In today's conversation Neil Pearson is helping us to understand what pain is. We discuss the assumption that all pain is directly correlated to tissue damage, why your brain is messing with you by creating pain in the first place- if it’s not always telling the truth about what’s going on on the inside.
Neil also discusses how pain isn’t just biological, biomechanical, or biomedical- and how better understanding how our lives and bodies are integrated can help us to address it more effectively than reducing this way and trying to put it into one “box”or another.
In fact we talk about the trouble that “it’s all in my head”- one such box- can lead to- things like deciding we need to only therapize our pain away from an emotional perspective, or that we can simply ignore it and push through it as if it being about our nervous system and not (necessarily) our tissue makes it somehow imaginary.
I also ask Neil his opinion on whether or not we can actually figure out how much pain a person is by doing a brain scan, and ask for his advice to yoga teachers and other movement and fitness educators about how they can best help their students.
- What is pain?
- Pain is a complex human experience. Typically we consider it to be a symptom of injury, but pain isn’t all about tissue damage, it has a relationship to that but also to other things. We feel pain when our brain decides that something dangerous is happening.
- We need to treat pain more like a verb than a noun.
- Is it possible to not have tissue damage and still have lots of pain? Think of a paper cut- small tissue damage, add lemon juice, get lots of pain. We can also feel pain in the absence of signals from our body, like with phantom limb pain.
- When the pain is really big it’s hard to imagine that there isn’t something horrific happening inside. When the pain is more intense the system is trying to get you to change behavior.
- When there’s a situation where the body has been sending signals to the brain but the person has been ignoring, the system may ramp things up in an attempt to get your attention. There’s a point at which ignoring the pain isn’t a good idea anymore.
- Pain as a biopsychosocial phenomenon- what does that mean?
- Pain isn’t just biological or biomechanical or biomedical. As if pain only has to do with the physical body. We as humans lead a very integrated life. What’s happening in our body, social relationships, emotions, work, etc. will have an effect on if and how we have pain.
- The most effective interventions are the ones that specifically address the body and the mind together.
- A recent article (in resources) that stated that scientists can measure pain with brain scans... Are we going to use a brain scan to figure out how much in love a person is? Pain is very individual.
- We can’t change pain like a light switch. We can have some influence- change it like a dimmer switch turning it down over time.
- We can also change pain through knowledge. There’s lots of great work that Mosely and Butler [resources] have done- when we actually understand pain it often decreases the pain signals.
- A number of studies show that [resources] you can change pain through breathing exercises.
- One of the reasons why some people don’t have success they want is we on the practitioner side give up too soon because we don’t understand that the nervous system is changeable but often difficult to change.
- If you ignore and push through the pain over and over and over again- carrying on because you are tough- you’re training the nervous system that you don’t listen very well. In that situation need to do less and to move in a way that doesn’t leave us worse afterwards.
- “Whatever you’re practicing now is what you’re going to get good at.” Neil's yoga teacher was talking about what you’re doing with your breath, your body tension, how you’re approaching it... If you practice pushing through the pain all the time, your system gets good at creating protection.
- Yet acute stress can be helpful for those in pain- how do we differentiate between acute and chronic stress- good stress vs. bad stress?
- Not only do we need to feel safe and feel like we’ll be ok later, we need to keep our bodies and breath as calm as possible. If pain’s not accurate, why don’t we use some of these other alarms- our breath, body tension, etc.
- Yoga means a lot of different things to different people- what is the approach with yoga to address pain ?
- What are some of the things that Neil would want teachers to know about pain so it could influence their teaching?
- If we understand it better we can provide students with better guided suggestions. Often teachers will say there should be no pain in yoga- which can be trouble for people with pain. Or people will say pain is something you will get used to, or that if you stay with it it will change. This is also well intentioned but incorrect.
- My insight on the "fragile" language I was using when teaching.
- We want people to find their way to yoga with a smile- to find a way with it that is peace and bliss to practice it.
I love the two questions Neil poses for people who are in pain to ask themselves at the beginning of an activity: "Does this feel like a safe space?" and: "Do I think I'll be ok later?". What simple yet phenomenal little check ins! I believe this helps us to cultivate a healthier relationship with our nervous systems, and whether you're in pain or not at the moment, that's a winning strategy for long-term health. I just started kettlebell training- which I'm both excited and nervous about- and I will for sure be using those little check in questions. How about you?
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The study it refers to: An fMRI-Based Neurologic Signature of Physical Pain. Tor D. Wager, Ph.D., Lauren Y. Atlas, Ph.D., Martin A. Lindquist, Ph.D., Mathieu Roy, Ph.D., Choong-Wan Woo, M.A., and Ethan Kross, Ph.D. N Engl J Med 2013; 368:1388-1397