The New Paradigm of Pain
Six weeks ago, I injured my tailbone. It was quite severe. I slipped down some stairs, bouncing on my booty a handful of times before I made it to the bottom. I immediately stood up without a sense of pain. I was at a going-away party for a friend of my husband’s and I hardly knew anyone there. I felt embarrassed. I wasn’t ignoring the pain … it simply wasn’t present. I continued my conversations with others for another 10 minutes or so. Then we left, and by the time I made it to our car, I was in excruciating pain.
HOW PAIN WORKS
Pain is so interesting. We used to think of pain pretty simply: an area of your body is damaged, then the nerve endings in that area are triggered and send a signal to your brain that there’s pain, and then injured area hurts. This is referred to as an “input” of pain (from injured area to brain). Now we know differently. Modern science has redefined the concept of pain, and it’s more complex and involves more brain function than previously conceived.
Using my experience of slipping down some stairs, this is how the old paradigm of the “input” function would play out: I slip down stairs and the nerves in my tailbone and sacrum signal to my brain that there’s pain, and then my tailbone and sacrum would hurt. What science now suggests is that I slip down the stairs and nerves called nociceptors in my tailbone and sacrum send a warning signal to my brain saying, “Hey, something just happened in my tailbone and sacrum … it’s important to check that out”. Then, within a second, my brain takes in information about my environment, including my safety, the likelihood of getting help and/or surviving, my emotional state and my previous experiences, and determines how much pain will manifest. This is wild! It’s not the damage to the tissues that determines the pain level … it’s what the brain prioritizes and how it responds to that assessment. This is called an “output” (from brain to tissue) pain experience.
Because I was in a new and slightly uncomfortable environment (new house and unfamiliar people) I felt somewhat, I guess you could say, emotionally unsafe. So, my brain didn’t output pain immediately. It takes several minutes for adrenaline (a hormone that can decrease pain) to kick in, so the lack of immediate pain wasn’t attributed to the release of that hormone. As I mentioned previously, it wasn’t until I left the party and made it to the car that pain started to kick-in. Once I left the party, I was alone with my husband and felt safe. It was at that moment that my brain reassessed the situation and delivered a different output of pain, so that I could attend to the injured area and wouldn’t exacerbate the injury. While this is an example in which the term “safe” and “unsafe” seems minimal, imagine if you were running from a predator and you tripped and fell. It would then behoove you to experience less pain from the impact of falling, so that you could get up and keep running. This discerning mechanism, the output of pain signals, is an important part of survival.
SO, IS MY PAIN REAL?
Yes, the experience of pain is real. This new way of understanding pain doesn’t diminish anyone’s experience. It does shed light on the nuance of pain, including chronic pain. Many studies have shown that pain isn’t necessarily correlated with tissue damage, and that tissue damage isn’t always associated with a pain response. For example, some people who experience low back pain don’t have any diagnosable injury. And some who have a bulging or herniated disc in their low back, have no experience of pain.
Given that we now understand that the presence and level of pain in acute situations is governed by the brain’s assessment of our immediate experience, it makes sense to consider that the mind is also involved in chronic pain. Yoga teaches that the mind, including thoughts, memories and emotions, colors our entire experience of life. The foundation of yoga is to “wake up” and to see reality clearly… to see beyond our colored perceptions, and to experience reality as it is.
Years ago, I worked with a client who had a suffered a severe shoulder injury six months prior. He couldn’t lift his left arm above shoulder height and even when he kept it close to his body he would experience unexpected and severe pain. When we met one-on-one to address his shoulder injury, I communicated optimism that he would recover his full range of motion, explained the tissues involved in his injury, and created a safe environment for him to breathe and explore movement. After a week of doing his yoga therapy homework, which consisted of only 10-15 minutes per day, he was back to his full range of motion without pain.
So, is the experience of pain real? Yes. It’s just as real as any of our other experiences, which are influenced by our perceptions. Can mindfulness practice influence our perception of reality? Yes. Can we use mindfulness practices to change our experience of pain? I believe we can.
THE SECOND TIME AROUND WAS DIFFERENT
I’ve actually experienced a tailbone injury to this degree before. Four years ago, I was bike commuting to teach class, and was rear ended by a car. The car hit my sacrum and tailbone, and I was catapulted off of my bike. At first, I felt fine, and after the man who was driving the car and I talked and exchanged information, I continued pedaling to class. Thankfully another teacher who just happened to be joining my class as a student that evening, stepped up to teach when I didn’t arrive (it takes a village!). I saw her teaching through the windows and decided to head home. Once I was safe at home, the pain manifested. I remember the level of pain being very similar in both instances, with the most recent perhaps even more severe. However, memory is colored just like the rest of the mind. Back then I was in massage, chiropractic and acupuncture care for 6 months, and still hadn’t recovered completely. On my last long flight there was still coccyx pain.
This time around I had a different group of practitioners - a naturopath and acupuncturist, a physical therapist and a chiropractor. They all assured me that my healing time wouldn’t be as long as that of the previous injury. I felt completely supported and hopeful. And, here I am, 6 weeks after the injury, and I’m almost back to 100%.
I believe that my speedy recovery can be attributed to my different mindset. Feeling safe, supported and optimistic not only influenced my level of pain, but also my recovery. I want to be clear that I’m not preaching that we can get rid of an injury or disease simply through positive thinking. I am sharing my enthusiasm for yet another instance of western science supporting what the yogis have been teaching for thousands of years. This practice never ceases to amaze me and I’m so grateful for the opportunity to share it with you.
A great source on this issue can be found at painscience.com for some evidence-based pain science from Paul Ingraham.
A couple of notes:
This is an article, not medical diagnosis or treatment and shouldn’t be interpreted as such. My hope in sharing this with you is that you remember that you have leadership to take your health and happiness into your own hands. You can take actions to help manage and overcome pain.