Image / Ion Chiosea

As promised in the previous post in this series, this post will help us more fully understand how the pain alarm system works within the nervous system - or how danger signals arise before they make it to the brain, and how the brain makes it's determinations about what they mean. Since we've been looking at pain for awhile now, I thought it might be fun to learn about this through story and with a little humor ;)  Hope you enjoy!

In future posts, we'll explore using practices of meditation and observation to help ourselves navigate pain situations.
Until then, breathe deeply, practice often, and be well.


Dana Wyss Healing Arts
http://www.danawyss.com/

Image / Ion Chiosea


Pain exists to encourage protective behaviors, and the brain’s perceived need for protection depends on factors beyond the current health of our tissues. While pain may not always be a signal of tissue damage, it is always a signal from the brain that an area or a movement or a behavior is in need of protection, alteration or cessation. Thus, contrary to our old popular (and fairly intuitive) understanding, pain is an output of the brain, not an input. Always.
 
“Pain is an action signal, not a damage meter.”
– Lorimer Moseley, Painful Yarns p. 34
 
The brain creates pain as a request (or a clear demand) that we avoid threat. Threats come in many flavors: physical, psychological, emotional, and social. Pain is a bio-psycho-social phenomenon. How the brain assesses threat varies, both from person to person and at different times for the same person. It’s a complex evaluation that may include: our present and past physical health; our general level of stress or ease; past experiences; our perception of our own resilience; our actual or perceived level of support (social, financial, etc.); our beliefs about our own bodies, about healing, and about the world; and our understanding of what is happening to or within our bodies. That’s an incomplete list of considerations, but you get the idea – our brain’s perception of threat arises out of a composite of factors. And all this transpires rapidly, below our conscious awareness. While taking in a great deal of information from various systems of the body, the brain is always trying to answer the question “how dangerous is this really?”, and the answer in large part determines: a) whether the brain elects to issue pain signals, and b) how strong those signals should be.
 
For example, let’s say two people bend over to pick something up and both feel some pain. In the forward bend, a small degree of mechanical damage was sustained, which triggered danger receptors (or, nociceptors) in the lower backs of both people. These nociceptors deliver danger reports to both brains. Let’s see how two brains may handle the same situation differently:
 
Person A has had a fair amount of back pain in the past, and the internal map of her back is very fuzzy. In fact, the brain isn’t really sure what’s happening on the back side of her body, and this contributes to a sense of threat. Prior to this incident, she’s been worrying a lot about finances and feeling troubled about her future. Additionally, two years ago she sustained injury to her lower back that began in just this way, and disabled her for several weeks. It was very painful, she was unable to work for two months, and even caring for herself was out of the question for nearly 10 days. When she was diagnosed, her doctor used the term “slipped disc” to describe her condition, and she now tends to envision her spine as weak and unstable. The pain medication prescribed to her back then did little to relieve her pain but greatly aggravated her digestive system. Thoughts of incapacitation, being a burden on others, and experiencing unremitting pain for weeks flash though her mind, all feeding into a growing sense of threat.
 
Person B is active and enjoys good balance, and has never had any noticeable pain in her back, nor any negative experiences with doctors, diagnosis or severe pain or pain medication. She has enjoyed a healthy, pain-free existence and expects to, and she believes her body to be very strong and resilient. She also has excellent health insurance, financial resources, and social support. All of this feeds into her brain’s assessment of how dangerous her situation is likely to be.
 
Person A and Person B had the exact same experience, mechanically speaking. But their experience in every other way will likely differ, and they’re unlikely to have a similar pain experience in response to the exact same stimulus. When these two brains sought to answer the question ‘how dangerous is this, really?’, the information each received painted very different pictures of what this injury could ultimately mean.
 
At this point, we have an idea of the function of pain, and some of the factors that affect the brain’s determination of threat. In future posts, we’ll look at how the pain alarm system works within the nervous system, or how these danger signals arise before they make it to the brain. We'll also look at some ways to use meditation and observation to help ourselves navigate pain situations. Until then, breathe deeply, practice often, and be well.


