Part 2 of a 3-part series about pain
Consider the familiar pain we call brain freeze.
That’s the universal experience of feeling a sharp pain in the forehead right between your eyes after you eat or drink something that’s icy cold. But when you feel this pain, it simply means that your hypersensitive nervous system is making a mistake.
There’s nothing dangerous actually happening to your forehead. Brain freeze pain does not mean that you have an injury – no matter where or how the pain hits you. What it does mean is that when the soft palate at the back of the roof of your mouth detects something really, really cold in there, it sends messages to your brain. But your brain can only hint at the general vicinity of where these signals originate from. So even though there’s absolutely nothing wrong with your forehead, that’s where you’ll feel brain freeze pain.
That’s one of the factoids I learned about pain at the Regional Pain Clinic I’ve been visiting regularly for a number of years since being diagnosed with the debilitating symptoms of Coronary Microvascular Disease.
The pain I experience – sometimes called refractory angina – is caused by non-obstructive coronary artery disease affecting the small vessels of the heart.
An example of an innovative program recently presented at our Pain Clinic was a 3-day workshop inspired by the pain self-management work of Neil Pearson, founding chair of the Canadian Physiotherapy Pain Science Division.
The mind-body physiology of pain is fascinating. And as Neil explains, pain is not always an accurate indication of what’s happening in the body despite what we may feel and believe.
At first blush, this doesn’t seem to make any sense, does it?
For example, when my son Ben fell and fractured his wrist playing dodgeball recently, the pain he experienced was a direct result of what had just happened to his radial bone – a clear connection between cause (fractured bone) and effect (pain). Wasn’t it?
Maybe. But with most pain, the severity of the pain we feel is actually influenced by many factors other than the severity of the injury.
I knew that this phenomenon is also seen in cardiology. Some people experience the so-called silent heart attack which has non-specific and subtle symptoms that may just feel like prolonged fatigue, indigestion, the flu, or a strained muscle – but with little or no actual pain. These pain-free heart patients are more likely to be female. Often the diagnosis is made weeks or even months later through cardiac testing – without the patient ever realizing anything had even happened. But the outcomes of silent heart attack can be deadly.
As Texas cardiologist Dr. Deborah Ekery explained:
“This is like any other heart attack where blood flow to a section of the heart is temporarily blocked, and can cause scarring and damage to the heart muscle.”
One study described heart patients with few if any severe cardiac symptoms as an “under-diagnosed and under-treated high-risk group”.(1)
So, heart muscle damage can occur despite very little pain.
Personally, I didn’t bother with one of those silent heart attacks. Instead, I had a loud, messy, garden-variety assortment of severe, textbook heart attack symptoms in 2008 – really what many would consider to be the classic male Hollywood Heart Attack.
In fact, what doctors often call my particular brand of heart attack is “the widowmaker” – which is not only self-explanatory, but pretty sexist. They don’t, after all, call this cardiac event “the widowermaker”, do they? (For more endlessly fascinating details on the nature of my chest pain, see Part 1 of this 3-part series: “The Freakish Nature of Pain“).
So, heart muscle damage can also be accompanied by lots and lots of debilitating and frightening pain. But remember that at least 10% of women experience no chest pain at all during a heart attack.(2)
Unlike the distinctive pain of a migraine headache, arthritis, acute appendicitis, broken bones or brain freeze, the reality of chest pain associated with angina pectoris – whether it’s severe or mild – feels like a potential warning sign that you might be about to die of a heart attack.
This is a pretty darned scary experience, take my word for it.
And let me say here that there will also likely to be lots and lots of pervasive anxiety. This is because there are few things in life more anxiety-producing, I’d dare to suggest, than being in the middle of a frickety-frackin’ heart attack. See also: “When Your Doctor Mislabels You an Anxious Female“
Ironically, even chest pain that’s alarming can sometimes be – like brain freeze pain – merely that hypersensitive nervous system of ours acting up.
Dr. Mohammed Memon at Medscape Reference cites studies showing that over 40% of patients living with a panic disorder seek treatment in Emergency Departments because of frightening episodes of chest pain that mimic heart attack pain.
According to Neil Pearson, another example of our hypersensitive nervous system making a mistake is how the mind can influence our perception of pain.
If you believe you are not getting the right care for your pain, for example, or if there is something dangerous going on around you, you may likely experience more pain than if those circumstances were not happening.
