Pain Week 2021

Your pain has a colour, a shape, a size, a volume, loads of feelings, things that make it bad, things that make it better, places it likes to be, a memory…it has a whole damn personality…

Have you ever stopped to wonder why?

Wonder why, let’s say your back pain, is not just, on its own, nothing else, but the super common ‘age related’ or ‘pretty much natural’ or ‘kind-of normal’ changes, that can happen with time and use, in the bone and the disc in your lower back at say, L4/5?

Ever wondered why your mate has the same changes in his spine, but no pain at all, never ever had to get it checked out?

We use back pain as an example because it is the world’s leading cause of life years lived with a disability. The Australian Spine Registry tells us that this year roughly 45,000 Australians will undergo spinal surgery this year, and of these thousands, some of them will go back under the knife because of complications or not getting a good result. But, it is far less likely any additional surgeries will work. In a US Review, the failure rate of lumbar spine surgery was estimated between 10 – 46%. Then, even after all of this intense and complex intervention, a UK investigation suggests around 20% of people still suffer from persistent post-operative pain, confirming their pain is no better or is actually worse than before.

Why?

We know why your pain has a personality because of what is going on in your brain in an astounding 16 areas (that we know of) that play the major parts in your pain experience.

Here is a basic breakdown of some of the brain areas and some of what they need to do as a job. The breakdown is based on decades of in-depth research that has been developed into practical treatments for complex pain experiences by Dr Michael Moskowitz and Dr Marla Golden from Neuroplastix in the US, Professor Lorimer Moseley from NeuRA and Professor David Butler founder of the Neuro-Orthopaedic Institute (noi group) here in Australia.

This snapshot might start to help you make the connections between how your experience of pain morphs from ‘some tissue changes in your lumbar spine (or anywhere in your body)’ to ‘oh, now I can’t think, can’t move, and I’m really depressed’. It is because when these large areas of your brain are ’doing’ too much pain, they just can’t crack on with their other jobs very well at the same time.

Here are the top 10 brain areas involved with pain, some of the jobs they do, and little insights that might explain why any pain can impact so many parts of your life:

1. The Thinking Brain - Prefrontal Area

Jobs: Thinking about complicated things; paying attention; solving problems; acting thoughtfully; planning; creativity; feeling for others; starting to do things; self-control; managing emotions; and pain.

Explains why when you’re experiencing pain it gets harder to think straight and keep up at work.

2. The Sensory Brain – Somatosensory Areas

Jobs: This part has amazing maps for all our body parts and how each of them senses - touch, pressure, movement, temperature, vibration, tickles, itches, and pain.

Explains why when you’re in pain your reactions to things like being touched, being too cold or hot, or even the way you find you have to lay in bed can change.

3. The Emotional Brain – Anterior Cingulate

Jobs: emotion and cognitive control; problem-solving; decision making; picking up on possible conflicts; regulating your nervous systems stress responses; and pain.

Explains why you might feel more irritable and crabbier at home when you are in pain.

4. The Movement Brain – Supplementary Motor Area

Jobs: movement of your body; pain; and mirror neurons – these guys light up when you watch someone else doing something.

Explains why you just can’t stand to watch gymnasts do backbends when your back is sore, makes you cringe or even cry out.

5. The Perceiving Brain – Posterior Parietal Cortex

Jobs: receiving, perceiving, and interpreting sensations like touch, movement, things you see and hear and feel, even smells and flavours; pain; and mirror neurons are here too – these guys light up when you watch someone else doing something.

Explains why some moments – kids screaming, loud music, bright lights – might be way too much for you to handle when you are in pain.

6. The Emotional Brain – Posterior Cingulate

Jobs: attention; memories of ourselves; planning the future; daydreaming; the way we think about ourselves; and pain.

Explains why when we are overwhelmed by chronic pain it can get really hard to think of a positive future, why it seems more normal to worry about how bad the pain might get instead.

7. The Remembering Brain – Hippocampus

Jobs: making maps of our environment to help us get around; making memories, keeping them, then pushing them out into your brain to be stored while you sleep; and pain.

Explains why we might feel a bit foggy and forgetful when we’ve been dealing with chronic pain for too long.

8. The Self-Awareness Brain – Insula

Jobs: the way we think about the feelings of others; our own emotional self-awareness; aspects of love; mirror neurons – brain cells that work when we watch other people doing things; even the way we may enjoy music; and some have suggested the way we taste wine.

Explains why, when you are often experiencing pain, it gets harder to manage our own emotions and reactions to even the little things, and harder to stay in tune with the emotions of our loved ones as well. Does the wine taste different when you’re in pain? Who knows?

9. The Emotional Brain – Amygdala

Jobs: experiencing pleasures; processing fear; deciding if something near us is important; memories of emotions; and pain.

Explaining why people enduring chronic pain can have their passions or hobbies (like running, sports, handicrafts, gardening…) become possible dangers that could lead to them experiencing pain instead of the great pleasures these pursuits should be.

10. The Behaviour Brain – Orbitofrontal Cortex

Jobs: it is involved with how we taste and feel food in our mouths; impulse control; the ‘weighing up what might happen’ type of decision making; ‘feels good’ or ‘feels bad’ based learning; pain; and research even suggests ‘gut feelings’ might be interpreted here.

This explains why we might find our social behaviour changing a lot when we experience chronic pain, we might not ‘feel like ourselves’ or that we are ‘a bit off’.

Possibly the most profound connection, when we think about pain having a personality, is the overlap of areas in the brain responsible for physical and emotional pain. Of the 10 areas above, 7 have responsibilities for emotion as well. This helps to explain why emotional upsets can be huge hurdles when we are experiencing physical pain, and also why deep emotion can literally feel like it hurts.

It’s not your body that’s making the pain so hard on your life, its your brain.
Solutions are found in the absolute fact that the brain can change.

All of this knowledge, and a great deal more, has helped to build a range of practical treatments to improve pain by working through the brain. The skilled Clinicians at Perth Brain Centre are equipped to teach you how these brain exercises for pain work and how to incorporate them into your daily life, to reclaim your brain and your life from chronic or persistent pain experiences. There are three easy steps to help get you started today.

About the author - Ms. Emily Goss (Occupational Therapist, Senior Clinician, The Perth Brain Centre).

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