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The Role Of The Mind In Pain Management

As a Chiropractor, I predominantly see people in pain, whether it be Mrs Jones that pulled her back yesterday when hanging up the washing or Mr Smith who has been suffering from chronic knee pain. Mrs Jones and Mr Smith both have something in common; they are in pain. But pain is a very subjective experience and manifests itself differently for everyone, for instance, I might see two people on the same day with the same condition but with hugely different levels of pain. Some people have high pain thresholds and other people low thresholds; this might change the level of activity they are able to do and how debilitating they find their pain to be.

It is important at this stage that we understand what pain is and how it comes about. Pain is a process that occurs purely within the brain, that is to say, that if you didn't have a brain, you wouldn't feel any pain or much else for that matter! Your brain has a wonderful ability to be able to block out certain messages it receives from the body. For instance, at the moment you are probably wearing trousers, when you think about it, you can feel the trousers on your skin, however before I mentioned this it wasn’t something you were aware of. This is because your brain can block out things like this, if it wasn’t able to do this, your brain would be overloaded with useless information, and you wouldn’t be able to concentrate on anything. Pain works in a very similar way; your brain is able to block out messages that it receives from your body.

When somebody is injured, then feeling pain can be a good thing and we wouldn’t want it to be blocked out by the brain as it is probably telling you that you need to get help or do something. However, some patients I see are not seriously injured, and they have a disproportionate amount of pain relative to the injury itself, this is because the brain is not blocking out the pain signals. The brain’s inability to dampen down someone’s pain response could be due to a number of factors. This could include stress, depression, anxiety and vitamin B12 deficiency, all of these things can mean that our brain doesn’t function as it should, and we feel more pain. The situation where our brain is unable to inhibit pain signals can lead to the nervous system becoming over sensitive, and subsequently, pain can be felt at times when there is no physical reason for it.

So, how do we fix this? How do we alter the way that our brain interprets pain? This is where for any clinician it becomes difficult to manage these issues as they can often be psychological (stress or depression for instance) or associated with nutrition. From a patient’s perspective, it can be very difficult to hear that your pain is not purely because of physical causes but may actually be to do with your nutrition or psychological well being. Being told that your pain is due to factors other than genuine tissue damage or dysfunction can feel like someone is telling you that you’re crazy, but with a little knowledge of the role the nervous system plays in pain, it can be easier to understand and accept.

Advising someone to change their diet to include more B12 and Omega 3 is easy enough, but getting patients to adhere to diet plans can be difficult, so educating people on the importance of good nutrition is key. Improving somebody’s stress levels, depression or anxiety requires a different approach with everyone as the reasons that underpin these conditions are likely to be complex. Relaxation techniques such as yoga and meditation can help to alleviate stress and advising people to take more time out of their day to exercise will release endorphins which play a significant role in pain inhibition. Cognitive behavioural therapy (CBT) is a method that attempts to alter the way people perceive and think about their pain and the research that has been done shows this to be very effective. All of these interventions require the patient to be fully committed and open to trying new things as there is no quick fix in this situation.

Everyone experiences pain differently, and this is something I have to take into consideration every time a patient walks into my office. Most people I see have clear reasons for their pain that are either fixable by a chiropractor or other health care professionals, however, everyone’s psychological well being affects how their brain interprets pain no matter how bad it is, and occasionally this warrants other interventions.

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