Pain is universal. It's also extremely personal.
Almost everyone has experienced some kind of pain in their life, be it emotional or physical. Many of us, millions in fact, also suffer from chronic pain. I know I have. And while we might think we know exactly where the pain stems from, many times, the source of the pain is not what we think.
Every year, the medical community is learning more and more about pain — its origins, its function, and its relationship to the mind and body. While research has long shown that pain comes from the brain, many scientists and doctors haven't necessarily engaged with this critical information. Remember the last time you went to the doctor for pain? You were probably prescribed medication, maybe you got an X-ray and perhaps that did the trick.
Unfortunately, for the millions of Americans suffering from chronic pain, simple interventions often don't work. Why? Because we're often misdiagnosing the source of the pain and thus, mistreating it as well.
Thankfully, a new study published in the Journal of Pain provides new data to help us understand pain — where it comes from, why we experience it, and how we can not only better manage it, but in some cases eradicate it completely.
Scientists now believe that all pain is generated in the brain, but that doesn't make the pain any less real. And it's understandable if this is triggering for some. Many people, women especially, aren't heard when they say they feel pain. There's even a term for it — "medical gaslighting." Have you ever had a doctor say to you "it's all in your head" in a dismissive way?
"It's not all in your head, but it is coming from your head," said Nathaniel Frank, an author and historian who is writing a book about the mind-body connection to pain. Frank recently wrote an op-ed in the LA Times called "The pain in your back? It's really a pain in your brain." His article cites the new research on pain, which further proves this premise.
"Pain experience is generated from a whole variety of experiences," said Frank, who also directs Cornell University's "What We Know" project, which collects scholarship on cultural and policy issues for the general public. "If you've broken a bone, slipped a disc, torn a muscle, you likely experienced structural pain. What's fascinating is that over time, even as the injury heals, our pain can get worse."
So, why does our pain get worse even when your bodies are getting better?
Michigan State University Clinical Professor Dr. Howard Schubiner recently led a study that revealed something about pain that's counterintuitive — back pain can occur in the absence of tissue damage due to learned neural circuits in the brain.
"We see this all the time," said Schubiner. "Normally when you have an injury it will heal. It may take weeks. In chronic pain sufferers, it increases over time and spreads to different areas of the body."
In Schubiner's study, doctors examined 222 patients suffering chronic neck and back pain. After running MRI tests and physical exams, the researchers found that nearly all the patients had spinal anomalies. However, only 12% of the participants showed a structural problem as the root of their pain. The other 88% of participants had what the researchers call primary pain, meaning the pain was generated by neural circuits in the brain, not by structural damage.
"The existing medical paradigm assumes a physical cause for most chronic pain," Frank wrote in his LA Times op-ed. But the results of Schubiner's study show that's often not the case.
"The results are really remarkable. If you have chronic neck or back pain and you get an MRI, the MRI will be abnormal. But it turns out, that most people have an abnormal MRI even if they have no pain. So mild findings on an MRI may not be the cause of the pain," said Schubiner.
To further conclude that most participants were experiencing non-structural pain, the researchers looked at patient histories and the characteristics of their pain.
"If the pain comes and goes, shifts and moves, turns on and off, is triggered by an innocuous stimuli, that's what was the determining factor," Schubiner said.
These findings confirm a suspicion I had about about my own experience with chronic pain — that while it likely began with my head injury, over time it morphed into an emotional pain.
"All injuries heal, but sometimes the brain will continue to send these pain signals," said Schubiner. "It creates a spiraling process. Especially when people think they're in danger."
Your pain is not trying to hurt you. It's actually trying to help you.
"The brain has a danger alarm mechanism. It turns on and it turns off. And so the brain is actually in charge of whether or not we experience pain in any given situation," says Schubiner.
Even after our pain alerts us that we've been harmed, it doesn't always turn off. The danger has passed, but our bodies don't know it.
It's not all in your head, but it is coming from your head.
"Anxiety can make the pain worse," said Schubiner. "This has actually been proven. So when we go to the doctor for an MRI and it reveals an abnormality, it's critical that we remember that the brain can cause pain. In fact, functional MRIs have shown that physical pain lights up a similar part of the brain as emotional pain."
New treatments are helping people reverse or eliminate chronic pain without invasive treatment or medications.
"This is an epidemic of fear as much of anything else," said Nathaniel Frank. "Of course, you need to go to an M.D. and rule out anything life-threatening. But once that's been ruled out, there are all these resources online now who can help you understand that others have gone through similar experiences."
Pain education is important, said Frank, who has dealt with his own chronic pain.
"For some people this happens quickly when they learn about pain education. But for others, particularly those who may have had real adversity of trauma when there young, it can take a long time to rewire your brain," says Frank.
All injuries heal, but sometimes the brain will continue to send these pain signals. It creates a spiraling process. Especially when people think they're in danger.
Going to different doctors and getting different diagnoses are important steps — the more perspective you have on your pain, the more likely it is you'll be able to address it.
But pain can also be an incredibly lonely experience, which may seem odd given how universal and ubiquitous it is. But it can carry with it a degree of shame, stigma and certainly misery. Frank suggests finding community, reaching out to folks who are also struggling and researching the mind-body connection.
My own story with chronic pain begins and ends with the mind-body connection. A couple years ago I sustained a concussion after I was violently mugged. When the headaches lasted past two weeks, and then past a couple months, I started to worry. Is my brain bleeding? Am I permanently damaged? Will I ever be OK? The more I worried, the worse it got. If you’ve dealt with chronic pain you know the cycle can be vicious. I decided to get a CT scan for peace of mind, and yet even with normal results, it didn't bring me any. The headaches persisted.
Three months into the head pain, and after changing my whole lifestyle appease it, I decided to do something a little more drastic and entirely experimental — I booked a 10-day trip to Hawai'i. Maybe I knew something intuitively that I would soon find out, or maybe I was just that desperate, but from the moment we took off the throbbing, pounding, pulsating stopped. Just like that, I felt like myself again.
But this is the part that astounds me and lends itself to the paradigm shift around pain — while I likely sustained a concussion that caused my headaches for the days and weeks that followed, at some point, it is also likely that my pain was no longer being caused by the physical injury but by the emotional one. My body still thought I was in danger.
In the end, my pain lasted for only months. I'm one of the lucky ones — many people suffer for years with no end in sight. This is why Frank and Dr. Schubiner believe a paradigm shift around pain is necessary. And why everyone, as Frank wrote in his op-ed, deserves access to that paradigm shift.
The key to stopping the pain, Frank said, is teaching your nervous system that it is safe and can turn off the pain, which functions as an alarm signal. Nervous system safety is achieved through pain education and therapeutic approaches including mindfulness, self-compassion exercises, and emotional expression techniques including journaling.
Frank says he is also collecting personal stories for his book and future research — you can email him at nathaniel@nathanielfrank.com.
