Professor Lorimer Moseley delivered Musculoskeletal Australia’s annual Koadlow Lecture in 2018. He talked about “Pain, the Brain and your Amazing Protectormeter.” There was a lot of important information in that talk that helps 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 the clip below, and read the post that explains why this is so important for people in pain to understand.
This post is written by Physiotherapist and Local Pain Educator, Amanda Simister. Amanda is one of our first cohort of Local Pain Educators, she is based in Nowra, NSW, and will be joining us on the road as part of the education team for the 2019 Rural Outreach Tour in Tasmania.
The Power of your Previous Experiences
What does a red light mean to you? If you throw this question at a group of kids, they will come back at you with answers like hot, danger, “power on” or “stop”.
What about a blue light? Kids will give answers like cold, water, sky, soothing and similar peaceful ideas.
Have you ever stopped to think about the unconscious links we make between things in the environment, their meaning and how they inform our actions?
When it comes to the experience of pain, these unconscious links become very important.
Consider this experiment mentioned by Lorimer in the video. It was conducted on normal, healthy adults who were shown either a blue light or a red light whilst simultaneously being given a painful stimulus ( in the form of an extremely cold probe) on the back of their hands.
They were asked to rate how much pain they experienced when they were shown the red light and when they were shown the blue light.
Almost everyone in this “normal” group rated their pain as “worse” when they were shown the red light, compared to when they were shown the blue light.
Really stop and think about this for a moment.
Red has a social, cultural and personal meaning that was an important part of the way that the person in the experiment interpreted the linked stimulus of the red light and the skin stimulus.
In the insect world, red is used to signify poison. To humans it means “Stop”, it infers bleeding, it’s the colour of stovetops when they might burn you. As children can identify, it is a signal for something that’s dangerous, and we have to be more careful around these things.
In the experiment, there was an unpleasant danger signal coming from a cold probe at the same time as the lights. The unconscious associations that exist with the lights, plus the uncomfortable sensation on the skin make our brains believe that we are in significantly more danger when we see red than when we see a blue light (which tends to evoke pleasant, safe things like coolness, the sky and water).
Is tissue damage important?
This experiment neatly reveals a part of the experience of pain. The pain that you feel is not only reliant on what is happening on or in your body. It also depends on the other information coming in from your environment, and on the information stored in your brain from your past experiences.
All the other information that comes from past experience and the environment forms the “context” in which pain happens. Your brain is taking into account all of these factors to look for evidence of danger, and evidence of safety, and see if you are at risk of something damaging you. Pain is one of the ways your brain tries to protect you from damage.
This means that in certain contexts, it is possible to have a serious tissue injury and experience very little pain. In other contexts, you might have little or no injury, or change in your body’s tissues but experience a whole lot of pain.
Have you ever noticed a bruise on your leg, but have no memory of how you got it?
A bruise you can see is caused by bleeding in your muscle. You had to sustain a forceful impact to have the bruise and cause some tissue trauma. But you don’t even remember doing it! You have had tissue damage without any pain.
For you to have a pain-free injury like this, there was more important things to pay attention to at the time of the injury than the need to make you aware that you have some tissue damage.
You might have been enjoying dancing with a sexy stranger ( there’s lots of cool safety cues there!), or laughing so hard you banged into a table ( again, lots of safety in a good belly laugh), or perhaps you were absorbed in playing a football Grand Final - in all of these contexts, pain was not deemed to be a useful or necessary part of your brain’s actions.
If you think about it, you will notice this sort of thing happens more often than you realise.
There’s many stories of people with life-threatening injuries that report no pain at the time of the injury. You might be able to think back to a similar experience yourself of pain and injury, like this one from one of my clients recently:
“I was crossing the road with my four-year-old grandson, and I tripped on my skirt and fell over in the middle of the road. I jumped up and hurried to the other side of the road. I was so worried about my grandson’s safety, and about oncoming cars, and I had to get off that busy intersection. It wasn’t until I had dropped him safely at preschool and was walking back down the hill that my ankle began to hurt.”
It turned out that she had fractured a bone in her ankle. Her brain did not make pain for her until she was safe, and it became helpful for her to make sure the tissue damage healed.
Take a look at your danger/ safety balance
Many factors affect whether we get pain, and how intense that pain will be. Gaining an understanding of this becomes critically important to make sense of how people can suffer intense pain for years, without there necessarily being any change or damage to the part of the body that hurts.
In this situation, the brain has enough evidence of danger from other sources to ensure that when there is just a little change to the information coming from the body, a severe pain response is triggered. And the more the brain makes pain, the better it gets at doing it.
How does this help you, and your pain?
Take some time to look for the unconscious links to pain you have in your life, things like:
- things you see ( like the light experiment),
- things you hear ( you have the back of an 80 yr old),
- things you think and believe ( I’m only going to get worse, it must be really damaged if I still hurt this much)
Recognise that these things are danger signals that are encouraging your brain to keep making pain for you. Then its time to replace them with safety cues- the biggest of which is knowing that pain can change and that it's not a measure of how strong or fit your body actually is but more a measure of how much protection your brain thinks you need.
The evidence is out there, and the Pain Revolution is bringing it to you.