This is a summary of section 4 of “Explain Pain” by David Butler and Lorimer Moseley. CNS Alarms While much of talk in rehab deals with tissue injury and tissue pain, realize that the brain always makes the final decision as to whether or not you should feel pain. No brain, no pain. This sentiment does not mean that pain is not real. All pain is real. However, pain is a construct that the brain creates in order to ensure your survival. Spinal Cord Alarms When an injury occurs and the DRG receives impulses from peripheral structures or the brain, the spinal cord neurons must adapt to better uptake all these signals. In essence, the DRG becomes better at sending danger messages up to the brain. This change leads to short term increases in sensitivity to excitatory chemicals. Those stimuli that didn’t hurt before now do (allodynia) and those that used to hurt now hurt more (hyperalgesia). In persistent pain, this change continues occurring to the point where neurons that do not carry danger messages start growing into space where danger messages are taking place. Now innocuous stimuli such as grazing the skin begin hurting. The pain may be normal, but the underlying processes become abnormal. When these spinal cord alarm systems become unhealthy, the brain no longer receives an accurate message of what is going on. The alarms become magnified and distorted. The brain is told there is more damage in the tissues than is actually present. What is good is
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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. 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.
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