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Understanding Pain Theory

The following paper covers various Pain Theory Models.  It is interesting to see how modern medicine derives it’s knowledge and how these theories are applied in practice.

This specific theory of pain hypothesizes that pain is the result of complex interactions between biological, psychological, and sociological factors, and any theory which fails to include all of these three constructs of pain, fails to provide an accurate explanation for why an individual is experiencing pain.

Overview of Pain Theory

Introduction:

Chronic pain has multiple aetiological factors and complexity. Pain theory helps us to guide and organize our thinking to deal with this complexity. The objective of this paper is to critically review the most influential theory in pain science history (the gate control theory of pain) and focus on its implications in chronic pain rehabilitation to minimize disability.

Methods:

In this narrative review, all the published studies that focused upon pain theory were retrieved from Ovoid Medline (from 1946 till present), EMBAS, AMED and PsycINFO data bases.

Results:

Chronic pain is considered a disease or dysfunction of the nervous system. In chronic pain conditions, hypersensitivity is thought to develop from changes to the physiological top-down control (inhibitory) mechanism of pain modulation according to the pain theory. Pain hypersensitivity manifestation is considered as abnormal central inhibitory control at the gate controlling mechanism. On the other hand, pain hypersensitivity is a prognostic factor in pain rehabilitation. It is clinically important to detect and manage hypersensitivity responses and their mechanisms.

Conclusion:

Since somatosensory perception and integration are recognized as a contributor to the pain perception under the theory, then we can use the model to direct interventions aimed at pain relief. The pain theory should be leveraged to develop and refine measurement tools with clinical utility for detecting and monitoring hypersensitivity linked to chronic pain mechanisms.

“Pain is as elemental as fire or ice. Like love, it belongs to the most basic human experiences that make us who we are.” (Morris 1993, 1)

Pain Theory -NCBI Paper NBK545194

Lindsay A. Trachsel; Sunil Munakomi; Marco Cascella.

Last Update: April 17, 2023.

Definition/Introduction

An individual’s capacity to feel pain is an essential component of the body’s ability to heal. Pain is the body’s way of telling us there is an injury, and we need to do something about it to ensure that healing occurs. An important consideration when talking about pain is the fact that one patient’s pain is not the same as another patient’s pain, even if they have experienced similar injuries. Pain perception, indeed, is a subjective experience, influenced by complex interactions of biological, psychological, and social factors.

Although inflammation and pain are an essential part of healing (acute pain), in some circumstances, they can lead to negative effects. Several mechanisms involving the activation of peripheral and central sensitization pathways through the sensitization of peripheral nociceptors, and alterations in spinal dorsal horn neurons, and central nervous system (CNS) brain areas, can trigger a pathogenetic cascade that ends with the development of chronic pain. Again, pieces of evidence suggest the paramount role of the environment (i.e., epigenetic) and genetics. Thus, the chronicity of pain is the effect of changes in pain processing through transcription and transduction processes. As a consequence, chronic pain is no longer simply a symptom but becomes itself a disease. Currently, in the United States, estimates are that 100 million individuals suffer from the negative effects of protracted courses of pain and inflammation.  This epidemic is growing at an alarmingly fast rate and is taking a significant toll on the economy as well as patients and providers. In fact, there are reports that the cost for chronic pain patients is anywhere between 560 to 635 billion dollars annually. Furthermore, increased opioid prescription and use, until opioid addiction in the United States and Canada is a dramatic phenomenon that has been responsible for up to 70.000 drug overdose deaths, in 2017. Although it appears that in other countries (e.g., Western Europe) the data is not so alarming.

The underlying foundations of pain perception (and its processing) represent a field of study that has interested researchers for centuries. Throughout the history of medicine, several theories have been proposed to explain why and how individuals feel the pain they feel. Although the beliefs about where the pain originates have varied throughout the years, the desire to elucidate this phenomenon has led to the proposal of many different philosophies. The pain theories that this activity will discuss below include the intensity theory, Cartesian dualism theory, specificity theory, pattern theory, gate control theory, neuromatrix model, and biopsychosocial. The topic has not only historical and didactic interests but involves important practical and therapeutic implications.

Issues of Concern

Intensity pain theory

Intensity Theory

The theory goes back to the Athenian philosopher Plato (c. 428 to 347 B.C.) who in his work Timaeus, defined pain not as a unique experience, but as an ’emotion’ that occurs when the stimulus is intense and lasting. Centuries later, we are aware that especially chronic pain represents a dynamic experience, profoundly changeable in a spatial-temporal manner. A series of experiments, conducted during the nineteenth century, sought to establish the scientific basis of the theory. These investigations, based on the tactile stimulation and impulses of other nature such as electrical stimulations, provided important information concerning the threshold for tactile perceptions and the role of the dorsal horn neurons in the transmission/processing of pain.

