In preparation for the barrage of questions that I expect to receive this week, I’ve taken this opportunity to explain my own pain story. I hope this is an effective way of explaining the alarm system that is our pain experience! …..
Slicing through a frozen passion fruit as I’m getting ready for work I notice the resistance through the handle of the knife feels different. “That didn’t feel right!” I think as I look down to see blood pouring out of my thumb! But at this point I still have not experienced any pain at all. I have cut through the nerves responsible for ‘sharp signals’, the receptors of which are in my skin. I’ve done this so fast they are not functioning and not sending messages to my spinal cord.
Looking for something to compress my thumb, I repeatedly turn around on the spot, like a homing pigeon before it sets coarse. I then think: “My hiking kit has stretch tape in it.” I hurriedly pour out the contents of the kit and fish out the tape. As I apply the tape, I look at my wound for the first time. Now the pain sets in as I start to comprehend the gravity of the cut. Adrenaline begins to flow through me and my heart rate rises. My brain is more preoccupied on what I have to do next, rather than worrying about the degree of damage.
I wrap the thumb in the tape removing the wound from sight. Nerve signals from my vision stop influencing my pain experience and my pain drops to a more manageable level. Frantically, I jump in the car, “the drug cabinet in my brain,” is releasing natural opioids that will travel down to the spinal cord to block some of the neural signals travelling up to my brain… My brain starts to get its head around it (pardon the pun!).
There is some danger here… but how much?
A part of my brain, “the dorsal posterior insula” (and no we’re not going to test you on that) gathers information from about 500 different regions of my brain. It weighs up the DIM SIM’s! Danger Input Messages (DIM’s) like, “holy moly, that’s a lot of blood,” and, “My livelihood depends on this thumb!” And Safety Input Messages (SIM’s), “pfft it’s a cut on your thumb, it’s not life threatening,” and, “you’ve cut yourself before, too many times to count on one thumbless hand, and all those injuries seamed to heel up ok!”
My conscience has dealt with the “noise” the knife made and the sight of how deep the wound was, the amount of blood present, the consideration of my housemates reaction when he gets home to find the bloodbath.
I jump in the car and do what any 30(+1) year-old male would do… I call my mum! As an ED nurse at Rosebud, she advises me to come straight in. Whilst driving, I poke my thumb, my brain is searching for more information… its numb… that’s bad!
Fast forward a few hours because this is the 21st century and 40% have already stopped reading to hit like on a few more newborn’s and furry friends…
The plastic surgeon’s opinion isn’t great – I’ve cut to the bone, through a nerve and possibly the tendon but she won’t know the degree until the theatre room. If that’s the case, it will be 6 weeks off work. Then she’s gone, faster than Melbourne’s premiership hopes. I reach for my phone and it stings, “that must be the severed nerve,” I think. And i lay there, I turn into a “patient”, I don’t get out of bed, I say a whole host of words I shouldn’t, and I complain about… well everything!
After the surgery the surgeon tells me the nerve damage will heal… yes, nerves can do that! The tendon is undamaged. Great news!! I’m so relieved. Suddenly my thumb doesn’t hurt that much. I start to focus on this nagging achy low back as a result of all this lying around.
So why have I written this lengthy blog? I’ve done it to highlight one very important thing about pain… pain requires meaning! Our brain draws upon the context of everything surrounding the situation we are faced with and provides the appropriate response.
It’s a protection mechanism. Pain can be an awful experience. It needs to be in order to be effective. But our pain experience is the result of much more than just the neural input from the injured tissue alone.
Pain is a complex, multidimensional experience, which causes activity in many brain regions involved with things like attention, feeling emotions such as fear, locating where the pain is, and so on. It is an alarm system triggered by what we know about the danger we are in and is influenced by danger input messages and safety input messages (DIM SIMS).
Understanding the cause for your pain can be really beneficial. An important part of our role as Osteopaths can simply be explaining your injury to you, giving you clarity and understanding so you can manage the condition more effectively. I believe the most profound conversations I’ve had with patients involves giving them the confidence to keep moving, and removing the fear associated with their condition. Lower back pain can be a good example of this.
So the next time pain hits, ask yourself, “how dangerous is this… Really?”