I was listening to Rachel Zoffness, a pain psychologist, and thought I would share some of her ideas in case others found them helpful or illuminating like I did.
So, her big message is that pain is not merely a physical reaction to an event in the body as modern medicine has reduced it to: pain is much more complex than that. Pain stems from 3 sources and is the result of biopsychosocial influences. Bio here refers to the body, or how most people understand pain, as a feeling resulting from a discrete event within the body. Psycho meaning the mind, as in the influence our thoughts, our past experiences, and our own psychological predispositions on pain. Social being the last piece, indicating that how severely we experience pain is affected by those around us and how others react to our pain-inducing experiences.
"Thoughts, beliefs, perceptions, emotions, past experiences, context, and input from your body all affect your experience of pain (Edwards et al, 2016). All of the time, always."
To illustrate the point, Zoffness tells "The Tale of Two Nails"
"Case Study 1: The Nail in the Boot
In 1995, the British Medical Journal reported on a 29-year-old construction worker who'd suffered an accident: after jumping onto a plank, a 7-inch nail pierced his boot clear through to the other side (Fisher et al, 1995). Screaming and in terrible pain, he was carted off to the ER and had to be sedated with opioids. When the doctors removed his boot, they discovered a miracle: the nail had passed between his toes without penetrating his skin! There was zero damage to his foot: no blood, no puncture wound, not even a scratch. But make no mistake: despite the absence of injury, his pain was real. So what happened?
Sensory receptors in the man's body reported to his brain that there’d been an accident, that a nail had penetrated his boot. His brain, perceiving potential threat to his safety and well-being, used context to determine what had occurred, collecting information from his five senses (including the visual of a nail sticking out of his shoe!), knowledge of the dangerous work environment and its risks, his co-workers’ horrified faces, and other data to make a guesstimate about what had happened and how to respond. Thoughts, beliefs, and emotions—including panic and fear—set off a cascade of biological and neurochemical processes. His brain, synthesizing the sum total of this information, decided that he was in danger, so it made pain to protect him. In this case, real pain was generated entirely as a result of factors having nothing to do with actual tissue damage—yet was as intense as if he’d been stabbed.
Case Study 2: A Nail to the Face
On the flip side, another construction worker (dangerous job, that!) was using a nail gun when it unexpectedly discharged, clocking him in the face (Dimsdale & Dantzer, 2007). He and his coworkers saw (what he thought) was the nail bounce off of his face. Other than a mild toothache and a bruise under his jaw, he thought he’d escaped relatively unscathed. Six days later—six days of eating, sleeping, and going to work—he went to the dentist. Much to his surprise, an X-ray revealed a 4-inch nail embedded in his head! Indeed, the nail had pierced his cerebral cortex, putting him in potentially grave danger. However, because contextual cues failed to put his brain on high-alert, his pain system remained quiet—despite actual bodily harm and need for medical intervention (#fail)."
(These stories are quoted from an article she wrote.)
Essentially, pain is only an estimate provided by your body by your brain. Your brain provides a certain level of pain in response to what it guesses, based on biological, social, and psychological factors, is the amount of damage that has occurred or is occurring in your body.
There are a ton more points and discussions that this idea can highlight, but I will only name a few:
- Chronic pain can not be treated exclusively with painkillers, and needs to be addressed at a social and psychological level as well.
-There is a reason that folks who are lonely often report more pain and more severe pain
-Those of us that are anxious at baseline are much more likely to suffer from chronic pain over the course of our lives
-Placebo pills and procedures (because of the psycho aspect of pain) can cure people of chronically pain and other conditions and should not written off as medically unethical. There was a well known study done a few decades ago where folks with chronic knee problems either got FAKE knee replacement surgery (which they did not know was fake) or real knee surgery and the people who got the fake surgery often did BETTER than those who got the real surgery. These were people with serious arthritis in their knees. (https://www.painscience.com/biblio/f...arthritis.html provides a summary if you're interested).
