Pain Science and the Biopsychosocial Model: 5 Steps You Can Take to Minimize Pain
Pain is complicated. It’s unique, misleading, and subjective. It can be delayed or immediate, acute or chronic, intermittent or constant. There are many theories as to how exactly we experience pain. All sensation is technically experienced by your nervous system and is an output from the brain. In other words, pain is not a signal that the brain passively receives, rather the brain produces pain in response to signals from the body. A noxious stimulus and pain tend to happen together but they are separable. In fact, some people are born with CIP (congenital insensitivity to pain) which is an inability to experience pain and they commonly die in childhood due to unnoticed injuries.
Pain is information that there is something wrong. It’s the brain’s way of telling you that there is a threat. There are pathways within the nervous system that can basically control the volume of a pain signal. The volume does not always match the severity of what is happening to the body. In severe scenarios such as a shark attack, pain may not be perceived. There may be an evolutionary reason for this. Chances of survival in extreme instances improve if the organism is not having pain at the moment.
There are times where the opposite happens; the volume knob on the pain is disproportionately high compared to the injury. This is where we see an ankle sprain that has been plaguing someone for years. The pathways in the brain that handle pain reception pass through neural centers in the limbic cortex. The limbic cortex is also the emotional region of the brain. We know that our emotional state has a strong influence on our perception of pain. It is commonplace for an athlete to sustain an injury and have to be temporarily sidelined. In turn, the athlete’s mood diminishes which causes an increase in pain. This quickly can spiral out of control and is what is known as a negative feedback loop.
Arguably, one of our most important roles as physical therapists is to break this pain cycle. Outside of the techniques we have to modulate pain, there are things you can do on your own to minimize the influence of other variables. Think of it like turning down the volume on an amplifier. Here are 5 aspects in your environment that you can control to minimize pain augmentation:
Sleep: This needs to be prioritized. We are the only creatures on the planet that intentionally deprive ourselves of sleep. In certain circles, there is almost a bravado to this, as if it shows how hard of a worker you are. Well the research is clear, lack of sleep causes a cascade of negativity and stress on the body. Sleep deprivation affects the endocrine system, cardiovascular system, immune system, and even your DNA. It has been correlated to dementia and cognitive dysfunction. How do we improve the quality of sleep besides the appropriate length of time? Keep it dark, keep it cool, and keep it consistent. By the way, the recommendation for how cool to keep it is surprisingly low: 65 degrees. For more details, check out this blog post here.
Hydration: lack of hydration has a direct impact on the quality of our tissues. Healthy muscle tissue should look like a filet mignon. Dehydrated muscle tissue is more like beef jerky. (Pardon the somewhat eerie analogy). All of our tissues in the body depend on hydration to function properly, not just muscle. Intervertebral discs rely on hydration to maintain their height. Dehydration can negatively effect your blood pressure. The general rule of thumb is that if you are thirsty, you are already dehydrated. A lesser known fact is that as we age, our ability to perceive thirst declines. There are countless apps that track how many glasses you are drinking. Just documenting how much you drink will tend to increase your water consumption. I personally have a water bubbler in my house which has dramatically increased my water consumption. The recommendation is to drink half of your body weight in ounces. If you weigh 200 pounds, drink 100 ounces.
Nutrition: Although there is no one diet that is right for everyone, there are general guidelines that apply to almost everyone. Garbage in=garbage out. Limit sugars, fried food, processed food, and vegetable oils. If it doesn’t rot, don’t eat it. Stay on the perimeter of the grocery store. Basically quality meats, vegetables, and fruit.
Stress: We are great at charging ourselves up with multiple coffees, pre-workout drinks, supplementation, etc. However, we are not great at coming down. Our lives tend to stimulate the sympathetic “fight or flight” nervous system; traffic, work, bills, just life in general. There are simple things you can do to calm down and the best athletes find ways to stimulate the parasympathetic nervous system. This can be meditation, breathing drills, of self care maintenance such as using a foam roller on aching muscles. Find ways that bring the heart rate down. Hint: it’s not looking at your cell phone before you go to bed.
Movement: This one is supposed to be simple. We were built to move. Just watch kids. They jump, they squat, roll, stand on their head. They are building their “movement fluency”. As we get older, we tend to stop doing these types of movements. Like forgetting a foreign language you took in high school, your ability to get into different shapes diminishes. Most jobs lend to a sedentary lifestyle, creating weakness and mobility restrictions. On top of that, there is a pervasive movement phobia within the medical community. We are told squats are bad for the knees, sit ups are bad for the spine, running is bad for arthritis. Well squats are getting out of a chair, sit ups are getting out of bed, and running is just a normal function of being a human. We are more resilient than that. Of course, there is a right and wrong thing to do anything and technique matters. You should aim to sweat in a pain free manner, everyday.
Get all of these things in check and you’ll be surprised of the effect it has not only on pain, but on your quality of life in general. When these environmental factors are out of balance, it can lead to chronic inflammation, increased cortisol, and blood pressure. Basically the recipe for metabolic syndrome. It may be overwhelming to do all of these at once, so pick one. Where one good choice is taken, another one usually follows. Remember the negative feedback loop? Well it has an anti-dote; the positive feedback loop, and it’s your path forward.