Dana Wyss Healing Arts
http://www.danawyss.com/

Image / Ion Chiosea


In the previous post, we looked at the ways our models of pain have changed over the years, which has contributed to a shift in how we view pain, healing and the body as a whole. This week, we'll be looking at the relationship between pain and tissue damage, or injury. Does pain always mean there is injury to the body? Do we always feel pain where there is measurable damage?

It frequently happens that tissue damage and pain occur commensurate with one another. So it’s understandable that many of us perceive that a great deal of pain must signify a great deal of damage in the body. Or conversely, that no pain means there’s no problem. We know now that the relationship between pain and tissue damage isn’t nearly so straightforward as our intuition might suggest. We know now that it is possible to have significant damage with no pain at all, and that a previously unimaginable number of people do.
 
In one study of people with no reported shoulder pain, 23% overall were found to have rotator cuff tears, and in one of these study groups 51% showed signs of tear and yet had no pain at all. Zero. Zilch. Do you find that surprising?

In studies of the knees, the numbers are even more striking. When researchers studied the knees of asymptomatic volunteers between the ages of 20 and 68, they found that all but one of them had some damage to the meniscus, and that fully 61% showed signs of damage in at least three of the four regions of the knee. 

When researchers studied the lumbar spines of people with no back pain, they found that
52% of their subjects had at least one disc bulge, and that 38% had abnormalities in more than one disc.  
A great deal of damage can be present without making us wince, it seems.
 
To the relief and validation of a great many people, we’ve also come to understand that people can and do experience pain – real pain – without the presence of any tissue damage at all. We know that amputees experience phantom limb pain in great numbers, especially if they experienced pain in the limb prior to amputation. And we know that this pain is as intense and as real as any limb pain you or I might experience in our palpable, visible and fully intact limbs.

Pain can also show up as an abnormal response to previously innocuous triggers. We’ve come to understand that in allodynia, people experience real pain in response to stimuli normally not associated with pain responses. And in hyperalgesia, others experience a far greater pain response than is typical even to a stimulus normally associated with pain responses. We know that these pain episodes are very real for those experiencing them, are legitimately occurring in the brain, and that they are neither exaggerations or fabrications. This invisible pain really hurts!
 
So we have seen that pain can exist without a corresponding injury, and that substantial damage can exist without pain.
What understandings have these discoveries given us regarding the function or purpose of pain? We'll explore that question in the next blog post. Until then, breathe deeply, practice often, be well.


Dana Wyss Healing Arts
http://www.danawyss.com/

Image / Ion Chiosea

What is pain?

Why and when do we experience pain?

What does it mean when we experience pain?

How can we best support ourselves through pain experiences?

What does our pain need from us?

We used to think that poor posture and pain went together like cookies and cream. We used to think that pain only occurred when tissue damage was present. We used to think that painful stimuli created pain in the body and that message was simply carried to the brain and duly reported. We used to think that pain was an input. We used to think that reports of pain without measurable damage or disease meant that someone was making it up, exaggerating or embellishing their experience, that the whole problem was just “in their head” in a way that implied they were a little nuts. We used to treat them like that was the case.
 
Fortunately, we’ve learned a lot about pain over the years, and what we’ve found has shown us that pain is far more complex than our early models suggested. Our current understanding considers the whole being, validates and humanizes the experiences of so many who were discounted in the past, and acknowledges that pain is an output of the brain in response to perceived threat. It’s a dynamic experience, and a personal one. For each individual, the sources of pain experiences, and the solutions for them, will vary. Curiosity, awareness and creativity can help us navigate our diverse pain experiences.
 
In the following weeks, we’ll be exploring: the function of pain within the body/mind; the relationship of posture, movement and pain and how our understanding around that has changed; some of the factors that influence whether we experience pain during or after an injury and how intensely; and some of the more effective ways to support the body/mind in navigating pain states and enhancing resilience. In the meantime, here's a an interesting short video that shows the history of change in our thinking about pain that enabled the research and discovery happening today. Stay tuned to learn more!
 
Breathe deeply, practice often, be well.