Descartes and dualism

Cartesian Dualistic Theory

The oldest explanation for why pain manifested in specific populations was rooted in religious beliefs. Throughout history, religious ideologies have had a substantial influence on people’s thoughts and actions. As a result, the majority of people believed that pain was the consequence of committing immoral acts. There was also a belief that the suffering they endured was the individual’s way to repent for these sins.  Although this belief remained popular up until the nineteenth century, this was not due to the lack of other available theories. One of the first alternative scientific pain theories was bravely introduced in 1644 by the French philosopher Renee Descartes (1596-1650). This theory has the name in current literature as the Cartesian dualism theory of pain. The dualism theory of pain hypothesized that pain was a mutually exclusive phenomenon. Pain could be a result of physical injury or psychological injury. However, the two types of injury did not influence each other, and at no point were they to combine and create a synergistic effect on pain, hence making pain a mutually exclusive entity.  In an attempt to placate the church, Descartes also included in his theory the idea that pain has a connection to the soul. He claimed that his research uncovered that the soul of pain was in the pineal gland, consequentially designating the brain as the moderator of painful sensations. The dualistic approach to pain theory fails to account for many factors that are known to contribute to pain today. Furthermore, it lacks an explanation as to why no two chronic pain patients have the same experience with pain even if they had similar injuries. Despite these shortcomings, it still provided future researchers with a solid foundation to continue expanding the scientific understanding of the intricate phenomenon of pain.

Specificity pain theory

Specificity Theory

Many scientists continued to do research long after Descartes proposed the dualistic theory of pain. However, it wasn’t until 1811 that another well-known pain theory came onto the scene. This theory, initially presented by Charles Bell (1774–1842), is referred to as the specificity theory. This theory is similar to Descartes’ dualistic approach to pain in the way that it delineates different types of sensations to different pathways. In addition to the identification of specific pathways for different sensory inputs, Bell also postulated that the brain was not the homogenous object that Descartes believed it was, but instead a complex structure with various components.  Scientists and philosophers alike spent the next century and a half further developing the specificity theory. One of the many contributors to this theory was Johannes Muller. In the mid-1800s, Muller published in the Manual of Physiology that individual sensations were the result of specific energy experienced at certain receptors. Furthermore, Muller believed that there was an infinite number of receptors in the skin, and this surplus of receptors accounted for the ability of an individual to discriminate between different sensations.  In 1894, Maximillian von Frey made another critical addition to the specificity theory that served to advance the concept. This contribution to the theory was the discovery of the four separate somatosensory modalities found throughout the body. These sensations include cold, pain, heat, and touch.  This concept correlates well with previous research done regarding this theory of pain, which served to reiterate the presence of distinct pathways for different sensations. Although this theory and the research surrounding it provided significant advancement to the understanding of pain, it still fails to account for factors other than those of physical nature that result in the sensation of pain. Much like the dualistic approach to pain, this theory also lacks an explanation for why sometimes pain persists long after the healing of the initial injury. This incomplete nature of the specificity theory regarding pain etiology necessitated additional theories and continued research.

Pain theory

Pattern Theory

Following the specificity theory, there were a handful of other philosophies introduced regarding the sensation of pain. Of these philosophies, the pattern theory of pain has the greatest coverage in the scientific literature. The American psychologist John Paul Nafe (1888-1970) presented this theory in 1929. The ideas contained in the pattern theory were directly opposite to the ideas suggested in the Specificity theory in regards to sensation. Nafe indicated that there are no separate receptors for each of the four sensory modalities. Instead, he suggested that each sensation relays a specific pattern or sequence of signals to the brain. The brain then takes this pattern and deciphers it. Depending on which pattern the brain reads, correlates with the sensation felt.  At the time of its introduction, the pattern theory gained significant popularity among many researchers. However, through further research and the discovery of unique receptors for each type of sensation, it can be stated with certainty, that this theory is an inaccurate explanation for how we feel pain.

Gate Control Theory

In 1965, Patrick David Wall (1925–2001) and Ronald Melzack announced the first theory that viewed pain through a mind-body perspective. This theory became known as the gate control theory.  Melzack and Wall’s new theory partially supported both of the two previous theories of pain but also presented more knowledge to advance the understanding of pain further. The gate control theory of pain states that when a stimulus gets sent to the brain, it must first travel to three locations within the spinal cord. These include the cells within the substantia gelatinosa in the dorsal horn, the fibers in the dorsal column, and the transmission cells which are located in the dorsal horn as well.  The substantia gelatinosa of the spinal cord’s dorsal horn serves to modulate the signals that get through, acting similar to a “gate” for information traveling to the brain. The sensation of pain that an individual feels is the result of the complex interaction among these three components of the spinal cord. Simply stated, when the “gate” closes, the brain does not receive the information that is coming from the periphery to the spinal cord. However, when the signal traveling to the spinal cord reaches a certain level of intensity, the “gate” opens. Once the gate is open, the signal can travel to the brain where it is processed, and the individual proceeds to feel pain. The information mentioned above accounts for the physical component of pain, but as stated earlier, the Gate Control Theory was one of the first to acknowledge that psychological factors contributed to pain as well. In their original study, Melzack and Wall suggested that in addition to the control provided by the substantia gelatinosa, there was an additional control mechanism located in cortical regions of the brain.  In more recent times, researchers have postulated that these cortical control centers are responsible for the effects of cognitive and emotional factors on the pain experienced. Current research has also suggested that a negative state of mind serves to amplify the intensity of the signals sent to the brain as well.  For example, somebody who is depressed has a “gate” that is open more often, allowing more signals to get through, increasing the probability that an individual will experience pain from an otherwise normal stimulus. Also, there are reports that certain unhealthy lifestyle choices will also result in an “open gate,” which in turn leads to pain that is disproportionate to the stimulus.  The gate control theory has proven to be one of the most significant contributions to the study of pain throughout history. The concepts that Melzack and Wall introduced to the study of pain are still utilized by researchers today. Even though this theory initiated the idea that pain wasn’t solely a result of physical injury but rather a complex experience, influenced by cognitive and emotional factors, there was still additional research necessary to comprehend the mechanisms and etiology of pain completely. This need precipitated the introduction of the following two philosophies regarding pain.

