Video script: when pain continues

So why has my pain got worse, not better? 

In the last presentation we talked through how all pain is produced, but this may have left you with some questions about your own pain.  

People who suffer with chronic pain have often had investigations that have not shown any “issues with the tissues”, their pain may have not started as a result of an injury, or any injury they had should have long since healed. You may have noticed over time that your pain has worsened, spread, or is now accompanied by other strange and not so wonderful symptoms such as fatigue, brain fog, or unusual sensations like a feeling of running water or crawling on the skin.  

The purpose of this presentation is to talk through some of the changes or adaptations that occur in the nervous system when pain persists and answer whatever questions you have. 

Remember that your nervous system is like an alarm system, whose job it is to alert you to danger and keep you safe, and that pain is a very effective protective response the brain can produce if it thinks your body is under threat. 

Lets start from where we left off in the previous presentation. The brain has received incoming information , evaluated that information, and concluded there is some sort of threat to the body. Pain is produced.  

But the process doesn’t end there. The nervous system is highly adaptable and changes depending on the needs of the body. 

But the whole system gets very well practiced at the adaptations it is making. It’s like an orchestra practicing the same tune over and over and over. The more they do it the better they get at playing the “pain tune”. 

Receptors 

So what are these adaptations? Well let’s break it down and talk about the receptors first 

If the brain perceives there may be a threat it will use the sensory receptors to gather more information. 

The excitatory chemicals that “ramp up” the sensitivity of the nervous system cause the receptors to be stimulated and fire off more easily, allowing more impulses to pass with less resistance. 

Another way of gathering more information from the tissues is by recruiting, or switching on, receptors in other parts of the body that were dormant. This means larger areas of the body are affected. This can explain pain becoming more widespread over time. 

Peripheral Nerves 

So when sensors are staying open more easily and additional sensors are also in the mix, there are more electrical impulses transmitted via the peripheral nerves.  

But also, as the nervous system as a whole becomes more excitable, nerves can sometimes fire without having been stimulated. Have you ever experienced a sudden, spontaneous pain for no reason, without even moving or doing anything? Well that can be why.  

Spinal Cord 

So the flood gates have opened and the nerves are transmitting a deluge of impulses which arrive at the spinal cord.  

The once organised “postal sorting office” becomes flooded with messages it has to deal with. Probably like an actual postal sorting office at Christmas time! 

The spinal cord can’t scrutinise every message coming in anymore and those excitatory chemicals knocking about the system mean the channels up to brain are open. This all means that more incoming messages get sent straight up to the brain, special delivery, for processing. 

Now even incoming harmless information is translated within the spinal cord as being harmful and sent up the pathway to the brain normally reserved for harmful messages. Ever wondered why things that shouldn’t be painful, like light touch, a cool breeze, or our bed sheets against our skin, can feel so painful? Well, that’s why. 

Brain 

So it’s fair to say that the poor brain is now getting bombarded with messages from the tissues, this in itself reinforcing that there is some sort of threat. 

So the brain will respond by continuing to release the chemicals that keep the nervous system sensitive. 

And practice makes perfect.  

The brain now recognises the information coming in very quickly and processes it all as danger – even if it may just be temperature, pressure, touch or chemical changes. The brain produces pain as an output to try to protect the body tissues.  Things that didn’t used to hurt now do. 

The overall picture is of each component of the nervous system becoming more sensitive and more easily stimulated, which in turn reinforces the release of further excitatory chemicals, which keep the whole system sensitised and whole loop going.)  

Your alarm system has responded amazingly well to the threat and undergone a major upgrade.  Previously there were sensors on the windows and doors and in order for the alarm to go off a window would have to be smashed or a door broken down.  This level of sensitivity was useful and in proportion to the level of threat. 

But now there are even more window and door sensors, and there are laser beams that detect the slightest movement, and pressure sensors in the floors. The whole system is much more sensitive and so it will take much less to set off the alarm. Maybe just walking across the floor, reaching for a cup of tea, or even a leaf blowing through the window.  The level of sensitivity has become out of proportion and less useful.  

Everybody feels differently to each other when hearing this information. Some people tell us it’s like a lightbulb going off and a relief to finally understand their pain. But for others it can feel upsetting or hopeless.  

So I want to reassure you, while the complexity of the problem means there is no “off switch” for pain, remember your nervous system is adaptable. Everything we will be covering in the upcoming Pain Management Programme is focussed on different ways on calming your sensitive nervous system, whether through a greater understanding of pain, and the interaction of our thoughts and feeling, understanding more about medication and its benefits and drawbacks, use of practical strategies like mindfulness and relaxation, and changes to how you manage activity.  

We need to begin to think of ways in which we can influence the nervous system to feel less threatened and break the cycle. 

End of video script

Return to preparation for session 2