Dana Wyss Healing Arts
http://www.danawyss.com/

Photo: James Jordan / Flickr

In exploring chronic tension over the past few posts, we began by looking into some of the physical causes that may be at play, and some of the functional changes and awareness practices that can help to address them. Next, we considered the relationship between our breath, our emotional state and our physical tension, and we evaluated whether it would serve us best to continue to dive deeper on our own, or with some help. Today we'll look at a simple practice of inquiry to guide our deeper dive. There are two ideas to keep in mind before we begin. First, it is of great importance that we enter this practice with a spirit of curiosity - every time we do it. Judgement or aggression towards ourselves has no place here, will not help us, and can certainly wound us. Please be kind, and remain curious. Second, we can give ourselves permission to leave the practice at any time if we begin to feel overwhelmed or anxious, knowing we can either come back to it later when we feel balanced or seek out a guide and return to the practice with help.

Once we've established that we're curious and ready, how might we proceed? We might begin by simply sitting in a comfortable position in a space that is quiet and safe, breathing deeply for a few moments to calm and center ourselves. We might then bring our awareness to the area of our body that is causing us discomfort. With curiosity, we might allow ourselves to feel what is happening in that area. If we are able to keep our attention on the area while still breathing evenly, we might start to inquire:

What is happening here?

What are the sensations occurring in this area?

Are there multiple sensations, or just one?

Do the sensations here shift and change? Or do they seem to feel solid, stuck, immobile?

Are there sensations here that we were not aware of before?

Are there any sensations here that are pleasant, pain-free, expansive?

The experience of this inquiry will differ for each of us, and may differ each time we engage with it - even when working with the same area! Our focus is to keep breathing, remain curious, and observe. We might notice after a short time that there are in fact multiple sensations occurring within our area of focus. We might begin to notice that the sensations in this area actually shift and change, rather than existing as the static block of the one particular sensation that we're typically aware of. We might notice sensations in this area that are not painful or uncomfortable, alongside some that are. We might notice sensations we've never experienced before, or that we've never experienced in this part of our body. We might spend a minute or five doing this, as our comfort and curiosity allows. When we are ready to leave the inquiry, we can open our eyes, take several deep breaths, thank ourselves genuinely for our efforts, and go on to something else. We can return to the practice another time, when we're feeling steady and curious.

“Much of what goes on within us remains dulled and hidden from us until it reaches the muscles. We know what is happening within us as soon as the muscles of our face, heart, or breathing apparatus organize themselves into patterns, known to us as fear, anxiety, laughter or any other feeling. Even though only a very short time is required to organize the muscular expression to the internal response or feeling, we all know that it is possible to check one’s own laughter before it becomes noticeable to others. Similarly, we can prevent ourselves from giving visible expression to fear and other feelings...The whole system ranges itself so that the muscles are ordered and ready either to carry out the action, or to prevent it from being carried out.”
- Moshe Feldenkrais, from Awareness Through Movement

An important tool to bring into our ongoing exploration is patience. We can begin to visit this area with curiosity for short periods of time, noticing what we notice. We can begin to bring our attention here throughout the day, noticing:

Are there are thoughts, events or interactions in our lives that seem to intensify the sensations in this area?

And conversely, are there thoughts, interactions or events that seem to ease the intensity of sensation?  

It can be helpful to view our body, and this area of longstanding tension in particular, as a teacher who has much to share with us. It can also be enormously beneficial to keep a journal of our observations as we work with an area over time. This can help us to gather the insights we receive along the way, allowing us to create a map of the internal territory we're traversing, and later to see how the process of looking and listening effected our patterns over time. None of this has to take large chunks of time - a few minutes of looking, a few minutes of writing what we noticed. And while we'll want to be patient with ourselves and considerate of our readiness prior to each inquiry, consistency in our practice will yield the greatest results. A little bit of frequent practice will likely prove more tolerable, sustainable, and effective than large efforts less often.

Wishing you each a beautiful week, with many moments of kind and patient observation.


Dana Wyss Healing Arts
Breathe deeply, practice often, be well.
http://www.danawyss.com/