Neuromatrix pain theory

Neuromatrix Model

Almost thirty years after introducing the gate control theory of pain, Ronald Melzack introduced another model that contributed to the explanation of how and why people feel pain. Until the mid-1900s, most theories of pain implied that this experience was exclusively due to an injury that had occurred somewhere in the body. The thinking was that if an individual suffered an injury, whether it be through trauma, infection, or disease, a signal would transmit to the brain which would, in turn, result in the sensation of pain. Although Melzack had contributed to these previous theories, it was his exposure to amputees that were experiencing phantom limb pain in well-healed areas that prompted his inquiry into this more accurate philosophy of pain. The theory he proposed is known as the neuromatrix model of pain. This philosophy suggests that it is the central nervous system that is responsible for eliciting painful sensations rather than the periphery.  The neuromatrix model denotes that there are four components within the central nervous system responsible for creating pain. The four components are the “body-self neuromatrix, the cyclic processing, and synthesis of signals, the sentinel neural hub, and the activation of the neuromatrix.”  According to Melzack, the neuromatrix consists of multiple areas within the central nervous system that contribute to the signal, which allows for the feeling of pain. These areas include the spinal cord, brain stem and thalamus, limbic system, insular cortex, somatosensory cortex, motor cortex, and prefrontal cortex. The signal that these areas of the central nervous system work together to create is responsible for allowing an individual to feel pain, and he referred to as the “neurosignature.” Furthermore, this theory states that input coming in from the periphery can initiate or influence the neurosignature, but these peripheral signals cannot create a neurosignature of their own. This idea that peripheral signals can alter the neurosignature is an important concept when considering the effect that nonphysical factors have on an individual’s experience with pain. Melzack’s theory claimed that not only are there specific neurosignatures that elicit certain sensations, but when there is an alteration in a certain signal, this allows for memory formation of these particular experiences.  If the same circumstances occur again in the future, it is this memory that allows for the same sensation to be felt. In addition to the hypothesis that pain was a product of different patterns of signals from the central nervous system, the neuromatrix model continued to elaborate on the idea that was initially brought forward in the gate control theory, that pain can be affected not only by physical factors but by cognitive and emotional factors. Melzack suggested that hyperactivity of the stress response has a direct effect on pain. Hyperactivity of the stress response is when an individual exposed to increased levels of stress experiences a higher level of pain. Taking all of these claims into consideration, it is evident that pain is a complex issue that cannot be accounted for by physical factors alone. Even though the neuromatrix model further established the idea that pain gets influenced by cognitive and emotional factors as well as physical factors, it still fails to account for social constructs of pain. Therefore, a new theory of pain must be utilized to appropriately explain the mechanism behind pain and why each individual’s experience with pain is unique.

Biopsychosocial Model

The biopsychosocial model provides the most comprehensive explanation behind the etiology of pain. This specific theory of pain hypothesizes that pain is the result of complex interactions between biological, psychological, and sociological factors, and any theory which fails to include all of these three constructs of pain, fails to provide an accurate explanation for why an individual is experiencing pain.  Although the term biopsychosocial was not introduced until 1954 by Roy Grinker (1900-1993), a neurologist and psychologist, there have been many physicians who had considered the utility of using such a model to approach the management of a patient’s pain long before this.  One of the most prominent physicians who utilized this more comprehensive approach to pain was John Joseph Bonica (1917-1994), a Sicilian American anesthesiologist at Madigan Army Hospital, known as the founding father of the discipline of pain medicine. In the 1940s, Bonica was caring for many patients who had returned home from World War II and were now experiencing debilitating pain due to injuries they had suffered in the war. He had recognized that the pain these wounded soldiers were experiencing was rather complex and not easily managed. This situation led him to propose that to adequately manage these patients, physicians needed to create interprofessional pain clinics comprising multiple disciplines.  At this moment in history, there was little support for the idea that pain was more than just the result of an injury, and Bonica was relatively unsuccessful in establishing these clinics. It wasn’t until 1977 that the biopsychosocial model was scientifically suggested as an explanation for the etiology of some medical conditions. George Engle claimed that to treat disease adequately, one must consider multidimensional concepts and manage the whole patient instead of focusing on a single issue. This methodology takes into account that the human body cannot be divided into separate categories when considering treatment options. Instead, it is beneficial to acknowledge the fact that illness and disease are the results of complex interactions between biological, psychological, and sociological factors, and they all affect an individual’s physical and mental well-being.  Although Bonica had technically been the first physician to comprehend the importance of using a biopsychosocial approach to pain, John D. Loeser, another anaesthesiologist, has been credited as the first person to use this model in association with pain.  Loeser suggested that four elements need to be taken into consideration when evaluating a patient with pain. These elements include nociception, pain, suffering, and pain behaviours. Nociception is the signal that is sent to the brain from the periphery to alert the body that there is some degree of injury or tissue damage. Pain, on the other hand, is the subjective experience that occurs after the brain has processed the nociceptive input. The last two components of pain that merit consideration is suffering and pain behaviours. The thinking is that suffering is an individual’s emotional response to the nociceptive signals and that pain behaviours are the actions that people carry out in response to the experience of pain. Both of these can be either conscious or subconscious.  Loeser’s four elements of pain account for the biological, psychological, and sociological factors that can create or influence an individual’s experience with pain. Failing to consider any one of these four elements when determining the cause or establishing a management plan could be a consideration as inadequate assessment or care. With a better understanding of what is causing a patient to experience pain, the doctor is provided with a more accurate foundation to begin formulating a treatment plan. Loeser’s findings prove that the Biopsychosocial Model of pain offers the most comprehensive philosophy and provides the framework that is needed to start appropriate therapy to manage patients with chronic pain adequately.

