What do you think is pain?
Here are a few definitions:
- An unpleasant sensation + a negative emotional response = pain
- Acute pain is protective the tissue is damaged, like a twist ankle
- Chronic pain is the protective system gone wrong the result = pain.
In chronic pain the brain can perceive the pain as REAL yet there may not be (or only slight) tissue damage in your body.
- An example is Phantom limb pain when there is the feeling that an amputated leg is still there.
We all get this perceived feeling PLUS the objective feedback from our leg nerves where it is. 98% of the time this is the same so we are not aware of this brain activity. (From a doctor on the radio)
- The brain decides how we feel pain. For example an injured soldier can feel no pain until he reaches a place of safety, the brain thinks the dangerous situation is more important than thinking about the injury.
Dr Jonathan Kuttner
has written an excellent book 'You pain free'. I think this is the best explanation of central sensitisation I have heard in 17 years of research. He writes about how we can have pain from actual tissue damage then we can get secondary sensations that ramp up our initial pain. We can reduce this 'ramping up' of pain and other odd sensations.
He divides pain into 3 types: Hotline, Reactive and Autonomic. The following is a VERY brief summary of these...
Hotline pain – the message is real but not accurate.
SYSTEM MALFUNCTIONING for example the pain can be constantly present (aching, stabbing, prickling, shooting, tearing) and it can change or move WITHOUT A REASON.
These can be ‘weird’ sensations! The message can be amplified and distorted. For example warmth changed to unbearable heat or to the sensation of something crawling under the skin.
How to stop Hotline pain..
- Medications - can reduce pain 30-50%, but give possible side-effects.
Eg the low dose Tricyclics -Amitriptyline, nortriptyline (block messages between nerves).
Blockers - Venlafaxine, Duloxetine & Milnacipran reduces anxiety and depression which can increase the sensation of pain.
Antiepileptic's - Gabapentin & Pregabalin stabilises nerve membranes.
- Mind body techniques - humans are a mind with the body attached - the mind is the boss. With knowledge it can be a very powerful tool.
- Exercise, this can be just movement.
- Trigger point release, I get really good results using Dr Kuttner's gentle approach.
- Pacing, it not just the usually pacing, I call it 'Strategic pacing'.
- Natural movement.
Habit (some habits are helpful others are not), an activity can be linked to a pain response such as -
- Sitting at a desk is associated with getting shoulder pain
- Getting up in the morning is associated with getting back pain
For example: you may ask the question: Last time it hurt after I sat for this length of time…
I wonder if it’s going to hurt again?
It does and again you ask the question this ties the stimulus (sitting) with the unconscious response (pain amplification).
How to stop Reactive pain
- Is your pain a conditioned response?
- Switch it off – set a court of enquiry inside your head.
Do I hurt like this in another similar situation such as on holiday?
Delayed pain after a few days? This is not a usual response.
Pain happening at 10 am or 3 am?
Planning a holiday?
- How accurate is your explanation for your pain?
- This is Pain + other symptoms, such as - racing heart, increase in temperature, bowel or bladder sensitivity, dizziness, skin sensations.
- The over reactive ‘fight and flight response’. This is the imaginary scene of meeting a tiger, your adrenaline can increase and then decrease when the danger has gone. In Autonomic Pain it can feel like you are shut in the cage with the tiger (Quote from Dr Patrick Woods)
- Adrenaline hypes up symptoms, this increases pain and anxiety
My Trip to London
This is an example of how I put into action techniques to stop the ramping up of my pain caused by Central Sensitisation:
- I woke up with a pounding headache.
- My inner voice questioned - How was I going to cope?
- My Habit reaction was– These pain symptoms usually increase on trips to London.
So I did the following
- Mindfulness – breathing and concentrate on the present moment.
- Habit breaking – I’ve had a bad reaction before it doesn’t mean it will happen this time.
- Trigger point release.
- Comfort scanning.
- Visualisation- see the diagrams
On the left how my pain felt at the time. I had a pain that should have only felt like a feather in my right shoulder, (it had been checked out before and wasn't a new pain). By the time the nerve signal reached the 'dorsal horn' in my spine the pain had ramped up to feel like a drummer hammering on his drum. By the time it reached my brain my head felt like it was exploding.
The message the nerves should have sent...
This picture shows how I imagined it to be, that the pain should only be feeling like a 'feather like pain' at my spine and in my brain. The correct size of message being sent to my brain.
I breathed in and imagined a cool mist in my brain and as I breath out this moved down my spine and then towards my shoulder. It was surprising how the pain reduced. This confirmed to me that the initial feeling of my pain had been ramped up and was caused by central sensitisation.
This works for me and I plan to repeat this for it to become more effective. I'm still a work in progress and developing better methods. This is one of many mind-body ideas. It is best you work out your own mind-body sessions to get the best results for you.
of pain and central sensitisation.
If you'd like to learn more about this either read Dr Kuttner's book or contact me and I can help you with an individualised plan to reduce your pain and central sensitisation.