Professor Lorimer Moseley delivered Musculoskeletal Australia’s annual Koadlow Lecture in 2019. He talked about “Pain, the Brain and your Amazing Protectormeter.” There was a lot of critical information in that to help people move towards recovery from persisting pain. We’ve asked some of our expert clinicians and researchers (who are part of the 2019 Rural Outreach Tour in Tasmania) to add some more details to the short video clips, so you can fully understand the reason these concepts are so important for people in pain.
Watch this short video and read the post written by Hobart-based Exercise Physiologist, Brenton Watson. Brenton is riding on the 2019 Rural Outreach Tour and he represents the south-east region of Tasmania as of our nineteen newly-selected Tasmanian Local Pain Educators.
What’s a danger message?
Danger messages are a vital piece of physiology that serves to protect us. The danger detectors, known as ‘nociceptors’, detect stimuli from your body’s tissues, and forwards the message to your brain. Our brain determines, based on all credible evidence, whether you need protecting. Pain is about protection!
This makes sense, when you think about a typical injury such as an ankle sprain. You’re running along a rocky path and take a wrong step, you see your ankle twist on impact and you have sprained that ankle before. In this situation, it would be quite sensible to protect that ankle. Your brain produces pain, it changes your behaviour (you stop running and walking with a limp), and your immune system starts to fire up to promote healing (inflammation).
All of these are outputs designed to protect us.
The importance of meaning
“What’s more important than danger messages coming from the tissues of your body? What your brain thinks those danger messages mean.” - Professor Lorimer Moseley
These danger messages, or nociception, don’t always result in pain. The meaning of the signal is vital in determining whether pain is produced or not. Take the story of a war veteran, who went for a routine x-ray only to find a bullet lodged in his neck 60 years after returning from war.
He was aware of being shot at, but had no experience of pain at the time. The danger messages were still sent (nociceptors were activated) – since escaping and finding shelter from gunfire was more vital for survival, protecting his neck by producing pain would be counter-productive. Since he also had no idea he had even been hit, he experienced no neck pain after the event. All credible evidence suggested this bullet wasn’t dangerous.
This is an example of the complex nature of pain. Various factors and their associated meaning are always interacting to decide whether pain is necessary at this current time. When danger detectors are activated, your brain has to decide: Do I need protecting right now? Does the information from my environment, my past experience, information from other senses, my knowledge, thoughts and beliefs, suggest I need protecting? The meaning and context is vital. For the man at war, the context didn’t require protecting his neck. What about if the same man rolled his ankle like the example above, do you think this would’ve hurt as much in this situation?
How does this relate to your pain?
As stated in the video, MRI scans can have scary findings, and this meaning can suggest you need protecting. You might have been told you have a slipped disc, a bone out of place, a pinched nerve and have a crumbling spine, or worse! These commonly used descriptive metaphors all have associated meaning, which can suggest danger.
The good news, imaging findings are not very well related to pain and can be common age-related changes, just like wrinkles on the inside. For example, 84% of those 80 years of age had a disc buldge on an MRI, but had no pain. This is simply a normal part of getting older. And even when serious structural changes do exist, such as a severe disc buldge, the body can always heal. It may be surprising to you that the more severe the disc buldge, the more likely it will recover spontaneously.
So things such as what you have been told and how you interpret what is happening within your body, along with many other factors not mentioned in this blog, can ultimately result in the body over protecting you.
The pain system protects you even when it’s not warranted. Even if you might have normal age related changes, or injuries that are well past their expected healing times, the body can still produce pain. The body learns pain, however this can be reversed.
What can you do to retrain pain?
We are not suggesting you can simply think your pain away. But reframing your understanding is the first step to recovery.
Learning about pain, and all the things that can influence your experience of pain, can enable a change in mindset that allows a new road to rehabilitation.
Taking a deeper look at things that you’ve seen, things that you’ve been told, things that you believe, things that you do and things that you say, and the meaning of these things is vital.
Once you reframe your understanding, and have trust in your body, you can start your journey to recovery. Beginning an exercise program, trying activities that you’ve previously avoided, and doing these in a slow and progressive manner is important. But doing this with the knowledge that you are safe, even if your pain system is being over-protective, allows progressions you may not have thought were possible.
Finding a good coach with a good understanding of pain, such as a Physiotherapist, Exercise Physiologist, or even your GP, can help with this.
Albert Einstein once said that the definition of insanity is doing the same old thing but expecting a different result. It might be the same old thinking is the road block to your recovery.
Time to re-think, re-engage and recover!
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