The original podcast for those of you who want to know more: https://soundcloud.com/zdoggmd/rachel-zoffness
So, her big message is that pain is not merely a physical reaction to an event in the body as modern medicine has reduced it to: pain is much more complex than that. Pain stems from 3 sources and is the result of biopsychosocial influences. Bio here refers to the body, or how most people understand pain, as a feeling resulting from a discrete event within the body. Psycho meaning the mind, as in the influence our thoughts, our past experiences, and our own psychological predispositions on pain. Social being the last piece, indicating that how severely we experience pain is affected by those around us and how others react to our pain-inducing experiences.
"Thoughts, beliefs, perceptions, emotions, past experiences, context, and input from your body all affect your experience of pain (Edwards et al, 2016). All of the time, always."
To illustrate the point, Zoffness tells "The Tale of Two Nails"
"Case Study 1: The Nail in the Boot
In 1995, the British Medical Journal reported on a 29-year-old construction worker who'd suffered an accident: after jumping onto a plank, a 7-inch nail pierced his boot clear through to the other side (Fisher et al, 1995). Screaming and in terrible pain, he was carted off to the ER and had to be sedated with opioids. When the doctors removed his boot, they discovered a miracle: the nail had passed between his toes without penetrating his skin! There was zero damage to his foot: no blood, no puncture wound, not even a scratch. But make no mistake: despite the absence of injury, his pain was real. So what happened?
Sensory receptors in the man's body reported to his brain that there’d been an accident, that a nail had penetrated his boot. His brain, perceiving potential threat to his safety and well-being, used context to determine what had occurred, collecting information from his five senses (including the visual of a nail sticking out of his shoe!), knowledge of the dangerous work environment and its risks, his co-workers’ horrified faces, and other data to make a guesstimate about what had happened and how to respond. Thoughts, beliefs, and emotions—including panic and fear—set off a cascade of biological and neurochemical processes. His brain, synthesizing the sum total of this information, decided that he was in danger, so it made pain to protect him. In this case, real pain was generated entirely as a result of factors having nothing to do with actual tissue damage—yet was as intense as if he’d been stabbed.
Case Study 2: A Nail to the Face
On the flip side, another construction worker (dangerous job, that!) was using a nail gun when it unexpectedly discharged, clocking him in the face (Dimsdale & Dantzer, 2007). He and his coworkers saw (what he thought) was the nail bounce off of his face. Other than a mild toothache and a bruise under his jaw, he thought he’d escaped relatively unscathed. Six days later—six days of eating, sleeping, and going to work—he went to the dentist. Much to his surprise, an X-ray revealed a 4-inch nail embedded in his head! Indeed, the nail had pierced his cerebral cortex, putting him in potentially grave danger. However, because contextual cues failed to put his brain on high-alert, his pain system remained quiet—despite actual bodily harm and need for medical intervention (#fail)."
(These stories are quoted from an article she wrote.)
Essentially, pain is only an estimate provided by your body by your brain. Your brain provides a certain level of pain in response to what it guesses, based on biological, social, and psychological factors, is the amount of damage that has occurred or is occurring in your body.
There are a ton more points and discussions that this idea can highlight, but I will only name a few:
- Chronic pain can not be treated exclusively with painkillers, and needs to be addressed at a social and psychological level as well.
-There is a reason that folks who are lonely often report more pain and more severe pain
-Those of us that are anxious at baseline are much more likely to suffer from chronic pain over the course of our lives
-Placebo pills and procedures (because of the psycho aspect of pain) can cure people of chronically pain and other conditions and should not written off as medically unethical. There was a well known study done a few decades ago where folks with chronic knee problems either got FAKE knee replacement surgery (which they did not know was fake) or real knee surgery and the people who got the fake surgery often did BETTER than those who got the real surgery. These were people with serious arthritis in their knees. (https://www.painscience.com/biblio/f...arthritis.html provides a summary if you're interested).
The original podcast for those of you who want to know more: https://soundcloud.com/zdoggmd/rachel-zoffness
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