional neuroimaging to show that different regions of the brain are affected by pain. Therefore, cognitive and emotional factors that modulate pain play a key role in the processing and perception of pain. These areas include attention, fear/anxiety, empathy and direct control (Sinatra). From these studies the neuromatrix approach to pain is being explored, meaning how these brain regions are connected is of increasing importance.
These studies are tremendously imperative because they show how critical pain pathways travel through brain areas that closely interconnect with cognitive and emotional activity. In work done by Melzack and Wall, they showed how these pathways in the brain have the capacity to enhance or inhibit the sensory flow of painful stimuli. Pain management treatment is now incorporating psychological interventions as a way to change how pain is interpreted by the brain.
Neuromuscular Therapy integrated with Mindfulness
“Treating a pain patient can be like fixing a car with four flat tires. You cannot just inflate one tire and expect a good result. You must work on all four.”
—Penny Cowan, American Chronic Pain Association,
Neuromuscular Therapy deals with the biological and mechanical aspects of pain. To explain how neuromuscular therapy can help acute and chronic pain, a simple understanding of how myofascial trigger points work is worth discussing. The most researched theory concerning myofascial trigger points and muscular pain is the energy crisis and motor endplate dysfunction.
What does this mean? The motor endplate is located at the neuromuscular junction, the site where the nerve innovates the muscle. At this site tight contracted knots are called active trigger points. When there is dysfunction at this junction, chemicals and calcium are continuously released causing maximal contraction of muscle segment involved. This in turn creates a maximal energy demand and chokes off local circulation. With increased metabolic waste and no new blood to the area, this continues to keep the muscle in a maximal contraction.
How do we shut down this vicious cycle? Through the use of specific deep tissue techniques to the trigger point area, this breaks down the cell, which releases other chemicals called myoglobin. Ultimately these specific techniques destroy the neuromuscular junction signals, therefore releasing the sustained maximal contraction. As more trigger points are eliminated, increasing relief of symptoms is found.
Putting it all together
Neuromuscular therapy can help with acute myofascial pain, however, to address the pain from reoccurring or becoming a chronic issue, the other factors need to be addressed during the treatment plan. Neuromuscular therapy and mindfulness can be a collective way to address the complexity of persistent pain. One relieves the immediate mechanical component while the other works on the processing and perceptions of pain.
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