Clinical Significance

Pain is the result of complex interactions between biological, psychological, and sociological factors that individuals experience, with no two individuals’ experiences being the same. It makes sense that an individual’s treatment approach should align with what it is treating. An appropriate method of treating pain must be multidimensional and tailored to individual experience. Utilizing the biopsychosocial model to treat chronic pain allows health practitioners to do just that. This model has been proven to have superior outcomes in terms of increased patient satisfaction and a better degree of restoration of functionality. In addition to this, it also is shown to be a more cost-effective method of treating patients with chronic pain, compared to other commonly used treatment plans. When taking all of this into consideration, it becomes quite evident that an interprofessional biopsychosocial model for the management of chronic pain should be the standard of care for all patients. Ethically speaking, when a means of decreasing a patient’s suffering exists, it should be utilized to its fullest capacity.

Addressing a patient who is suffering from chronic pain using a biopsychosocial approach provides the physician with the knowledge that is necessary to treat all factors contributing to pain instead of only treating the pain itself. There are multiple advantages to utilizing this type of model to address pain. One of the most critical benefits seen in clinics when this model is in use is a higher success rate in terms of increased functional capacity and patient satisfaction. This type of treatment focuses not on curing the problem but instead on gaining back maximal functional capacity. Certain specialties need to be included in a biopsychosocial treatment plan when managing patients with chronic pain to achieve this goal. These mandatory specialties include a primary care physician, psychiatrist or psychologist, physical therapist, occupational therapist, and sometimes a disability case manager. Multiple research studies evaluating the effectiveness of this approach have continuously shown that, versus other more traditional methods of managing pain, the biopsychosocial approach to pain allows for greater restoration of functionality. This type of treatment provides the patients with the tools that they need to take control of their pain, as opposed to letting their pain control them.

In addition to better outcomes and increased patient satisfaction, a biopsychosocial approach to pain management would serve to reduce the financial costs associated with caring for chronic pain patients. Research has been conducted comparing an interprofessional biopsychosocial pain management protocol to alternative methods.  All the studies have come to the same conclusion: an interprofessional approach to pain management is 21 times more cost-effective compared to other methods. This reduction in cost can be attributed to a decreased need for pain medication, reduced calls for health care, and emergency room visits, and decreased disability payments. In a country where 17.5% of gross domestic product gets spent on health care, it would only be logical to implement methods that help to reduce some of this financial burden, and that is why applying an interprofessional approach to pain management is the obvious solution.

The Biopsychosocial Model is the only theory of pain that provides the most comprehensive explanation as to why people have pain as well as the unique nature of each patient’s experience. With chronic pain now considered a public health crisis, clinicians must alleviate suffering by trying all means possible instead of continuously using old methods that have been shown to be ineffective. In proceeding with future research on the concept of pain and its management, clinicians must maintain this biopsychosocial approach and continue to preserve the words of Aristotle, who was ahead of his time, in saying that “pain is quality of all senses.” Even with the availability of these new comprehensive approaches, it remains challenging to effectively manage pain and therefore, will continue to be a topic of future research.

