Explain Pain Section 1: Intro to Pain

This is a summary of the first section of the book “Explain Pain” by David Butler and Lorimer Moseley.

Intro

The major premise of this book is that pain is normal. It is the way that your brain judges a situation as threatening. Even if there are problems in the body, pain will not occur if your brain thinks you are not in danger.

It would be extremely painful…unless the brain deems otherwise.

Explaining pain can reduce the threat value and improve pain management. And the good thing about explaining pain? Research shows that it can be an easily understood concept.

Pain is Normal

Pain from bites, postures, sprains, and other everyday activities are more often than not changes in the tissues that the brain perceives as threatening. This system is very handy, as often it keeps us from making the same mistake twice. I personally akin this to patients as recognizing a certain smell and that smell reminding you of something. Pain is often the reminder of previous injuries.

Pain becomes problematic when it becomes chronic. This pain is often the result of the brain concluding that for some reason, often a subconscious one, that the person is threatened and in danger. The trick is finding out why.

Pain Stories

Stories are some of the best ways to relate pain to patients. There are many cases when you hear soldiers sustaining major injuries yet charging further into battle. On the flipside, take a look at paper cuts. The damage is very miniscule; however, the pain levels are huge. Point being, what occurs in the tissues is only one component of the pain experience. And if pain is not perceived, then tissue changes are not deemed threatening by the brain.

Pain Context

Pain oftentimes can be modified by various cues that the brain experiences called ignition cues. Take prescription drugs for example. The tablet’s shape plays a huge role in how effective the drug is.

Transparent capsules with colored beads > capsules with white beads > colored tablets > square tablets with corners missing > round tablets.

Pain is dependent on the perceived cause as well. Take someone who has survived cancer. If that person attributes a painful experience to cancer returning, the pain is often worsened regardless of what is occurring in that person’s tissues.

Lacking knowledge and understanding also increases pain and fear. We are afraid of the unknown, and if we do not know why we hurt, often the pain will increase in response to fear.

Phantom in the Body

Tissue-centric pain explanations are incomplete. The biggest example of this is phantom limb pain. The reason why these phantom limbs create pain is due to the body’s virtual representation in the brain.

The virtual body, or homunculus, is what allows us to know our body’s location in space. You access the virtual body every time you perform an action with your eyes closed. In this case of phantom limb pain, the virtual leg is still present and relates to the rest of the virtual body. This experience can even occur in children born without limbs, because that virtual representation is still present.

When a phantom limb pain occurs, the virtual leg becomes smudged. This change results in an unclear representation of the limb in the brain. This phenomenon also occurs in people who have chronic pain.

Smudging in the virtual body.
Smudging in the virtual body.

Other Factors

Our pain perception can often be attributed to our parents. When an infant falls, they will often look to their parents to gauge the optimal response. However, the pain experience is unique to each individual.