Where Does it Hurt?

When we are pain we tend to think we know what is hurting.  We twist our ankle, our ankle hurts.  We say, ‘my ankle hurts’.  It’s probably fair to say, yes, the ankle hurts.  But what about chronic or persistent pain?  What if you tweak your back and 3 months later it hurts to do anything.  In the old biomechanical model we would say that you have a back injury and that the back is signalling pain.  We now know though that a lot of this is ‘learned’ pain.  The pain is in our head.  This isn’t to say that it is psychological or that the pain isn’t real.  The pain is in the wires, the neurones, and it is a complicated beast.

How does this happen?  It’s a lot like learning.  Say you want to learn French.  The best plan is to go to France.  Have a lesson everyday, talk to locals, watch French films, read French newspapers.  After a couple of years, give or take, you would be fluent.  The saying in neurology and learning circles is that ‘neurones that wire together fire together’.  Well pain is like this too.  Back to the ankle that we twisted.  If we get scared to walk on it and hobble around indelicately for a couple of months, don’t seek any treatment, maybe knock it again a couple of times then those pain signals can get locked in a self-reinforcing loop in the brain and nervous system.  We can learn to have a pain.  The fear of the pain can restrict what we do in daily life.  And like learning French, once you can speak like a local, you aren’t going to forget it in a hurry.

So what are the implications to this?  Well, sadly, just receiving passive treatments isn’t going to teach your brain to re-learn how to lesson the pain signal or to remove your fear of movement.  Yes, treatments like acupuncture, chiropractic and physio can help, but you also have to tackle this problem systematically.  Below is a fantastic booklet I came across today with a great summary of persistent pain and how to tackle it: