Pain and the Brain

I’ve been working on a post about pain gates and the neurology of pain for a little while now but it’s been a bit of a unwieldy subject to try and grapple with! However, watching last weeks Horizon, The Placebo Experiment: Can My Brain Cure My Body reinforced that it’s something really important that I want to address.

I’ve seen many people on Twitter raise very pertinent, valid questions about the methodology used for the experiment and I’m not really going to talk in much detail about the placebo itself but I do want to hone in on the role of the brain and some of the opportunities that I think were missed in the programme. 

One of the earliest things taught on my pain management programme was the theory of pain gates: developed in the 1960s by Ronald Melzack and Patrick Wall the theory suggests there are ‘gates’ in the brain and nervous system that, when open, allow us to experience pain. Opening and closing the gates is an incredibly complex process however so for now just bear in mind the point that the gates can also be closed, which is what happens when pain lessens. 

Pain itself as sensation is referred to as Primary pain, tending to arise from illness or injury whilst Secondary pain can be seen as the mind’s reaction to Primary pain. When Primary pain occurs signals are sent to the brain, where it processes and analyses all the information received – not just the pain itself but occasions when you have suffered similarly in the past, searching for a patterns or clues, that will lead to a solution. 

I’m going to defer to the words of Vidyamala Burch and Danny Penman now, who explain this further:

         “ … pain is far more subtle and complex than the traditional idea of damage signals being sent to the brain which are then passively felt. Pain is a sensation, which means that it is an interpretation made by the brain before it is consciously felt. To make this interpretation, the brain fuses together information from the mind as well as the body. In practice, this means that the thoughts and emotions flowing through your mind, both conscious and unconscious, have a dramatic effect on the intensity of your suffering. Not without reason did the ancient Greek philosophers consider pain to be an emotion.”

Taking this idea then of the role of thoughts and memory, one of the most relatable examples I can think of is Exercise. In my circumstances, the problems in my back have often made exercise difficult and painful. Say I go to the gym, use some machines and do arm and leg work that places strain on the core – the brain retain this memory. I do this a few times and the “(T)rouble is, if you have suffered from pain or illness for months or years, then the mind will have a rich tapestry of painful memories on which to draw – but very few solutions.” The brain processes this information in seconds, before we’re even consciously aware of it. But each memory and thought builds upon the last and soon there is a vicious cycle that actually ends up amplifying pain because each time thereafter you attempt exercise your brain is recalling its past experiences and immediately preparing the body for pain – thereby stimulating pain responses before any pain is actually felt as a sensation. This is partly how we can get stuck in a vicious cycle of needing to exercise to strengthen and repair our bodies but the exercise itself being painful, creating reluctance to partake in it – and as we further decondition exercise becomes harder, which may well cause more pain (or at least discomfort) but the brains role means those pain memories are also called upon, amplifying pain sensations.

I have to admit that when I learnt this in my pain management programme it blew my mind! They, and I, were very keen to stress though that this does not mean the pain is in our minds. It is being created by our minds but the physical sensation of pain being felt is still thoroughly real. But imagine years and years of those sensations, memories and emotions building up, layer upon layer upon layer. No wonder things like the vicious cycle of exercise can be difficult to break out of. 

To go back to the Horizon programme – this is what I wish they had explained! It could easily have been done by one of the medical professionals involved and would have given not just the general public but also people living with chronic pain who were watching some idea of the brains role in experiencing pain. Which is what the whole programme was ultimately about! Some fundamental understanding of that role would I think have gone a really long way to helping people understand how on earth it is possible to retrain the brain, to trick it into believing a placebo is a real painkiller. What a missed opportunity. It took me 25 years to encounter the theory of pain gates and even begin to understand the brain’s role in our experiences of chronic pain. How many other people are there out there who would benefit from this knowledge?

I would also hate for someone living in daily pain and doing everything they possibly can to free themselves of it – as most of us are, whatever the method we choose – have someone who’s seen this programme go up to them and say, you don’t really need those painkillers, it’s mind over matter, you just need to try harder. It’s a genuine worry the programme left me with because it is not as simple as that. Retraining the brain to let go of those layers of memories and experiences is hard work - it takes time, an incredible amount of hard work, patience and kindness to yourself and more time again.

For anyone wishing to learn more about this area I would highly recommend the book Mindfulness for Health – a practical guide to relieving pain, relieving stress and restoring wellbeing by Vidyamala Burch and Danny Penman, which I have quoted here. It contains an eight-week programme that uses mindfulness meditations to relieve chronic pain. I’ve been working through it and am learning so much and finding the meditations really useful. 

One final note on the programme, specifically to the producers: don’t book a venue that doesn’t have adequate wheelchair access if your participants in the programme are wheelchair users. It’s downright rude and disrespectful. 

The Placebo Experiment: Can My Brain Cure My Body? is available on the BBC iPlayer until 3 November 2018

Photo by Florencia Viadana on Unsplash