I’m not here to say that your pain is all in your head… but it is literally, 100%, with no embellishment, all in your head. There’s no way around it. Everything is “just in your head.” That incredible three dimensional landscape in front of you? Constructed entirely in your head based upon the input of two tiny sheets of light-sensitive retina. All of those distinct objects that are so clear to you, like your computer monitor, or that oncoming car, or your dear mother’s face? All fabricated in post-processing by your team of faithful visual nuclei, all working together to make sense of the mishmash of light that smashes into our eyes (our ability to distinguish objects is an incredibly complex trick of the brain).
I’ve Got Some Upsetting News For You…
The rich green of the grass outside of your window, my friend, isn’t even fucking there. There is no “green.” We create color after we’ve processed the scene in front of us, giving different visual flavors to the wavelengths of light striking our eyes. Unable to distinguish between different wavelengths? Your brain fills in colors anyway, because your brain is incredible. I’m color deficient (“color blind”), but I never really notice it unless I pick the wrong crayon when coloring and people proceed to make fun of me. Hell, for all I know, my blue might be your chartreuse.
As you might imagine, the same goes for all of your senses. Audio is extremely muddy at the level of the ears, but yet we can pick out our name in a crowded room. We can locate a songbird in a distant tree because of how fantastical our brains are at creating 3D maps. Our sense of taste is as sophisticated as a doll made of a single stick (I call her Tabitha), but we seamlessly combine it with our sense of smell to create flavor. Oh, and half of the things that we perceive aren’t even fucking there. Consider how we can take 24 still frames per second and turn them into movement. Consider how you have a big-ass blind spot in each eye. Notice those? Nope, your brain creates visual information to plug the holes, all in real time, all before it even chooses to make you consciously aware of what you’re seeing.
Trying So Hard Not to Reference “The Matrix”…
That, dear reader, is kind of the crux of the matter. Our experience of the world is not created directly from our sensory equipment. It’s run through a huge meat-based supercomputer, new shit is added in, unimportant shit is discarded, and we get this really neat Reader’s Digest version when all is said and done, about 100-200ms later. Did you notice the delay? Of course not.
What This Means For Pain
Pain, just like everything else, is the product of your supercomputer. Sure, it’s based upon sensory input (you’ve got these little nerve endings called nociceptors that notice when a stimulus is “too much,” like too much heat or friction or pressure), but the brain takes this about as seriously as anything else.
You’re getting nociceptive input all the time, but your brain usually chooses not to tell you about it. If this wasn’t the case, your shoes would bug you all the time (pinchy bastards), your ass would be perpetually uncomfortable when sitting, and your head would be a nightmare of itchy madness. Instead, your brain will let you know when you’ve worn your shoes for too long, or when you’ve done enough dancing for one evening. You are left blissfully unaware of your ass until it starts to fall asleep, at which point you may shift a bit. Instead of trying to peel your scalp off, you unconsciously give it a scratch here and there to keep it exfoliated (and you probably don’t even notice).
This is the case with all pain. What does your brain let through? What does it filter out? More importantly, what does it flag as “super fucking important, hey Ian you should pay attention to this”? That sense of importance is not a part of the input, but rather like the color green. It’s something that your brain, in its vast-but-limited wisdom, adds on after the fact. Take 15 minutes and watch this TED talk by prominent pain researcher Lorimer Mosely. You will find that he is charmingly Australian:
If you didn’t get a chance to watch, the upshot is this: Pain is incredibly intense when the brain thinks that it really needs to get your attention. Broken knee? Important. Painful. Scraped knee? You might not even notice until you get home and find your jeans glued to your leg.
Your Structure Is Not Your Destiny
This all becomes especially relevant when we consider the pain industry here in the West. If you go to a doctor with pain, they will find a structural cause, even if it means doing three different kinds of scans and five nerve conduction tests. Scan a body enough times and you will fucking find something weird about it. A spinal disc that’s squished out like jelly from a poorly-constructed PB&J. A joint that has rough cartilage, or that’s at a weird angle. Reduced space between bones. Bursitis, tenosynovitis, arthritis, bone spurs, etc. I once had a client who was diagnosed with “calcified trigger points.” Yes, a chiropractor was responsible.
Could these be the issue? Sure (except for the last one, which doesn’t exist). Are they the cause of your pain? Well, no. Your brain is the only thing that can cause pain. Think I’m just being a supercilious prick? Consider the following:
- Severity of knee osteoarthritis does not predict pain. Patients with mild osteoarthritis can have severe pain, and patients with severe osteoarthritis can be pain-free. People with the same amount of joint degradation can have a wide range of pain.
- “Sham surgery” can be just as effective for curing pain “caused” by meniscus problems in the knee as actual surgery. They simply don’t do the damned surgery, and people get better at the same rate.
- Talk therapy is an effective intervention for pain. Swedish massage is an effective intervention for pain. Acupuncture (both real and sham) is an effective intervention for pain.
How can these be true if your structure determines your pain?
Okay, structure is involved. If you break your knee, it will hurt. If someone pinches you really hard, it will hurt. Nociceptors exist, and they will report to the spine/brain when shit gets really bad. So how do we explain the weirdness above?
I’ve got two explanations: Pain thresholds and the psychosomatic effect (more on the second one later).
Central Sensitization and You
Why does a teeth cleaning hurt some people more than others? How come some of my massage clients need light touch, while others would like me to club their muscles with rocks until my arms give out? Why does my pain get worse when I’m depressed/anxious?
The answer to all of these is likely central sensitivity. This is how far your brain has its “pain knob” turnt up. Another way of putting it would be your “pain threshold.” How much abuse can your body take before your brain presents you with the perception of pain? How willing is your brain to create pain with minimal input from your body, or no nociception whatsoever?
It turns out (as you may have seen in the video above) that this is a variable phenomenon that is influenced by many sources. Stress can reduce your pain threshold. Lack of sleep can reduce your pain threshold. And, perhaps most crucially, pain can reduce your pain threshold.
This phenomenon, called “central sensitization,” is the real turd in the punchbowl of life. The more pain you experience, the harder your brain “listens” to pain inputs. It’s as if it realizes that you’re in an increasingly dangerous environment, so it makes you hyperaware of danger. It’s using pain as a lever, as a compliance tool, to keep you from getting into any more trouble.
It’s kind of sweet when you think about it. It’s trying to be your bro and keep you safe, but it mostly just ends up causing you to take time off work and hate getting up in the morning.
Fiddling With Your Pain Knob
So, if pain causes pain, what can you do? Aren’t you kind of stuck in a vicious circle? Not really. As we’ve figured out so far, when you’re in pain, your body listens. Well, it also listens when the pain chills out. As pain decreases, pain sensitivity decreases. If you do a lot of painless activities, you can kind of trick your brain into not paying so much attention to nociception.
This, in my informed opinion, is why massage works for pain. It gets your central nervous system (your brain and your spinal cord) used to the idea of the body being able to move and interact in a pain-free way. Sure, that hip used to be a hotbed of pain and despair, but there’s this hour every week where it feels kind of nice. Maybe it’s not the shitshow that your brain has become accustomed to.
How should you, the pain consumer, go about reducing your pain threshold? Move in low-pain ways. Go on walks, even when your knees complain a bit. Move your arms around, even if you’ve got frozen shoulder. Stretch, do yoga, and swap massages with someone you love.
Finally, think differently. It turns out that just being more informed about pain science can improve your pain outcomes. You’re welcome.