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Wednesday, Feb. 18th 2015

The Brain and Chronic Pain

Neuroscience brain chronic painThe following article, written by By Ann Karasek MHS/PT and Dr. Jim Lemons Ed.D, appeared in the January-March issue of Fibromyalgia Solutions, the magazine of the Fibromyalgia Coalition International.

The Brain and Chronic Pain

If you are reading this article there is a good chance that you or someone close to you has chronic pain. Many people with chronic pain feel like their body has betrayed them. I’m going to ask you to take a leap and look at your pain differently, not as a betrayal, but as an act of love. It may be a misplaced act of love, but none the less an act of love. Pain is your brain’s way of protecting your body. If your brain perceives your body is in danger, it produces pain to protect you. Most of the time this is a good system that works. If you place your hand on a hot stove, it hurts and you take it off. If you have a tooth ache, you make an appointment to see the dentist. Sometimes, however, this system goes awry. Your brain may perceive you are in danger, and tries to protect you when in fact you are not. This is what happens in chronic pain conditions such as fibromyalgia. Although it may feel like your body is betraying you, what is actually happening is your brain is trying to protect you against what it perceives as a threat. It may be mistaken and may be seeing danger where there is none, but it is merely trying to protect you. If you can change your brain’s perception of danger, you can change your pain.

Often people with fibromyalgia may be perceived as lazy. More often the opposite is true. People with fibromyalgia frequently were very active people before the pain started. Nothing could stop them. Even with the pain, many people continue to try to work through and get things done, even though they may crash later. Perhaps we can look as fibromyalgia is our brain’s way of telling us to slow down. When we won’t do it ourselves; the only way to get our attention is to make it impossible to keep going, therefore the pain signal does that.”

One way our brains get us to slow down or stop is to make our nerves more sensitive. Nerves are electrical, that is how they send messages up to and down from the brain. Nerves always buzz at a low level. If we put more input into a nerve, it buzzes at a higher level. If we put enough input, the nerve fires and sends a message. Our nervous system is like a burglar alarm. If someone is breaking into our house, we want the alarm to go off to warn us. If our house was broken into once, we may get scared and set our alarm to be more sensitive.  While this may be good at times, if the alarm is too sensitive, it may go off if a leaf blows against the window. Our nervous system can act the same way. If our brain thinks we may be in danger, it can turn up the nervous system to be more sensitive. Things that did not used to hurt now do, or things that were a little uncomfortable may be very painful.

If your burglar alarm is waking you up at night for no good reason, you would turn it down. If your nervous system is producing pain for no good reason, you need to help your brain turn it down.  When we are in danger our sympathetic nervous system is turned on. Your sympathetic nervous system is your fight or flight system. If a lion walks in the room, what would happen? Your heart would race, your blood pressure would go up, you would breathe quickly, your muscles would tense up and your nervous system would get more sensitive. Your body would prepare to either fight or run away from the lion, which is a good thing. It may save your life. If our sympathetic nervous system kicks in when we are in danger, and pain is our brain perceiving that we are in danger, then if we have chronic pain, our sympathetic nervous system is always turned on. While these changes may be good in the short term, they are not good in the long term. We do not always want our heart racing, our blood pressure up, our muscles tense and our nervous system to be over sensitive. To turn down our alarm system, we need to turn down our sympathetic nervous system.

There are several ways to do this. The first is education. If we understand our pain, it is not as scary. We are starting to get the lion out of the room.  Just understanding how pain works can decrease it.  The second is relaxation. Relaxation techniques turn down the fight or flight response to give our bodies a chance to rest and restore. Most of us think we know how to relax, but what we think of as relaxation often is not. “Relax” is not the same as “Collapse.” I can collapse on the couch in front of the television but still be tense. On the other hand, I can be up and moving around, but be relaxed. I am not carrying any extra tension in my body. Being aware of whether we are relaxed or tense is the first step. Both of these take practice. If you have fibromyalgia, you have had pain for a while. You have been thinking about pain and reacting to it the same way for a while. It will take a while to learn a different way to think and manage your pain, but IT CAN BE DONE!

Ann Karasek graduated from Northwestern University with a B.S. in Physical Therapy and Washington University in St. Louis with a Masters in Physical Therapy. She is the Director of Physical Therapy at The Lemons Center for Behavioral Pain Management in Lenexa Kansas.

Dr. Jim Lemons received his doctorate in counseling psychology from the University of Nebraska and has been a pioneer in the field of pain management ever since. He is the Director of The Lemons Center for Behavioral Pain Management in Lenexa, Kansas.

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