Deepening our Understanding of Pain

Whilst at first thinking hard about pain can give you a bit of headache, doing a bit of hardwork now could well save you lots of unnecessary stress and excessive pain later on.

So you may need a nice cup of tea or coffee to get through this blog - but I promise it will be worth it !

Warning - for most people this isn’t an easy read, or easy to understand at first - that’s completely OK!

To learn about these things is not a standard part of physiotherapy currently.

But these are important conversations to have - as having accurate up to date knowledge is a big part of genuine recovery.

So if you are open to learning and being patient - you will most probably end up knowing more about pain that 95% of doctors and health care professionals, who by a large and stuck in the one-dimensional view of pain that is called the Biomedical Model (that states all pain must arise directly from tissue damage in a linear relationship).

OK, here we go….

Re-framing Pain as an Emergent Process

Pain is something we all experience and it often becomes a source of frustration and anxiety when it refuses to subside.

Whether acute or chronic, pain has a way of affecting our lives and pushing us to seek relief.

But instead of trying to attack, suppress or eliminate the pain…. what if we re-framed the pain? What if we changed the way we thought about the problem?

Rather than a simple mechanical response (damage = pain), we could view it as a complex emergent process (sensation + emotion + metabolic heath + past history + past expereinces + anxiety about the future etc = pain

By doing so, we open ourselves up to the fascinating intricacies of pain perception and potentially find new ways to address it. You gain empowerment over the pain.

Pain as an Emergent Phenomenon

The first step in re-framing pain is to understand that it is always an emergent phenomenon.

Emergence, in this context, is a concept borrowed from complex systems theory.

It implies that pain doesn't arise from a single source but rather results from a complex interplay of factors.

Let's break it down:

  1. Bottom-Up (Physiological Sensation): The physiological aspect of pain begins with the actual sensation. It's the raw data sent from the site of discomfort to our brains, signaling that something isn't right.

  2. Autonomic Nervous System (ANS) and Heart Rate Variability (HRV): Our body's autonomic nervous system, which regulates functions like heart rate and digestion, plays a crucial role. Changes in heart rate variability can affect pain perception and contribute to its complexity.

  3. Past Experiences: Our personal history with pain and related emotions can influence how we perceive and respond to it. Past traumas or experiences can amplify or diminish pain signals.

  4. Top-Down Influence: This refers to the cognitive and emotional aspects of pain. Our thoughts, beliefs, and emotions can either amplify or dampen the pain experience.

Examples of Emergent Systems

To better grasp the concept of emergence, consider everyday examples like making coffee, baking, gardening, or listening to the sound of an acoustic guitar.

These activities involve numerous elements coming together in unpredictable ways to create a unique experience.

Similarly, pain is not a straightforward cause-and-effect relationship but always a complex amalgamation of factors.

Emergent Complex Systems vs. Linear Mechanical Systems

It's important to recognize that emergent complex systems, like pain, behave differently from linear mechanical systems.

Linear systems produce predictable, proportional results.

In contrast, complex systems exhibit nonlinear behavior, leading to outcomes that may not be proportional to the inputs.

This nonlinearity makes pain a highly variable and individualized experience.

The good news!

Whilst the above few paragraphs may sound very complex, that is actually a GOOD thing!

If you notice yourself feeling a bit anxious, frustrated, confused or overwhelmed - that is a great sign and very normal.

When we start on a new road of learning - there is an initial feeling of resistance as our systems are wired to avoid feeling overwhelmed and would much prefer simplicity.

Amongst the confusion, if you feel just a tiny bit of curiosity to learn more - that’s a great achievement.

The bottom line is - Humans Are Complex Systems.

And that complexity (counter-intuitively) opens the door to non-linear improvements in the way our bodies function (and in particular our pain levels).

In simple words when we stop ‘chasing pain’ at a mechanical level, we can be open to more simple, intuitive natural ways of healing.

You don’t have to wait until you get ‘stronger’ or ‘more flexible’ or ‘looser’ until you get out of pain.

Conclusion

Re-framing pain as a complex emergent system allows us to embrace its intricacies rather than anxiously avoiding them.

By recognizing that pain is not a simple linear response, we can explore more holistic approaches to managing and treating it.

This shift in perspective encourages us to consider the multifaceted nature of pain, incorporating both physiological and psychological aspects into our understanding and treatment strategies.

In doing so, we open doors to more comprehensive and effective pain management solutions that respect the complexity of the human experience.


Has this blog sparked any curiosity? Please feel free to leave a comment and I’d love to hear your thoughts.

For more reading - this is a good starting point

The Complexity Model: A Novel Approach to Improve Chronic Pain Care

Affordance-based practice: An ecological-enactive approach to chronic musculoskeletal pain management