Sunday, 22 June 2014

Sometimes pain can become a self-fulfilling prophecy!

As a physiotherapist working with people in chronic pain, I often find that people are very uncertain about doing certain movements and activities. In a lot of cases it goes even further and people avoid doing certain movements or activities altogether for fear that they will damage themselves. When this happens, I ask people what they think would happen if they went to do this movement? and I get an array of answers, including:, ‘I’m worried my disc will pop out’, ‘It feels like something is going to snap!’, ‘if I do this movement I’ll pay for it the next day’ and ‘I can’t do that because my physio/doctor, told me it is dangerous’. Well imagine that you are about to do a certain movement and you are telling yourself ‘this is going to be dangerous!’ what do you think will happen in your body?

What happens is your brain quickly sends a signal down to the central nervous system to put it on high alert. It tells the receptors in that area of the body that danger is imminent and that they should be careful. Once the central nervous system becomes more hyperactive it also tells the muscles to be more protective. So, if you did go to do the movement, it becomes more guarded and more awkward. By thinking something is going to cause you damage you have automatically triggered the body’s protective mechanisms and pain is a protective mechanism. By telling yourself it could cause you damage you are more likely to feel pain when you go to do the movement. Then, if you continue to avoid certain movements it maintains the central nervous system in a hyperactive state, it maintains muscle over-activity and maintains a restricted range of movement. All caused by how you are thinking!

An interesting study was conducted recently at the University of Manchester into anticipation of pain (Brown, El-Deredy & Jones, 2014). In the study they found that in people with chronic fibromyalgia and chronic osteoarthritis pain their brains anticipated pain in a different way to people who didn’t have pain. There was more activity in an area called the insula and less activity in an area called the dorsolateral prefrontal cortex (DLPFC). The insula is part of the brain that is involved with negative conditioning, i.e. telling yourself to avoid certain activities because they may be harmful. If this part of the brain becomes more over-active, you are more likely to stop doing certain activities. The DLPFC has also been shown to reduce the unpleasantness of pain (Lorenz, Minoshima & Casey, 2003), so if this area is less active you are more likely to attribute unpleasantness to painful stimulation, which may further enhance the avoidance behaviour.

So, what can you do to help stop thinking yourself into pain? Well one technique I use regularly with people is visualisation. If someone has been told that a prolapsed disc is the cause of their pain, it’s quite common that people avoid bending forwards. They may have been told by their physio or GP that this movement is dangerous because it will increase the bulge in the disc. Once you start thinking this, each time you go to bend forwards at the back of your mind you may imagine that the disc is bulging even more and if you do, you’ll trigger the protective mechanism. What I do, is to get people to visualise that there back is nice and healthy, their disc is healthy and the muscles are nice and relaxed. This way it helps to switch off rather than switch on the protective mechanism. This then helps people to start doing activities they may not have done for a while.

If you would like any help in understanding how you thought processes affect pain and other physiological processes, feel free to get in touch.

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