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But there might be a way. The question is whether any of this is applicable to pain , and no one knows the answer to that yet. If so , it can probably be disrupted. In most circumstances, acute pain usually correlates quite well with tissue damage. With major sources of nociception , that is. As pain drags on, its relationship to actual tissue trouble gets sloppier, and in some cases breaks down completely.
Sensitization is probably a major factor in most of the pure chronic pain conditions — nasty chronic pain that seems disconnected from any cause, like fibromyalgia , irritable bowel syndrome, or complex regional pain syndrome. More commonly, chronification of pain involves relatively mild exaggeration of the intensity of ordinary pain problems.
This may actually be the much bigger problem for our species. Sensitization really needs an entire article to itself, and it has one: Sensitization in Chronic Pain: Pain itself can change how pain works, resulting in more pain with less provocation.
Sorry about that. The chronification of pain is dominated by the concept of sensitization, but there is more to it. Another weird thing about pain, another major wrinkle…. Pain sensation and perception can be badly distorted in various ways, and that is weird and cool, but also relatively rare.
We can make pain up out of thin air, like the guy with the nail driven between his toes, but we rarely do. And we can have bizarrely painless trauma — like the soldier who barely feels his wound — but we rarely do. All the famous and fascinating examples are famous because they are rather exotic. The boring-but-basic reality is that tissue trouble still usually leads directly to pain.
Just because that correlation can get messy and break down does not mean that it always does. Much is made of the difference between acute pain and chronic, generally assuming that acute pain is accurate , while chronic pain is exaggerated or outright bogus. Some ongoing causes of pain — a thorn, an old wound, a tumour — are almost too obvious to be worthy of mention.
But the cause of persistent pain is often baffling. For instance: my friend who had an almost literally invisible cyst pressing on a nerve root, a pathology that could only be seen if you looked in just the right way, with just the right kind of imaging. Until diagnosed, he was treated by more than one healthcare professional as a dysfunctional chronic pain case — but it was actually a clear cut case of chronic-acute pain, not dysfunctional at all, not a false alarm at all.
And, of course, these scenarios are not mutually exclusive : you can have both tissue damage and a wonky, disproportionate relationship to pain. In this case, the weirdness is just as much about our lack of clearly labelled concepts as it is about the nature of pain itself. A more technical description could be persistent nociceptive pain. Naming it is valuable.
I once had a persistent pain with no apparent cause, and I was told by a series of professionals that my only problem was pure pain dysfunction. Ta da! So I suffered a year of serious chronic pain with no apparent source that absolutely was positively, strongly correlated with a tissue insult. My brain was not lying. The alarm was not false. There was just a sneaky reason for it.
If that is true — and it really is technically true 23 — does that mean can we think brain-built pain away? Can our minds un -build pain? Yes and no, because, as Dr. Many wise, calm, confident optimists still have chronic pain. Pain is a motivator. It exists to get us to act. We hurt when our brains reckon we should do something differently, for safety … but safety is not always possible. But we do have considerable control over the context in which our brain lives.
We can change our circumstances. We can improve the odds that our brains will become less concerned about our tissues, and lower the volume of the alarm. I explore all the various mind-over-pain possibilities in as practical away as possible in a separate article: Mind Over Pain: Pain can be profoundly warped by the brain, but does that mean we can think the pain away?
So what do you do with the information that pain is an output of the brain? What does in mean for what you do with patients? Often the problem is not the tissues, but a pain experience spinning out of control. Explaining pain is by far the most well-known strategy for dealing with it, and it seems to sideline clinicians. Professional paralysis. Be kind to it. Be the source of a positive sensory experience.
Barrett Dorko, Physical Therapist, online discussion, Many moons ago I started trying to understand and explain pain, gradually producing this article, only dimly aware as I worked that I was re -producing some much more mature ideas. Explaining Pain, according to Dr. There have been a lot of misunderstandings about EP. Because explaining pain is tricky.
There are still plenty of unanswered scientific questions, too. Nevertheless, for the record, here are some key misconceptions about EP …. But the mother of all misunderstandings is the popular idea that if pain is an output of the brain, then we must be able to think our way out of it.
This is such an important and difficult topic that I've devoted a separate article to it: Mind Over Pain. That question was asked in a popular Facebook discussion group in early To be clear, it was not a reference to this website, but to ideas that are explored here especially in this article , which are regularly mistaken for a treatment method Explain Pain, either specifically or more generically.
Why capitalize it like a brand? The owner of the domain PainScience. If we are talking about the science of pain, then the question is effectively asking if clinicians are paralyzed by… knowing things. Are clinicians becoming paralyzed by the application of science to their work? By a modern and nuanced understanding of how pain works? Maybe they are! EBM is indeed harder than what came before.
Experience is especially seductive and misleading. But we do EBM not because it is easy, but because it is hard… and because it is better. There is no zealot like a convert, and some people get so entranced by the idea that pain is an output of the brain that they seem to deny that tissue state matters at all.
Yes, sometimes they do go too far! Challenge accepted! Voloco was originally available exclusively on mobile platforms. In fact, you can still download the iOS and Android versions of the software if you want to play around with pitch correction on your mobile phone or tablet. The apps are free to download and use.
Tomislav is a content creator and sound designer from Belgrade, Serbia. He is also the founder and editor-in-chief here at Bedroom Producers Blog.
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