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I’m delighted to have another guest post from Brandon Ulmer at Elevation Process. This week, the topic is distraction and why it helps with pain. I’ve written several posts about distraction previously, but this post goes in to the theory behind it – something that I am extremely grateful to Brandon for explaining.
A while back I was given free access to the Elevation Process online Chronic Pain programme and learned so much about what pain is and how we can learn to self-manage our own pain.
I highly recommend this programme to anyone who want to take control of their lives (and not let pain do the controlling). Check out the 50% off discount code for readers of my blog at the end of this post.
After having worked with hundreds of people experiencing chronic pain over the years, I have come to realize that we can all essentially agree on two things. The first is that living life in pain sucks! The second is that if we can manage to distract ourselves from the pain in some way, it does seem to help. Becoming immersed in a good book or hooked by that next great show on Netflix can, at times, seem to be as beneficial (if not more so) than the medications that we take to manage pain. How can this be? What is the “science” behind this phenomenon, and can it help to manage pain in a more effective manner in the future? Absolutely!
For those of you who are familiar with our online program for pain management, you will have heard me rattle on about the importance of education and becoming an active participant in your own healthcare. This is because the more that you know and understand about pain, as well as your body’s reaction to that pain, the more empowered you will feel about seeking healthcare and conversing with the various medical professionals that you will come into contact with.
The frustration and hopelessness associated with trying to find that “cure” can be greatly alleviated by educating oneself, as well as a basic understanding of human anatomy. The Gate Control Theory helps to provide several answers to important questions and is the topic of today’s post.
What is chronic pain?
Chronic pain has been described as a disorder of sensation. Without going into too much detail on an extremely complex subject, and at the risk of sounding redundant, chronic pain is caused by a dysfunctional pain system.
Essentially, nerves in our bodies can become damaged to the point where they continue sending messages of pain to the brain even though we may not even be physically doing anything. This injury can become severe enough that allodynia (i.e. nerve damage), or pain to the light touch, becomes prevalent. Once this is present, even rubbing a feather on the injured area can cause extreme pain.
Important to our discussion today, was the discovery that our perception of pain (i.e. how we feel our pain) could be altered significantly by psychological factors. Researchers had already known for some time that factors such as thoughts, emotions and our expectations could significantly impact our experience of pain. In simplified terms, if you expect something to hurt, it will undoubtedly hurt worse. If you are upset, anxious or frightened, pain will seem worse than if you were calm. By the same token, depression, loneliness, and isolation can similarly make your experience of pain worse.
What is the Gate Control Theory of Pain?
Up until the 1960’s, there was no coherent explanation as to why psychological phenomena could impact our experience of pain. That all changed in the mid 1960’s when the two good looking chaps below (both of whom are now deceased) proposed The Gate Control Theory. This theory is still the best way we have of conceptualizing how our bodies pain system works, and we have only found more evidence to support this theory over time. It is important to remember though, that the more we learn about how our brain processes pain, the more complicated the picture gets. We are still working towards unlocking this mystery today.
Medicine had already identified that pain (and all sensations) travel down nerves. We also knew that nerves from different parts of the body all send messages to the brain via the spinal cord (called our central nervous system). The theory proposes that there is a series of metaphorical gates that exist in the spinal cord, and in certain areas of the brain, that all messages (including pain) have to travel through in order to reach the part of the brain that recognizes and interprets pain signals.
Central to this theory was the idea that these gates could be open or shut by allowing different amounts of pain to be experienced. Also, key to the theory, was the recognition that the gates will never completely close; this is important because it helps to explain why we do not currently have a “cure” for chronic pain. Afterall, theoretically, if we could close the gate and stop the signal from reaching the brain, we should not feel any pain.
Interestingly, this is exactly what we can experience when we are put under anaesthesia for surgery; in this example, our gates are entirely closed (due to the medications) and we feel no pain. The moment we wake up however, the connection is resumed, and the pain is experienced.
So, what opens and closes the gates?
Current recommended best practice for the ongoing treatment of chronic pain involves many different specialities working together in a multidisciplinary approach. This means that dedicated pain clinics often enlist the help of many other specialists (i.e. physiotherapists, psychologists, etc.) to assist in your fight with pain. This is because, as we will see, your experience of pain is subject to many different factors, most of which are outside the scope of a single doctor to treat.
One of the biggest mistakes that we can make as patients, is to assume that medications are the only answer and rely on them exclusively to manage our pain. While they certainly can be an important part of therapy, they do come with their own hazards and list of negative side effects; work closely with your prescribing doctor whenever taking medications for chronic pain.
What stuff opens gates?
What stuff closes gates?
- Lack of activity
- Stress/muscle tension
- Lack of sleep
- Anxiety/mood disorders
- Focusing on the pain
- Exercise (when done correctly)
- Sleep hygiene strategies
- Distracting/challenging thoughts
As you can see, how you choose to live your life can have a significant impact on the amount of pain that you experience (i.e. how closed your gates are). This realization can help to give us a sense of control and speaks to why education is so important.
Since you are the expert on your own body (because no one else knows what it is like to be you), it is important to take an active approach in your own care. You can also, unknowingly, be contributing to making your pain worse by choosing to continue living a life that is not conducive to pain management (i.e. opening pain gates).
So how does distraction help?
Distraction helps with pain by temporarily refocusing our thoughts and attention away from the pain, and onto whatever we are focusing on. This has the effect of temporarily closing the pain gates a little, allowing fewer messages to reach the brain, and less pain to be experienced as a result. When my Netflix show (for example) is over, my attention returns to the pain and the gate re-opens allowing more messages to reach the brain and more pain to be subsequently experienced.
How can distraction hurt us?
Distraction can make pain worse whenever we get so into and focused on our task that we refrain from movement for an extended period. Essentially any position that we stay into for too long can make our pain worse. This speaks to the importance of pacing and switching positions regularly.
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A brief word on tertiary treatments
I field a great number of questions related to the benefit of some of the treatments that are offered for chronic pain including (but certainly not limited to) acupuncture, massage, physiotherapy, chiropractic etc. The answer is unfortunately very unsatisfactory in that it depends on you and your individual chemistry. Just as there is not one medication that works across the board for everyone, so too there is not one therapy that works either. Some people find massage to be helpful, whereas some people cannot stand being touched; it totally just depends on what you find to be helpful.
However, we do need to Modify Our Expectations. As stated earlier by the gate control theory, we do not currently have a cure for chronic pain, because we cannot stop nerve messages from being sent and received by the brain. Each of the tertiary services can help but expecting them to “cure” your pain is not reality.
I have seen many people spend vast sums of money, that they do not have, on the dubious promise of the next “cure;” most of these treatments have little, if any, scientific evidence supporting their benefit. This is not to say that massage, for example, may not be effective for you, just that it is not a long-term cure. If, for example, after having a massage you reliably have a good day, it may be worth your time (and hard earned money) to get that treatment; just know that it is temporarily closing pain gates that will eventually open up again.
In my own experience, taking the money that I would spend on these services and spending it on a vacation somewhere warm once a year does just as much (if not more) for my pain and mental health than these treatments ever could. However, that is just my experience.
Many thanks for reading this. If you are interested in learning more about the complexity of chronic pain, as well as what you can do to manage it in your own life, access our online program for pain management.
Readers can access the program at a 50% discount by entering the code notebooksandglasses at checkout.
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