Beyond Pain
By Maggie Good
Pain, particularly chronic pain, is much more than a neurological response, a simple cause-and-effect. It is a complex physical, emotional, intellectual, environmental and social response to damage, disease or distress. While most pain becomes evident with nerve or tissue damage, the origins of some pain may be emotional, intellectual or even spiritual.
Pain is a common human experience and yet we don't really know what someone else's pain is like. Pain is personal; we all feel and respond to it differently and our tolerance levels vary. What is painful for one might be dismissed as insignificant by another. Long-term pain, or chronic pain, can be a lonely experience and sufferers can feel isolated and powerless.
Perhaps the most destructive aspect of chronic pain is the way it steadily erodes and fragments the life force of the person in pain. The pain sufferer can lose a sense of being in charge of their life, becoming reactive and increasingly powerless, devitalised and demoralised. By its very nature pain can affect all aspects of the sufferer's life — their relationship with themselves and with others, their finances and, if they are able to work, their work performance.
In the range of help available to the chronic pain sufferer, there is a vast resource that is potentially and consistently the most powerful of all. This is the mind. In combination with appropriate therapies, the healing power of the mind gives us access to enduring, effective pain management.
The bodymind network
Psychoneuroimmunology (PNI), a science that integrates neuroscience, endocrinology and immunology, establishes that the nervous, endocrine and immune systems are functionally integrated. What all three systems have in common is they each have a number of locations throughout the head and body and they 'speak' to each other in a biochemical language. PNI makes it clear that the mind and body contain interrelated components of the same system that historically has been located only in the head and attributed only to the workings of the brain.
Pain affects more than the nervous system and brain because the mind network extends far beyond this. This mind is a communications network of hormones, chemicals and cells that move throughout the head and body. These biochemical couriers carry and deliver 'mind messages' as they travel through the head and body via the cardiac highway, the circuitry of neuronal synapses and the rivers of the lymph, cerebrospinal fluid and other extracellular fluids.
Beyond the physical body is an energy body called the aura or etheric body. The aura surrounds the body in an oval shape. In the average person it is between two and three metres across at its widest point and comprises several layers. It also includes a number of energy centres called chakras. Emotions, thoughts and states of being, including pain, also exist in the energy field around the body. Bio-energetic changes flow on throughout the entire system, including the etheric.
In good health, this psychosomatic network is in a dynamic state, a series of friendly conversations throughout the bodymind to create a constant flow of information, feedback and response to maintain homeostasis (balance). In the chronic pain sufferer, the communication system is 'down', conversations cease or become distorted, the flow of information is restricted or blocked.
Pain pathways
Pain generally begins with neurological or tissue damage, though this isn't always where pain begins. Depending on the type of pain, messages travel at different speeds and are stored in different parts of the brain. Pain is broadly categorised as acute or chronic, though even these distinctions can become blurred. Acute pain is sharp and insistent, caused, for example, by a heavy blow or fall, an infection or a bite, which eases as the injury heals. It doesn't last more than a few days. The acute pain pathway involves pain receptors reacting to tissue damage. The information is sent along the faster A-delta nerve fibres, through the dorsal horn in the spinal cord. The acute pain message is then passed along the neospinothalamic pathway to parts of the brain called the thalamus and the cortex.
Chronic pain is long-term. It can present after the acute pain of an injury or surgery has healed. In the case of disease, it may increase in intensity as the disease progresses. Chronic pain can be neuropathic (nerve), inflammatory, ischaemic (circulatory blockage causing diminished blood supply), visceral (internal organs), musculoskeletal (muscles, tendons, ligaments, bones) or psychological. In chronic pain, messages are relayed along C nerve fibres, which transmit more slowly along the paleospinothalamic pathway. Its final destination in the brain is different from that of acute pain. Chronic pain is registered in the hypothalamus and limbic parts of the brain.
The brain's response to pain is an area currently under investigation. There is still much to be substantiated. What is known is that the limbic system, sometimes called the primitive brain because it deals with survival and emotions, is part of the pain pathway. When pain messages are received in the brain, the limbic system sends messages to the periaqueductal gray (PAG), a part of the brain stem, which is filled with opiate receptors. The PAG acts as a sort of analgesic dispensary and these 'natural painkillers' are then sent to the site of pain.