References

1.
Cascella M, Thompson NS, Muzio MR, Forte CA, Cuomo A. The underestimated role of psychological and rehabilitation approaches for management of cancer pain. A brief commentary. Recenti Prog Med. 2016 Aug;107(8):418-21. [PubMed]
2.
Spofford CM, Brennan TJ. Gene expression in skin, muscle, and dorsal root ganglion after plantar incision in the rat. Anesthesiology. 2012 Jul;117(1):161-72. [PMC free article] [PubMed]
3.
Cascella M, Muzio MR. Pain insensitivity in a child with a de novo interstitial deletion of the long arm of the chromosome 4: Case report. Rev Chil Pediatr. 2017 Jun;88(3):411-416. [PubMed]
4.
Miceli L, Bednarova R, Rizzardo A, Cuomo A, Riccardi I, Vetrugno L, Bove T, Cascella M. Opioids prescriptions in pain therapy and risk of addiction: a one-year survey in Italy. Analysis of national opioids database. Ann Ist Super Sanita. 2018 Oct-Dec;54(4):370-374. [PubMed]
5.
Chen J. History of pain theories. Neurosci Bull. 2011 Oct;27(5):343-50. [PMC free article] [PubMed]
6.
Perl ER. Pain mechanisms: a commentary on concepts and issues. Prog Neurobiol. 2011 Jun;94(1):20-38. [PMC free article] [PubMed]
7.
Moayedi M, Davis KD. Theories of pain: from specificity to gate control. J Neurophysiol. 2013 Jan;109(1):5-12. [PubMed]
8.
Bernhard Naunyn (1839-1925), clinician, teacher, scientist. JAMA. 1969 May 19;208(7):1182-3. [PubMed]
9.
Dedeli O, Kaptan G. Spirituality and Religion in Pain and Pain Management. Health Psychol Res. 2013 Sep 24;1(3):e29. [PMC free article] [PubMed]
10.
Duncan G. Mind-body dualism and the biopsychosocial model of pain: what did Descartes really say? J Med Philos. 2000 Aug;25(4):485-513. [PubMed]
11.
Mehta N. Mind-body Dualism: A critique from a Health Perspective. Mens Sana Monogr. 2011 Jan;9(1):202-9. [PMC free article] [PubMed]
12.
Pearce JM. Von Frey’s pain spots. J Neurol Neurosurg Psychiatry. 2006 Dec;77(12):1317. [PMC free article] [PubMed]
13.
Melzack R. Evolution of the neuromatrix theory of pain. The Prithvi Raj Lecture: presented at the third World Congress of World Institute of Pain, Barcelona 2004. Pain Pract. 2005 Jun;5(2):85-94. [PubMed]
14.
Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965 Nov 19;150(3699):971-9. [PubMed]
15.
Ropero Peláez FJ, Taniguchi S. The Gate Theory of Pain Revisited: Modeling Different Pain Conditions with a Parsimonious Neurocomputational Model. Neural Plast. 2016;2016:4131395. [PMC free article] [PubMed]
16.
Garland EL. Pain processing in the human nervous system: a selective review of nociceptive and biobehavioral pathways. Prim Care. 2012 Sep;39(3):561-71. [PMC free article] [PubMed]
17.
Nijs J, D’Hondt E, Clarys P, Deliens T, Polli A, Malfliet A, Coppieters I, Willaert W, Tumkaya Yilmaz S, Elma Ö, Ickmans K. Lifestyle and Chronic Pain across the Lifespan: An Inconvenient Truth? PM R. 2020 Apr;12(4):410-419. [PubMed]
18.
Senba E, Kami K. A new aspect of chronic pain as a lifestyle-related disease. Neurobiol Pain. 2017 Jan-Jul;1:6-15. [PMC free article] [PubMed]
19.
Melzack R. Pain and the neuromatrix in the brain. J Dent Educ. 2001 Dec;65(12):1378-82. [PubMed]
20.
Meints SM, Edwards RR. Evaluating psychosocial contributions to chronic pain outcomes. Prog Neuropsychopharmacol Biol Psychiatry. 2018 Dec 20;87(Pt B):168-182. [PMC free article] [PubMed]
21.
Jensen MP, Turk DC. Contributions of psychology to the understanding and treatment of people with chronic pain: why it matters to ALL psychologists. Am Psychol. 2014 Feb-Mar;69(2):105-18. [PubMed]
22.
Ghaemi SN. The rise and fall of the biopsychosocial model. Br J Psychiatry. 2009 Jul;195(1):3-4. [PubMed]
23.
Lugg W. The biopsychosocial model – history, controversy and Engel. Australas Psychiatry. 2022 Feb;30(1):55-59. [PubMed]
24.
Sen S, Martin DP, Bacon DR. Exploring origins: was John Bonica’s model of modern-day pain management influenced by John Lundy’s earlier work? Reg Anesth Pain Med. 2007 May-Jun;32(3):258-62. [PubMed]
25.
Loeser JD, Melzack R. Pain: an overview. Lancet. 1999 May 08;353(9164):1607-9. [PubMed]
26.
Peng P, Stinson JN, Choiniere M, Dion D, Intrater H, LeFort S, Lynch M, Ong M, Rashiq S, Tkachuk G, Veillette Y., STOPPAIN Investigators Group. Role of health care professionals in multidisciplinary pain treatment facilities in Canada. Pain Res Manag. 2008 Nov-Dec;13(6):484-8. [PMC free article] [PubMed]
27.
Sokol RG, Pines R, Chew A. Multidisciplinary Approach for Managing Complex Pain and Addiction in Primary Care: A Qualitative Study. Ann Fam Med. 2021 May-Jun;19(3):224-231. [PMC free article] [PubMed]
28.
Mescouto K, Olson RE, Hodges PW, Setchell J. A critical review of the biopsychosocial model of low back pain care: time for a new approach? Disabil Rehabil. 2022 Jun;44(13):3270-3284. [PubMed]
29.
Darnall BD, Carr DB, Schatman ME. Pain Psychology and the Biopsychosocial Model of Pain Treatment: Ethical Imperatives and Social Responsibility. Pain Med. 2017 Aug 01;18(8):1413-1415. [PMC free article] [PubMed]

Disclosure: Lindsay Trachsel declares no relevant financial relationships with ineligible companies.

Disclosure: Sunil Munakomi declares no relevant financial relationships with ineligible companies.

Disclosure: Marco Cascella declares no relevant financial relationships with ineligible companies.

Copyright © 2023, StatPearls Publishing LLC.
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Despite Pain Blog – Talking About Pain

We know there are thousands of people living with trigeminal neuralgia but often their voices go unheard.

However there are pain warriors who are gifted writers, and share their experiences so others may benefit.  Liz the creator of Despite Pain Blog writes about her life with the aim of providing encouragement, education and support and welcomes sharing her thoughts.