Conversely, as a longtime former distance runner, I’ve heard many, many stories of athletes competing despite suffering catastrophic injury during competition. Remember the American sprinter Manteo Mitchell? He competed in the men’s 4×400 metre relay qualifying heat at the London 2012 Olympic games despite a broken leg. He actually felt his left fibula bone break at around the 200 metre mark, yet continued running so he could pass the baton to his waiting teammate Josh Mance – and thus help the U.S. relay team make the finals. Amazingly, he still managed a split time of 45 seconds running on a broken leg! As he explained to the media later:
“I didn’t want to let the team down, so I just ran on it.”
But, unlike Mitchell, if your own severe pain stops you in your tracks, you may now have two distinct problems:
- the original issue that caused the initial pain
- a hypersensitive nervous system that now makes even normal movements or normal touch on your skin – things that are not at all dangerous to your body – feel extremely painful and/or dangerous.
But it may also happen that your brain stops paying attention to pain signals once you have already done what’s necessary to take care of the problem.
Taking a pain pill that you believe will work, for instance, means that your sensation of pain actually begins to decrease even before the medication has time to be absorbed into your bloodstream.
Neil Pearson compares this phenomenon to drinking water when you’re feeling very thirsty. Even though it can take up to 10-20 minutes for that drink of water in your stomach to be aborbed into your bloodstream, you will almost immediately stop feeling thirsty – despite your body still sending “Blood volume is low!” warnings to your brain!
But what if you suddenly realize that you’ve run out of those trusty pain pills? Because you believe now that you cannot get the immediate help you need, your nervous system pays more attention to those pain signals, and you will feel more intense pain.
That’s where self-management of pain can come in.
A self-management approach in dealing with chronic pain may look far different than the usual medical reaction to pain, which is often to pull out the drug prescription pad or refer for surgery. But as Neil warns:
“Pain self-management should NOT be the last treatment resort for people in pain.”
At our Regional Pain Clinic, expert staff teach us holistic self-management techniques in a variety of modalities like Health Recovery Tai-Chi, meditation and yoga classes. Support groups, guest lecturers and even Laughter Therapy are offered as non-drug ways to help manage our own pain ourselves.
A pain self-management workshop on how increased stress can heighten our perception of pain, for example, recently attracted a full house of patients living with a wide variety of chronic pain symptoms. We learned there that if we can manage stress better, we can actually help lower our pain perception. Practicing stress-reduction techniques over and over can actually make the nervous system less sensitive, thus helping to turn down that protective reaction of pain.
None of these classes can change what’s happened to any of us to cause our pain in the first place, but many pain specialists believe that we can learn to decrease the hypersensitivity of the nervous system. And what your nervous system has learned can be unlearned.
The good news is, as a study in the medical journal Pain found, psychological treatments emphasizing a self-management approach have become commonly accepted alternatives to pharmaceutical drugs or surgical interventions – especially for those living with chronic pain.(3)
However, we know that pain self-management programs may not be for everybody. Pain specialists tell us that we have to be ready and able to adopt specific coping strategies, beliefs, and behaviours that are thought to lead to decreased pain in many patients.
Some of the beliefs that can support pain self-management include personal statements like:
- I have the ability to control my pain
- My emotions do influence my pain
- Feeling pain doesn’t necessarily mean my body is being physically damaged or that all activity should be avoided
- Health care professionals are not the only ones responsible for managing and curing my pain problems
“If you can, you should; if you can’t, you shouldn’t.”
- Accept that you have persistent pain
- Build a support team around you
- Learn pacing
- Prioritize and plan our your days
- Set goals and action plans
- Be patient with yourself
- Learn relaxation skills
- Stretch and exercise
- Keep a diary and track your progress
- Have a setback plan
- Keep it up! Steps 1-11
(1) David Brieger et al. Acute Coronary Syndromes Without Chest Pain, An Underdiagnosed and Undertreated High-Risk Group. CHEST. 2004;126
(2) S. Dey et al, “GRACE: Acute coronary syndromes: Sex-related differences in the presentation, treatment and outcomes among patients with acute coronary syndromes: the Global Registry of Acute Coronary Events”, Heart 2009;95:1 20–26.
(3) Robert D. Kerns et al. Predicting responses to self-management treatments for chronic pain: application of the pain stages of change model. Pain. Volume 84, Issue 1, 1 January 2000, 49–55
(4) Mark P. Jensen et al. Further evaluation of the pain stages of change questionnaire: is the transtheoretical model of change useful for patients with chronic pain? Pain. Volume 86. 2000. 255±264
Q: Which pain self-management techniques have helped you?
Part 1 of this 3-part series: The Freakish Nature of Pain
Part 3 of this 3-part series: Chest pain While Running Uphill