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When pain is in the brain

When you've had pain for a long time that nobody can help, sometimes it seems the pain came out of nowhere. A colleague of mine tells the following story, which describes well how it feels. One day, while you were minding your own business, suddenly an invisible flying saucer flew overhead and turned on a Martian Pain Ray. It's been following you around ever since. Since nobody can communicate with an invisible flying saucer, there's nothing anyone can do. You'll be in pain until the Martians turn off their pain ray and go home.

If you don't believe your pain is caused by an invisible flying saucer, there's only one other possibility. Something in your nervous system is causing the problem.

Now we know more about what that something is, and we have an idea how to fix it.

Scientists have discovered that an Emotional Motor System ("EMS") within the nervous system greatly modifies the amount of pain you feel. Its activation appears to be a key issue in most patients with chronic pain.

The EMS induces several distinct strong emotional states that flip on and off like a switch. Its effects are most clearly seen in animals, but people have them too. They include panic (like a panic reaction), rage, and fear. If you've had pets, you've seen each one of these from time to time. But there are also positive states that induce feelings of love, peace, and contentment, like when you pet your cat or scratch your dog's belly.

The EMS interacts with pain enhancement and pain inhibition systems in your brain and spinal column. Very few of my patients know these exist. Certain specific bundles of nerves send signals from the brain down the spinal cord to the spinal processing centers where painful signals are first processed.

Pain amplifying signals enhance the pain you feel. They can even create pain out of thin air when no painful signals are being generated in your tissues.

In contrast, pain minimizing systems can reduce or completely turn off the ability to feel pain. Indeed, this system (called the "endorphin" system) is the same one that is activated when you take opiate medications like Vicodin or morphine. Indeed, when you take those drugs, it's a little like plugging your pain-minimizing system into a 110-volt electrical outlet, or pounding on it with a hammer. They turn the pain-reducing system on full blast for a limited period of time. (The risk is that later, if you've pounded on the endorphin system with opiates for a period of time, it turns off -- unable to respond to normal inputs.)

Most people have no idea how powerful their nervous systems can be in enhancing or minimizing pain. The pain-relieving effect of opiates, the most powerful pain-relieving drugs available, comes solely from turning on the pain-inhibiting part of the nervous system.

We've known about the pain-modifying systems in the nervous system for some time. What's new information is the influence of the EMS on these systems.

The most important EMS state for people with pain is fear, which includes anticipation of pain. It modifies your nervous system to greatly enhance the amount of pain you feel. All your pain sensors are turned on to their maximum. By contrast, feelings of acceptance, peace, and contentment turn off pain enhancement and induce pain minimization. (If you think about it, this is exactly how you would want your nervous system to work: maximum sensitivity when you're in danger, and maximum quiet when you're relaxed and content.)

Here are some examples of the EMS and pain modifying signals at work:

The power of acceptance

The final example is the most powerful, and the most important. Most patients are upset when a doctor tells them, "There's nothing that can be done about your pain. You'll just have to learn how to live with it." They consider it an insult, but it turns out this may be the best advice of all.

Most of those who struggle with chronic pain are at war with it, and with themselves. If I tell a person with this problem they need to stop fighting their pain, many respond by feeling I don't believe they have pain. Or they think I'm insisting they give up completely and have their pain run them over like a bulldozer. They are able to consider only two possibilities: total war, and complete capitulation.

This is catastrophizing: refusing to see the middle ground between two extremes. Either extreme worsens your pain and makes you miserable.

The single greatest way to guarantee your chronic pain will be with you forever is to tell everyone they have no idea how extremely severe your pain is. No one knows how much you suffer. (As you now know, this perspective turns on the pain-enhancement system.)

In contrast, patients who've recovered from chronic pain often tell me the critical moment came when they realized they'd done all they could and would just have to accept it. Acceptance takes a while to carry out, but as they did so, the pain just started going away on its own.

Now you know why.

Last updated Sat, Oct 3, 2009

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©2011, James Gagné, MD