Welcome to Despite Pain

Thank you for visiting my blog. My name is Liz and I’ve been living with a few painful conditions for many years so I know first-hand what it’s like to live with chronic pain. You can find a bit more about me here.

 

Learning to Listen to Your Body When You’re in Pain

Liz slso posts to Instagram  Facebook and Pinterest

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Should You Stop Talking About Your Pain?

Should You Stop Talking About Your Pain?

Getting pain under control starts by talking about it differently—and less.

Posted April 9, 2021 Reviewed by Devon Frye

KEY POINTS

  • The language we use in both words and thoughts plays a key role in how the brain processes information and produces pain.
  • We often mistake symptoms that occur when the brain senses a threat—including pain—for a disease or disorder.
  • Healthcare providers unknowingly can increase a person’s concern about their health and well-being by using alarmist or hopeless language.
  • Reducing the sense of threat in the brain—and thus the pain itself—can start by simply changing how people talk about pain.

We love to share our struggles with others, get support, and feel understood. That is a good thing, right?

It depends. Talking about pain keeps pain at the center of our attention, which in turn keeps our brain in threat mode. When the brain senses a threat, increased pain may be the result. Luckily, this downward cycle toward pain can easily be stopped.

Why Pain Education Matters

A central part of pain rehabilitation is providing education to pain patients and their families. Chronic pain not only impacts the individual who is hurting, but it also impacts family, friends, and coworkers as well.

Most people share common misunderstandings about chronic pain—they picture that an injury, mechanical problem, or disorder has taken over a person’s life and is producing unmanageable pain. This misconception leads to a great deal of “pain talk.”

Chronic pain sufferers often talk about their pain levels, latest injections, doctor visits, and surgeries. Friends and family ask about sleep problems, medications, treatments, and therapies. Everyone feels bad that so little can be done to manage pain and worries about the wellbeing of the pain sufferer. This is understandable but not helpful.

What “Pain Talk” Does to the Brain

Pain neuroscience education begins by helping people understand the role of language in how the brain processes information and produces pain. As our brain monitors our peripheral nervous system, it is collecting evidence for danger and evidence of safety. The brain weighs available evidence to determine if there is truly a threat that requires it to produce a protective response.

The brain’s protective response might be pain, but it could be any number of rsponses. Common ways the brain says, “Something is wrong,” might be a tremor, non-epileptic seizure, stomachache, headache, dizziness, hives, nausea, blurred vision, muscle tightness, heart palpitation, chest pain, or a muscle twitch.

We often mistake symptoms that occur when the brain senses a threat for a disease or disorder. Chronic pain is often the result of an overactive nervous system that is constantly sensing a threat and producing pain even though pain would provide no help or protection. Chronic pain is thus not necessarily a disease or disorder that can be treated directly with medical intervention.

Healthcare providers unknowingly can increase a person’s concern about their health and well-being by the language that they use when talking with patients. Here are some common medical statements our brain would use as evidence for danger:

  • Your MRI is abnormal.
  • This is the worst case I have ever seen.
  • I am surprised you can still walk.
  • Strong medication hardly seems to touch your pain.
  • You have degenerative disc disease.
  • Your mother had the same problem. It runs in your family.
  • You are going to eventually need more surgery.
  • You need to start using a cane or walker to get around.

These statements are viewed by the brain as evidence for danger. When people have chronic pain, their brain lacks a good collection of credible evidence for safety. They have few reasons to believe that they should not be in pain, few reasons to believe that movement doesn’t cause harm, and few reasons to believe they can learn to manage their pain effectively.

How to Change the Conversation Around Pain

Reducing the sense of threat in the brain can start by simply changing how people talk about pain. The goal of changing how we talk about pain is to get our attention off pain and on to the direction we want to be moving with our life despite pain.

James Hudson, M.D., a chronic pain specialist, provides new chronic pain patients with two simple instructions written out on his prescription pad. He wants pain patients to change how they talk and how they think about pain.

The first prescription is simple: “Stop talking about pain.” People ask pain sufferers about pain all the time, but the pain patient needs to learn to redirect questions to focus on other aspects of life. They might say, “Thanks for asking. I’d rather not talk about pain anymore. I’d be happy to tell you what I have planned for this week.”

The second prescription is similar: “Stop exaggerating about your pain to others or even when talking to yourself.” We often use extreme language when referring to pain, such as, “This pain is killing me,” or “My pain is at a level 12 out of 10 right now.” This type of language only reinforces the idea that there is an extreme threat; when the brain senses there is a threat, it will often protect you by producing more pain.

When patients bring these two instructions home, it takes a while to retrain friends, family, and coworkers. Friends and family are often anxious and worried, which is why they ask about pain. But if the topic of conversation changes, the results are often dramatic. After years of starting conversations focused on their pain, pain patients begin to talk about things that are meaningful, hopeful, and enjoyable. They focus on what they can do, not what they can’t do.

As minor as these changes may seem, the language we use every day affects how the brain views and produces pain. You can start today by telling your friends and family that you appreciate their concern, but it’s time to start a new conversation, one that is focused on growth, hope, and a better future.

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President’s Monthly Musings – Feb 2023 Search for Hope

This month has been a big one in our household.  Patrick’s pain on both sides of his face is back with a vengeance.  The gamma knife treatment he had back in 2021 had kept the pain at bay but now it is back.