Ligands and receptors
Receptors are sensing molecules found on cell walls. The ligand is the chemical partner of the receptor. It binds with the receptor to cause a chemical change that results in a biological response. There are three types of ligand: neurotransmitters, steroids and peptides. Ligands, broadly speaking, are the couriers in the bodymind network; they travel throughout the nervous, endocrine and immune systems to find the particular receptor they 'click' into.
Natural ligands are produced in parts of the brain and at other sites throughout the body. The natural ligands of particular interest to the pain sufferer are epinephrine (also called adrenalin), norepinephrine (noradrenalin), cortisol, serotonin and endorphins. These ligands all play a vital role in alleviating pain, lifting depression, normalising biochemistry and promoting healing. Ligands to help the pain sufferer can also be synthesised in a laboratory. For example, morphine and codeine are some of the synthetic opioids used to treat pain. Another group of drugs produced to help with inflammatory pain are NSAIDs (non-steroidal anti-inflammatory drugs).
Post-traumatic stress disorder
Post-Traumatic Stress Disorder (PTSD) or Post-Traumatic Stress Syndrome (PTSS) are terms that describe a number of unpleasant symptoms, psychological and physiological, that can develop after a painful event such as a serious car accident or repeated surgery. If left untreated, symptoms can persist and even escalate long after the trauma. PTSD can add to the pain and suffering of someone who has been injured or badly traumatised, but not everyone develops PTSD.
As well as the physiological trauma suffered at the time of the event, there may be psychological trauma stored within the bodymind. For the person with PTSD, symptoms and sometimes memories of the trauma will keep replaying, sometimes at the slightest provocation. While PTSD isn't fully understood, it is believed that repeated post-trauma arousal may cause damaging changes to the nerve fibres in the limbic brain. The post-traumatic response isn't clear-cut but the following states can be identified and individuals may at times exhibit a combination of these.
Hypervigilance is the result of elevated levels of catecholamines (adrenalin and noradrenalin) and cortisol, the fight/flight hormones. It is a state of full alert, ready to fight or flee. Heart and respiration rates are elevated and there is a release of extra glucose into the bloodstream. When trauma has not been treated, relatively minor events can continue to trigger this arousal in what can seem to be an exaggerated reaction. Dizziness, shakiness and trembling may be felt. The individual is bio-chemically re-traumatised, which results in further emotional arousal, insomnia, irritability and anxiety. Repeated episodes of hypervigilance may lower cortisol levels in the long term.
Freezing or numbing affects the individual by creating tension deep within the body. It affects respiration and fluid movement. In this state the level of neurotransmitters tends to be low. In the frozen state, the individual will have a tight chest with shallow respiration, a rigidity or stiffness to their posture and appear to be emotionally numb. Freezing affects homeostasis by restricting the flow of cerebrospinal fluid, lymph and other extracellular fluids, thus restricting an already depleted supply of neuropeptides throughout the bodymind network.
Dissociation is caused by excess levels of adrenalin and endorphins, neurotransmitters that affect memory, and can result in amnesia of sorts. The person will be forgetful, depressed, disconnected and lacking motivation. These people may not feel very good but can't identify what is wrong and they may not be fully aware of pain. The pain sufferer becomes disconnected from the bodymind network and the ability to manage pain. It dulls the pain but also nullifies personal power and volition.
Psychological trauma in many cases accompanies physiological trauma. Someone who has been injured in a car accident will have possibly experienced fear, confusion and feeling out of control at the time of injury. Emotional states can become stored with the physical pain. Just as the nervous system responds to injury by setting off a chain of chemical reactions, so too the emotions that accompany a traumatic event produce an energetic pattern and a chemical response when injury occurs. Candace B. Pert, author of Molecules of Emotion, provides an explanation for the interrelatedness of energy, emotions and body states. She describes some ligands and their receptors as the biochemical substrate of emotion. For those with PTSD, emotional reactions become part of a cellular and etheric memory, locked in until there is a conscious release. The cortex, the conscious, thinking part of the brain, and limbic system, in part responsible for survival instincts and emotions, are both involved in the experience of trauma and pain.
