Pain is a simple word. But the experience in our brains is not.
As my legs were dangling off an exam table in a small, uncomfortable blue room; it occurred to me that the pure experience of pain – really is anything but simple. I’ve been seeing some specialists and a physiotherapist lately, for a hyper-specific pain I’ve been experiencing. It’s been fun looking for the patterns across their disciplines in how they approach questioning me and looking for solutions. They’ve had a few responses to me that I’ve found very intriguing.
On each of their walls is that chart of happy-to-despondent faces, which you are supposed to use to rate your pain. The prompt always resembles something like, one being barely noticeable, ten being the worst pain you’ve ever experienced.
While staring at the chart trying to figure out what number to assign to a pain that is strong enough that I can’t ignore it at all, but isn’t quite strong enough to prevent me from doing this. The smiley faces got me thinking; what if the worst pain I’ve ever experienced is throwing off the scale here? If the worst pain you’ve experienced is a serious stubbed toe, and I’ve recovered from laparoscopic surgery with only Tylenol – does ten genuinely mean the same thing to each of us?
So then, Doctor, why didn’t you ask me what ten means to me? I say these things are all relative, right? Tellingly, the only real limitation is your imagination and scope of experience. Or does that part not really matter as you are diagnosing and treating?
It might not be my business to worry or wonder – but wonder I did all the same.
I’d argue something like this can feel way more accurate some days. We do have to work with the tools we have and all, but given the spectrum of interpretation – it makes my mind race while I swing my feet back on forth on those exam tables.
Choosing to give my particular point of reference on the meaning of 10 at least quiets my mind. The jury is still out on whether it is helping the doctors assessments, but hell, I’m there to feel better right?
This pain scale gives me a chuckle.
It seems so much more descriptive. Not to mention accurate some days. But the wild difference between the two charts, and our ability to understand each other relative to them seems important, no?
It takes practice to communicate the pain effectively.
So let’s assume for a moment, the starting point where effectively no one interprets the same stimulus the same way. Given this assumption, empathy is required for the complex challenge researchers must face. Getting a person to describe their pain experience becomes more like interpreting a poem. The whole field of study is very complicated. It seems only in the last few years the advancements have been made to take us from, “it’s all in your head” to, “you can impact your recovery with your mind.”
Twelve years ago, I was diagnosed with Fibromyalgia. Strangely – I feel as though I deserve a certificate, some sheet of paper that acknowledges the battle that it was even to get that diagnosis. It was an uphill battle getting that confirmation. For a while, the doctors were treating me as a crazy person. It took me not backing down and pressing for solutions to see the one specialist that was familiar enough to recognize the problems I was having as real – in 5 minutes flat.
In the years since I’ve watched doctors begin to speak not only about my condition differently, but chronic pain in general. Perhaps as we wade through an epidemic of opioid addiction we are coming to realize that a complex problem involves more thoughtful treatment.
Perhaps therein lies a clue to why finding suitable treatment can be next to impossible for some. It can be a real race of hurdles, competing against the doctor’s education levels on chronic pain, your ability to communicate correctly the experience you are having, the resources available in your system, and even here in Canada – your medical coverage.
Many times, the perfect storm of a lack of understanding on the doctors’ part of effective therapies, and more importantly, the lack of willingness on the patients part to put some work in, lead us down the path of over-prescribed painkillers. I’ve seen many doctors whose first impulse is to throw a pill at it. For many years now, it’s not been a solution that I’ve been willing to accept – often to their surprise.
We have to be willing to put in the work.
From my fibromyalgia to the ruptured disk in my back, to the chronic acute pelvic pain I’ve had for nearly two years – not one of these conditions has been helped by a pill. Without fail, across the board, I’ve had to put in a consistent and concentrated effort to get the symptoms under control. I’ve had to learn and re-learn that showing up for myself consistently is the best course of action. Somewhere at the crossroads of mindful acceptance, patience and determination I’ve been able to improve the situation.
When I’ve allowed myself to lay down and forfeit – to curl up in a ball of self-pity and how challenging and unfair it all is, it has, without fail, made my pain worse.
The only real option here is to stay present and lean in. Shit, if you are going to be in neverending pain make the best of it. Get curious, explore it, examine it, and breathe into it. My physiotherapist was telling me, every three to fours days those pathways in your brain that send the pain signals start to regenerate. This is not to say that it only takes three to four days to silence the highway and re-route all traffic; it is saying that it only takes that amount of time to see progress. With a slow and deliberate effort, we can become the traffic cops, and route those signals to quieter options.
Precious little goes as far as the willingness to observe your mind and body. The curiosity to explore, and the steadiness to assure yourself that, even though you are in pain – you are not in danger is really the best cure.
But even at the simplest level – isn’t it a fascinating example of how perception really is our reality?
If you are interested in digging into how our brain interprets pain, here are two fascinating videos.
Lorimer Moseley is a very engaging speaker who breaks down those communication highways in the brain in a way we can easily understand (and laugh while learning).
He’s dedicated to helping those with chronic pain understand how the brain deals with pain. The things that happen in his research are fascinating. The nuances of perception change our realities and knowing this is the first tiny step in being able to change it. The first seeds of thought that can lead to feeling empowered to change.
It’s research and understanding like this that my physiotherapist was referencing in telling me that with time and attention, we can reshape the highways in the brain to quiet those pain signals.
Pleasure and pain share a lot of the same neurology
Elliot Krane explores some instances where the wiring goes incredibly wrong.
Interesting on many levels, another great breakdown of where the brain doesn’t always get it right. He speaks of moving beyond symptom modifying drugs and using complementary therapies to help leverage the plasticity of our brains to again re-route our pain. Another angle of understanding that can shine a light on the fact that chronic pain doesn’t have to be permanent.
We think of pain as a symptom, but there are cases where the nervous system develops feedback loops and pain becomes a terrifying disease in itself.
We are teaching our minds at the same time we are learning.
So why not teach them what we need them to know?
What would you like to teach your mind? Let me know!