We all know how debilitating this awful condition is, and the utter helplessness of family members who really do spend days looking for that mystical unicorn with a magic wand.  The zombie scrolling through google desperately searching for new treatments, or research, or ideas in the search for hope.

Our circumstances like many others, means we are reliant on the public health system, we took early retirement when Patrick’s condition was still undiagnosed and impacting his ability to work.   Private health costs had escalated, our superannuation fund, which we are reliant on, had been smashed, by first the GFC, and then the COVID years smashed it a bit more.

We are not unique.  We hear many stories from members how the condition has impacted their working life and that they find themselves on the treadmill of seeking diagnosis and treatment and hope, all the while trying to manage their precarious financial situation.  TN is not classed as a disability in Australia and even the Insurance Giants have no knowledge of the condition.

Part of our Vision is to raise awareness – trigeminal neuralgia is rare, most people have no idea such a condition exists.

This month is Rare Disease Awareness Month – we need to raise the profile of the condition – see our article about what you can do to highlight trigeminal neuralgia in February

Rare Disease Day February 28th 2023 – Trigeminal Neuralgia Association Australia (tnaaustralia.org.au)

The association wrote to the Queensland Health Minister, to request a meeting – see correspondence below

Nov 8 2022

Good Morning

I am the current president of Trigeminal Neuralgia Association Australia.

Our organisation has been supporting people suffering from trigeminal neuralgia for 20 years.

The WHO has recently recognised TN as a disability but there is very little awareness of the condition within Australia.

We are run entirely by volunteers and support sufferers with face to face, online and phone support group meetings.

It is extremely difficult getting stats within Australia about how many people actually suffer from the condition.  Sufferers often have to leave work because the pain is too hard to manage, which is a huge economic blow for them personally and of course our countries economy.

I would like to start a conversation about how we can help our sufferers, with better access to medical care, more training for neurologists, more neurologists, better pain management, stop the huge number of misdiagnosis and disability avenues etc.

I don’t really know the best first step, so I am hopeful, you can help us to make a difference.

See our website for further info

https://tnaaustralia.org.au/

I am sure you receive many submissions, but I am hopeful of a reply.

**********

Feb 17 2023

Good afternoon Lyn,

Thank you for your email dated on 8 November to the Honourable Yvette D’Ath MP, Minister for Health and Ambulance Services and Leader of the House requesting to meet.

Apologies for the delay in responding. Unfortunately, due to a heavily committed schedule the Minister is unable to meet. She has asked Julieanne Gilbert MP, Assistant Minister for Health to meet with you on her behalf.

The Assistant Minister’s office will be in contact with you shortly to arrange a time to meet via telephone. In the meantime, should you need to contact her office please email: assistantminister.health@ministerial.qld.gov.au.

If you no longer require the meeting, please advise the Assistant Minister’s office.

Kind regards,

All state governments run the health offering within their state.  We need to get all of the State Health Ministers on board to create a guideline for diagnosis and treatment of trigeminal neuralgia.

What else can you do to raise awareness about Trigeminal Neuralgia?

Last year we lit up landmarks in 11 cities on International Trigeminal Neuralgia Awareness Day October 7th.  This year we want to achieve much more but our volunteer base is very small.  I am asking that each of you read the article about what you can do to Light Up In Teal in 2023.

International Trigeminal Neuralgia Awareness Day – Light Up In Teal 2023 – Trigeminal Neuralgia Association Australia (tnaaustralia.org.au)

Direct involvement by members to nominate the next committee – we need volunteers

Lastly, my tenure as President has nearly run its course with our AGM scheduled for April 1st 2023, which will be conducted as a zoom meeting.  You can read the information about the committee nomination process in the link below and I encourage you all to make a nomination online, consider volunteering and at the very least, add the AGM date to your calendar and be involved in the meeting.

Nominate Your Committee – Trigeminal Neuralgia Association Australia (tnaaustralia.org.au)

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Pain and me – Tamar Pincus

This video provides a wonderful visual depiction of a personal interpretation of acceptance of chronic pain created by Professor Tamar Pincus.

Tamar Pincus is a Professor in Health Psychology at The University of Southampton, where she is also Dean of the faculty of the environment and life sciences. Until 2022 she was a Professor and Executive Dean at Royal Holloway, University of London. She has led the Research Centre for the study of Pain and Well-Being at Royal Holloway. Her research spans experiment approaches to explore psychological mechanisms in pain, observation studies to measure risk over time, trials to test effectiveness, and qualitative work, to examine the thoughts and beliefs of people living with pain and those who are part of their life. Examples include investigations of cognitive biases in people living with pain; the psychological predictors for poor outcome in low back pain, and the study of clinicians’ beliefs and behaviours and their effect on patients with pain, especially in reference to effective reassurance and return to work.

 

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Biopsychosocial Model and Occupational Therapy

Pete Moore runs the Pain Toolkit organisation in the UK and talks in this session about biopsychosocial occupational therapy.

This conversation is  with Bronnie Thompson, who is an occupational therapist.  Bronnie talks about how an OT can help a person dealing with chronic pain, manage their day to to day lives, incorporating psychology and physiotherapy and pain management.

It is an important issue which often gets overlooked.