Stored trauma, hurt and shock and the emotions that go with them remain subconscious until we do something to release the 'charge'. Does this awful stockpiling contribute to insidious diseases such as cancer, Parkinson's disease, MS, fibro-myalgia, chronic fatigue and chronic myofacial pain syndrome? The bodymind reaches a state of dysfunction and is unable to revive itself. Energetic patterns are distorted, bio-feedback is blocked, nerve pathways are broken, receptors wait in vain for ligands to 'fire-up' the cell into healing and pain-alleviating action and the pain state gets worse.
Emotional repercussions
Pain is rarely confined to aching, stabbing, burning or gnawing felt in the body. It often blurs into feelings of anguish, despair, anger and futility. Mind and body, thoughts and feelings mesh together in a series of unhappy reciprocal interactions. Exhaustion following a poor night's sleep can lower tolerance to pain. Lowered tolerance can make interaction with others and maintaining daily activities seem too difficult. Depressive withdrawal and inactivity may appear to be the only way to cope. This will, in turn, affect biochemistry, mood and pain levels.
The psychology of pain explains, in part, the factors that influence our experience of pain and recovery. The Olympic athlete with a painful chronic injury who is very likely to win an event has greater motivation and purpose to heal their pain than an injured worker who hates a job where they feel undervalued and underpaid. The athlete is motivated, feels important and, with a support team behind them, has much to gain by winning the event. The worker sees nothing to be gained by getting well and getting back to work. The emotions felt by the athlete and the worker will influence the pain state, which will have repercussions throughout their bodymind network.
The body can be the repository for repressed or denied emotions and thoughts. The body speaks a language all of its own. Learning to interpret this language gives us insight and a means to help heal disease and injury. Louise Hay, in her book Heal Your Body, makes a connection between disease and belief systems. The pain of the psyche can present ultimately in the physical body. Hay speaks of how she healed her vaginal cancer by mentally and physically cleansing deep resentment she had harboured in her body, mind and heart since being sexually abused as a child.
Healing
Pain is a warning signal that something is wrong, so it is important that you establish as clearly as possible the causes of your pain, both physical and metaphysical, in order to treat it most effectively. It may take time to change your pain. If you have had pain for a number of months or even years, you will have developed a pain habit. The pain will have become part of your life. There will be a certain degree of psychological dependence, as well as possible drug dependence, so taking charge of your pain needs to be a slow and steady process.
A combination of therapies -- meditation, clinical nutrition, movement and body therapy, psychology, subtle energy therapies and medicine -- will support, empower and encourage you to get your life back. Self-awareness is the key. It turns the tide on the wave of powerlessness that threatens to engulf the chronic pain sufferer. Taking charge of your pain empowers you to take charge of your life again.
Acute pain tends to be a more obvious cause and effect. Chronic pain is more complex and a lack of information or a wrong self-diagnosis can result in the wrong treatment. At best this may be a waste of time, effort and money; at worst it may delay proper treatment and this could be fatal. For example, pain felt in the chest that is thought to be indigestion could be cardiac dysfunction.
Ask your doctor or specialist to explain X-rays, test results and procedures. Identify where your pain is coming from and, where possible, what is causing it. Understand how your drug therapy works and be aware of any contra-indications. Many synthetic opiates block the body's natural response, so you may be able to plan to reduce or even eliminate pain medication under the supervision of your doctor. Many of these drugs are addictive and can have side effects. Morphine, for example, inhibits the production of the brain's own natural pain-killing ligands — enkephalins and endorphins.
Seek other opinions and enlist other health practitioners, such as a naturopath, herbalist or homoeopath. If they too prescribe remedies, be sure that all your health practitioners know what you are taking and doing. Herbal remedies, nutritional supplements, homoeopathics and allopathic medicine don't always combine well. For example, if you are taking pharmaceutical medication for depression and the herb St John's Wort (Hypericum perforatum), you will be running the risk of a serotonin storm. An overdose of serotonin may increase dissociative states. Some drug and herbal medicine combinations can be fatal.
Counselling and psychotherapy
Disease and injury are not simply bad luck. Thoughts and feelings are energy, which causes biochemical reactions in the psychosomatic network. There is no such thing as a bad or negative emotion. Love, anger, joy and grief all have a place in our emotional repertoire. An emotion that is repressed or denied could be considered unhealthy rather than bad. This pent-up energy has an effect on respiration, cardiac efficiency, bodymind chemistry and the etheric field. Repressed or denied emotions cause breakdowns in the communications network of the nervous system, endocrine system, immune system and etheric body.
