What in the World?
Pain ~ it’s all in your head
Lorimer Moseley is a Professor of Clinical Neuroscience at the University of South Australia. Professor Moseley has been researching pain for 25 years and is credited with developing new and effective clinical treatments for chronic pain.
Being an Australian, he enjoys the occasional walkabout in the bush. The following experience by Moseley demonstrates the complexity of pain. It also dispels the idea that pain is merely a one-way signal from the injury site to the brain.
On one fateful day in 2004, Moseley decided to walk in his sarong from his outback camp through the bush to take a swim in a nearby river. At some point in the hike, he felt a familiar sensation coming from the outside of his bare left leg.
His brain told him it was something that happens all the time when hiking in the bush – contact with a stick, no big deal. After his swim and on the way back to camp, he began stumbling and vomiting. And that’s pretty much the last thing he remembered before waking up in a hospital four days later.
Moseley was informed that he was the first known Anglo-Saxon to have survived the deadly bite of an Eastern Brown Snake, the second deadliest snake in the world.
Several years later, while hiking with a friend in the bush, something made contact with the outside of his left leg again. Moseley immediately fell to the ground writhing in pain. His hiking mate (I just had to use that word somewhere in this story) examined his leg, expecting the very worst.
But what he found was nothing more dangerous than a small scratch from a stick.
Was Moseley’s pain real?
Yes, it was as real as if another brown snake had bitten him. His brain had been re-wired years earlier to identify any similar touch to his left leg as a hazard. Moseley’s conscious mind was informed of this fact by pain.
Pain has but one function, to protect us. But sometimes our brain becomes overprotective, and pain continues long after the injury has healed.
New ways of thinking about chronic pain.
As we touched on in the last dispatch, pain is complex and much more than just a signal sent through nerves to alert us of injury. There are many neural inputs to pain, resulting in different intensities and longevity of pain as experienced by individuals.
Treatment theories go back to the time of Plato and continue to this day.
Today such treatment modalities run the gamut from surgical intervention to biofeedback. One size does not fit all when it comes to pain, even when dealing with the same type of injury.
The most widely accepted theory, and one that much of our clinical treatment of pain is based upon, is called the Gate Control Theory.
Now, I promised you that the Watoga Trail Report would explore science in the most non-technical way possible. Trust me, most of us would find it difficult, if not impossible, to understand a scientific paper on the Gate Control Theory.
But that doesn’t mean that we cannot understand the theory as it affects us. We all experience pain from time to time. We all have a stake in finding new and more effective ways to treat pain.
The Gate Control Theory explains how painful and non-painful sensations can be selectively sent to, or withheld from, the brain. This function is located at the back of the spine in an area called the Dorsal Horn.
Neural gates in this area can open, allowing both painful and non-painful sensations to travel to the brain. Conversely, by selectively closing these gates, it can prevent signals from reaching the brain. Hence, we can either experience pain or not, depending upon the preference of a neural complex outside the brain, i.e., the spinal cord.
How does the Gate Control Theory affect treatment?
The bottom line is that by using a multidisciplinary approach to pain management, we will achieve better results in more cases of chronic pain. The ultimate goal is to retrain our body to block the nerve fibers carrying the pain stimuli to the brain while allowing the non-pain sensations to reach the brain.
This approach requires that in addition to, or instead of, the standard treatment for chronic pain – analgesics and surgery – we employ physical therapy, biofeedback, behavioral and psychological treatments. And for many pain-sufferers, it works.
My recent experience with pain.
I recently went to my family medical practitioner here in Pocahontas County because I was experiencing pain from a long history of back injuries. This type of pain isn’t new to me, but it was hanging on much longer than usual this time.
My practitioner wisely sent me to Pocahontas Memorial Hospital for diagnostics and physical therapy. An X-ray revealed compression fractures, scoliosis and possible osteoporosis. A “perfect storm” for chronic pain.
He also sent me out for physical therapy. Being a runner and performing a daily routine of pilates, yoga, and weight training, I questioned what PT could do for me that I wasn’t already doing for myself. As it turned out, a hell of a lot!
My physical therapist made sure I understood how each exercise would affect the soft tissue involved in the painful area. She stressed that I should perform these specific exercises daily to get results.
And just as important as leading me through the exercises, she listened to my questions and provided thoughtful answers. She noticed other problems ancillary to the back pain, such as posture, which can also contribute to back pain. She offered guidance in that area, as well.
And, indeed, after three weeks of PT, I am noticing improvements on all fronts. My pain is diminishing, and I see more fluidity of movement when I walk.
My therapist’s approach is working for me.
Although pain, being very individualized, may require other sufferers to seek such treatments as bio-feedback or psychological therapy in addition to the conventional therapies.
We have come a long way from, “Take an aspirin, and call me in the morning.”
A couple of comments before closing.
My family medical provider shared some wisdom with me: “Don’t contact Dr. Google for medical advice!”
He is correct in that. The Internet is full of disreputable advice. Charlatans and crackpots are part of the Internet stew, so don’t believe every claim you read online. Always think critically and check out the facts – always!
As for the many workers who suffer chronic pain from work-related injuries, there is a persistent myth that malingerers file most workers’ compensation claims.
Particularly so, if the injury is not visible, Carpal Tunnel Syndrome, for example.
This is a blatant misconception.
An Ohio study concluded that, by far, unethical medical providers and employers accounted for the lion’s share of workers’ comp fraud. Unscrupulous medical providers charge for services not provided to the injured worker. Employers cheat the system by intentionally using incorrect compensation codes that cost them far less than their risk would indicate.
So, let’s be honest about who is really abusing the workers’ compensation system.
According to OSHA, 38 % of injuries to those employed happen in the workplace. In 2019 there were 2.8 million injuries and illnesses on the job and 5,333 deaths.
People frequently get hurt in their workplace. And for many, chronic pain is the result.
In the next Watoga Trail Report.
Next week we will tackle the mystery of placebo and the astounding findings of recent research on this mysterious antidote. We will also look at a condition called Congenital Insensitivity, where those afflicted by this tragic disease feel no pain.
We will conclude this series on pain with a discussion of how our pets experience pain.
A huge thanks to all of our great medical and healthcare providers here in Pocahontas County.
Until next week,