Pain – ‘Real but Not True’

“The healer you have been looking for is your own courage to know and love yourself completely.” ~ Yung Pueblo

Satya in the yogic philosophy is truthfulness.

Real but not true, is a Buddhist inspired mindfulness practice. This practice, asks us to look at our perception of an experience and recognize what is real versus what we are adding to the scenario, the elements that are not fully true. Sometimes these are thought of as stories in our heads. In other words these are fear-based thoughts that are rooted in real feelings but the truth of the situation or experience becomes greyed.

As we continue in the style of the book,"Pain Science Yoga Life," we will look at these two principles weaved into understanding physical pain with a hope of shifting the experience and decreasing some of the suffering persistent pain can bring into one’s life.

HEADSPACE The Satya of pain from the biological level

(as true as we know from the most recent evidence) The human body and brain are directly connected through the nervous system - containing 400 different nerves that if stretched end to end would extend 45 miles. These nerves sit at a resting level of excitement, ready at every moment to communicate necessary information from the peripheral system (body) to the central system (brain). Each nerve contains a series of receptor sites. These sites are specifically sensitive to changes in the internal environment, such as mechanical, chemical and temperature changes. To the surprise of many, no nerve in the body or brain contain receptors specific for pain. Instead the nerves are armed with something called Nociceptors. Directly translated these are danger or threat receptors. Nociceptors will fire along with the other receptors, if any of the changes detected are great enough for the body to perceive a potential of harm. Once a stimulus is registered at the receptor site, the message is then sent to the brain via the spinal cord. In the brain these nerve messages are received and interpreted by a series of complex events, involving multiple cortical regions. The brain will determine if said event is indeed dangerous. The sum of these events can be thought of like a fire-work. The initial ignition of one area can send an array of embers to light other specific areas. The end result, referred to as a neuromatrix, or on occasion a neurotag, will be unique for this particular experience.  If the brain believes this input does represent imminent danger, then a painful experience will be expressed. The brain will then command the body to take action. For example, remove that splinter from your finger before it becomes infected. If the brain decides this is not a place that requires action, pain will not be produced. This might appear confusing, “how do I feel pain in my finger without a receptor for pain?” It is no different than the process used by all of our senses. You do not have vision receptors in your eyes. You have light receptors.  What you see is a product of the neuromatrix in the brain. It is the brain that produces the visual experience not the eyes.  It is the brain that produces pain not the finger. Research has shown that nociception is neither required nor enough for pain to occur. These ‘tags’ can become part of our deepest memory system. When they are practiced or repeated they become easier and easier to access. Research has also shown us the longer pain is present (the more chronic or persistent) the less it accurately represents what is occurring at the level of the body tissues. It is possible this particular neuromatrix has gotten stuck on repeat (often referred to as central sensitivity). This challenges the common belief that something is still wrong with the finger. The very good news is we are not our neurotags. Our brain and nervous system are plastic. Even the best-practiced neurotag can be shifted with gentle attention and awareness.

Read more about pain and the brain here and here. Real but not true: Let’s look at a simplified example of a runner with knee pain. He has seen doctors and therapists. X-ray and MRI (scans) were performed. He has been assured his knee is not structurally compromised. Yet, every time he runs he suffers from pain in his knee. This has led him to stop running mostly out of fear that he is damaging himself. The pain – real.  Damage, disease, danger, need to protect – not completely true. OUT OF THE HEAD AND ONTO THE MAT As you choose a position of comfort that allows for a sense of alertness, I’ll invite you to bring to mind a fairly simple reproducible physical discomfort you experience. Think about the other sensory stimuli that may come along with it. Maybe you note changes in: breathing, heart rate, movement, muscle tension, thought pattern, and/or emotions. Maybe close your eyes or find a place to set your gaze. Let your hands and arms feel supported and rested. Allow your breath begin to slow and deepen. If you choose to continue with this guide, let yourself slowly begin to imagine a movement, activity or position that can be painful or uncomfortable. You might start to actually feel a bit of familiar pain or sensation, allow this with a gentle nod that is it ‘ok’ to feel these sensations. Then, let your awareness lean into the other sensory experiences. Can you place your attention on softening the reactions around the painful experience?  Aim to keep the breath even, slow and full. Allow the heart rate to settle. Encourage the muscles to relax. Imagine the movements as fluid and efficient. As potential fears and catastrophic thoughts begin to creep in, choose not to engage or consider this choice. You can acknowledge they are there - they are based on a real feeling - maybe begin to find the holes present in the truth behind them. See if you can temper the physical and emotional reactivity to the painful experience.

Perhaps, repeat this visualized practice until you feel you are ready to take these same techniques into the performance of the historically painful activity.

OFF THE MAT AND INTO LIFE

This one is up to you.

Maybe you can identify a relatively simple activity that you associate with being painful and/or uncomfortable? I invite you then to take the above practice into that activity.

For example, the runner with knee pain may, brace and adapt movement, heart rate and breathing may become fast and shallow, upon descending the stairs. So, they could take this exact practice outlined above and use it prior to and during the daily activity of going down stairs.

It is normal to find these practices challenging especially at first. However if you can continue with patience and kindness for yourself, you may find some confidence and ease and potentially even shift some of your experiences with pain.

Namaste,

Marnie

Photo Credit: Rustin Gooden, Haines. AK - Chilkat Lake Wier. 2020. Haines, AK.

References:

1. Moloney, N., & M. Hartman. PAIN SCIENCE - YOGA - LIFE. 2020, United Kingdom: HANDSPRING Publishing LIM.

2. Butler, D.S. and G.L. Moseley, Explain Pain. 2003, Adeliade: Noigroup Publications.

3. Moseley, G.L. and D.S. Butler, The Explain Pain Handbook: Protectometer. 2015, Adelaide, South Australia: Noigroup PublicationsMelzack, R. and P.D. Wall, Pain Mechanisms: A New Theory. Science, 1965. 150(3699): p. 971-9.

4. Gifford, L., Pain, the Tissues and the Nervous System: A Conceptual Model. Physiotherapy, 1998. 84(1): p. 27-36.

5. Butler, D.S., The Sensitive Nervous System. 2000, Adelaide: Noigroup Publications.

6. Louw, A., & Puentedura, E. (2018). Therapeutic neuroscience education. Kbh.: Nota.

7. Woolf, C.J. and Q. Ma, Nociceptors--Noxious Stimulus Detectors. Neuron, 2007. 55(3): p. 353-64.

8. Kingsley, R.E., Concise Text of Neuroscience. 2nd ed. 2000, Baltimore:

Lippincott, Williams & Wilkins.

9. Lee, H., J.H. McAuley, M. Hubscher, S.J. Kamper, A.C. Traeger, and G.L. Moseley, Does Changing Pain-Related Knowledge Reduce Pain and Improve Function through Changes in Catastrophizing? Pain, 2016. 157(4): p. 922-30.

10. Sullivan, M.B., M. Erb, L. Schmalzl, S. Moonaz, J. Noggle Taylor, and S.W. Porges, Yoga Therapy and Polyvagal Theory: The Convergence of Traditional Wisdom and Contemporary Neuroscience for Self-Regulation and Resilience. Frontiers in Human Neuroscience, 2018. 12: p. 67.