A less obvious but still significant emotional trauma can emerge from the circumstances around chronic pain. Anger, bitterness and resentment may be part of the pain of someone who has been disabled by pain and can no longer earn enough money to support themselves. Raymond B. Flannery, author of Post-Traumatic Stress Disorder, suggests that some chronic pain is psychological in nature. He calls it a somatoform disorder. Somatoform disorders are those disorders in which a person's psychological distress is expressed in bodily symptoms rather than in words, feelings, or recurring thoughts. This pain may have no apparent cause, but it is nonetheless real.
Psychotherapy can help you identify and release such health-damaging energy by changing belief systems, behaviour and emotional responses. The counselling process provides you with a trained listener with whom you can share your thoughts without censorship. Self-discovery and solutions emerge. Counselling, art therapy, psychotherapy, psychology, or psychiatry will encourage you to release submerged emotions. Discussion and processing will bring to your conscious awareness the beliefs that affect your pain levels and recovery rate.
Meditation and breathing
Meditation is perhaps one of the greatest analgesics available. The particular benefits of meditation for the pain sufferer are:
- It changes brain waves. It is believed that 'natural pain killers' serotonin and endorphins are produced by the body while in alpha and theta states
- It helps integrate all your therapies. Meditation communicates with all levels and aspects of who you are. It unifies body, mind, heart and spirit and provides you with a powerful synergy.
- It brings you into the moment. Time can become blurred for the chronic pain sufferer in remembering past pain and preparing for future pain. Meditation can do much to stem this energy-depleting behaviour by focusing attention on the moment, the here and now.
- Meditation potentiates change. Meditation is a time-out zone, a space in which anything is possible. It provides a gateway into a space and time separate and different from what you know. It is a place where things can be re-ordered, regenerated.
- Conscious breathing. This does more than oxygenate the body and boost the production of opiates. It restores life force — known as chi or prana, among others — that sustains all aspects of who we are - physical, mental, emotional and spiritual.
- It encourages you to face yourself and live consciously. In the stillness of meditation you have an opportunity to be more aware of your inner self. Just as a cloudy glass of water will settle and clear if left undisturbed, meditation will bring recognition and clarity.
- You don't have to make this journey alone. As you heal your pain, you can draw on Universal Life Energy (Source, God/Goddess) with every breath you take. There can be much comfort, solace and inspiration in connecting with this energy.
Physical therapies
Some aspects of these therapies can be part of your self-management plan. It is recommended that you consult with qualified professionals in these areas before you take up any of the suggestions.
Bodywork: Massage, Bowen therapy, reflexology, osteopathy and chiropractic will help restore your health and vitality by adjusting, stimulating and balancing visceral, circulatory, lymphatic and musculoskeletal systems. Aromatherapy massage, Bowen therapy, cranio-sacral therapy, reiki, acupuncture, kinesiology and ortho-bionomy, to name a few, will release the charge that locks pain and trauma memory into your system, counter the effects of dissociation, re-balance the subtle energy body and restore the physio-emotional field.
Movement, posture and exercise: Tai chi, yoga, qi gong, hydrotherapy, Pilates, Feldenkrais, Alexander technique and walking will improve circulation, help release distressing emotions, encourage mindfulness, encourage you to breathe better, improve strength and flexibility and, in some cases, promote the production of endorphins.
Restore the subtle energy body with vibrational medicine: Homoeopathy, reiki and flower essences correct patterns of imbalance. They heal and restore the auric layers, release traumatic cellular memories and provide a template for healing.
Clinical nutrition
Help your body produce its own opioids and anti-inflammatories. See a naturopath or herbalist. Clinical nutrition can, at the very least, improve your nutritional state. Nutritional deficiencies will affect healing and mood. Some pain states can be exacerbated by a deficiency of macro- and/or micro-nutrients. A deficiency of magnesium, for example, may cause muscle cramps and spasms.
It is known that some nutritional or herbal supplements decrease the side effects of drugs. In some cases, supplements will help the body produce its own opiates and moderate inflammatory pain. Tryptophan (a precursor to serotonin) will decrease the perception of pain and DL Phenylalanine will potentiate the effect of opiates. Zinc, GLA/EPA and Vitamin C are nutritional modulators of the inflammatory pain cycle.