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3.7 Motor Cortex Stimulation

FACIAL PAIN: A 21st CENTURY GUIDE For People with Trigeminal Neuralgia Neuropathic Pain 3.7  Motor Cortex Stimulation Olga Khazen, BS and Julie G. Pilitsis, MD, PhD Not all facial pain is TN. This is a common mantra of experienced physicians to their trainees. How to differentiate between TN, especially TN type 2 and trigeminal neuropathic […]
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How Intractable Pain Causes Brain Tissue Loss

By Dr. Forest Tennant, PNN Columnist -August 09 2

The brain not only controls pain but the endocrine, cardiovascular, metabolic, respiratory and gastrointestinal systems. Any or all of these biologic systems may malfunction if there is brain tissue loss.

Beginning in 2004, brain scan studies began to document that brain tissue loss can be caused by intractable pain. Today, almost 20 years later, this important fact appears to be either unknown or a mystery to both the public and medical professionals.

Basic science researchers have unravelled the complex process of how and why this pathological phenomenon may occur. A good understanding of how this pathology develops is critical to properly care for and treat persons who develop intractable pain whether due to a disease or an injury.

What Causes Tissue Loss?

Tissue loss anywhere in the body is caused by inflammation, autoimmunity, or loss of blood supply due to trauma or disease. The brain scan studies done since 2004 that documented brain tissue loss were not done in persons who had a stroke or head trauma, but in pain patients experiencing inflammation and autoimmunity (i.e., collagen deterioration). It turns out that both biologic mechanisms may operate to cause brain tissue loss in intractable pain patients.

In the pursuit of understanding brain tissue loss and its accompanying malfunctions, it has been discovered that the brain and spinal cord (central nervous system or CNS) contain cells called microglia. They are closely akin to the immune protective cells in the blood stream which are called a “lymphocytes.”

The microglia in the CNS lay dormant until a harmful infection, toxin or bioelectric magnetic signal enters its domain, at which time it activates to capture and encapsulate the danger or produce inflammation to destroy the offender.

If the microglia are overwhelmed by some danger, such as a painful disease that isn’t cured, it produces excess inflammation that destroys some brain tissue which can be seen on special brain scans. Some viruses such as Epstein Barr may hibernate in microglia cells and create an autoimmune response, which magnifies inflammation and brain tissue loss.

Intractable pain diseases such as adhesive arachnoiditis (AA), reflex sympathetic dystrophy (CRPS/RSD), and genetic connective tissue diseases such as Ehlers-Danlos syndrome may incessantly produce toxic tissue particles and/or bioelectromagnetic signals that perpetuate microglial inflammation, tissue loss and CNS malfunctions.

This is the reason why proper pain management must have two targets: the pain generator and CNS inflammation.

How To Know You Have Lost Brain Tissue

If your pain is constant and never totally goes away, it means you have lost some brain tissue and neurotransmitters that normally shut off pain. If you have episodes of sweating, heat or anxiety, you probably have inflammation that is flaring. Naturally, if you feel you have lost some reading, calculating or memory capacity, it possibly means you have lost some brain tissue. MRI’s may also show some fibrous scars.

Fortunately, studies show that if a painful disease or injury is cured or reduced, brain tissue can regenerate. While we can’t guarantee that brain tissue will be restored, we offer here our simple, immediate and first step recommendations using non-prescription measures.

First, do you know the name and characteristics of the disease or injury that is causing your pain? Are you engaging in specific treatments to reduce or even cure your disease, or are you simply taking symptomatic pain relief medications?

Start at least two herbal-botanical agents that have some clinical indications that they reduce inflammation in the brain and spinal cord: serrapeptase – palmitoylethanolamide (PEA) and astragalus-curcumin-luteolin-nanokinase. You can take different agents on different days.

Increase the amount of protein (meat, fish, poultry, eggs) in your diet. Consider a collagen supplement. Limit starches and sugars.

Start taking these vitamins and minerals:

  • Vitamin C – 2,000mg in the AM & PM

  • Vitamin B-12, Vitamin D

  • Minerals: Magnesium and selenium

We recommend vitamins daily and minerals 3 to 5 days a week.

The above will help you stop additional tissue loss and hopefully regenerate brain tissue.

Forest Tennant, MD, DrPH, is retired from clinical practice but continues his research on the treatment of intractable pain and arachnoiditis. This column is adapted from bulletins recently issued by the Arachnoiditis Research and Education Project and the Intractable Pain Syndrome Research and Education Project.

The Tennant Foundation gives financial support to Pain News Network and sponsors PNN’s Patient Resources section.

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Presentation by Karen Smith – Her experiences living with Chronic Pain

Karen Smith advocates for chronic pain sufferers in Canada, and shares her personal story in this presentation.

In this video she describes the impact on her, from other peoples reaction to her, when she discloses she lives with chronic pain.  In her case she suffers from a debilitating back injury, but I think her observations are true for all sufferers of invisible chronic pain conditions



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3.2 Microvascular Decompression: Attacking the Root of the Problem

FACIAL PAIN: A 21st CENTURY GUIDE For People with Trigeminal Neuralgia Neuropathic Pain 3.2 Microvascular Decompression: Attacking the Root of the Problem by Kenneth F. Casey, MD [Kenneth F. Casey MD FACS is a Past-President of the Medical Advisory Board of the American Facial Pain Association. He is an Associate Professor of Neurosurgery and Physical […]
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