Your Brain On Pain

By Dr. Jessica Warnecke PT, DPT, OCS

What happens to our body when we feel pain? Is there a difference between the pain you feel when you stub your toe against the coffee table versus when you’ve had low back pain for the past three years? The short answer is yes. The long answer is a more thorough explanation of what is occurring, why it is different, and how we can use our brain to resolve the pain and get us back to moving actively throughout the day.

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When we stub our toe, there is an immediate signal that the body creates and sends up from the toe to the brain. The brain processes this signal and tells the body that stubbing your toe does not feel good and you should probably not repeat that action. This helps us learn to be more aware of the furniture spacing and walk further from the table to avoid re-injury. Once we avoid the table leg, our body doesn’t get another signal, is able to calm down and the pain resolves.

When we’ve had low back pain for multiple years, the pain signal system is working differently. With this long amount of time, the brain has now adapted its signal interpretation and has adopted a new normal state for your body…not a fun one.

Let’s start at the beginning. We’ll use the common example of a patient that I see very often of this same nature. What initially caused the back pain? Often times there’s no specific injury. No fall off a ladder, no car accident, no lifting a heavy object. I’m serious! So many of my patients that I’ve treated over the years for chronic back pain tell me they woke up one day, had pain, and it’s been there ever since. After that initial morning with pain, the body reacts by altering its movement patterns. It compensates for having pain in one area of the back by bending forward, or leaning to the side, or walking with a limp. Often times, the person will also use pain medication to help lower the perceived intensity of the pain. The next day when they wake up, they’ll still feel a little discomfort and in order to avoid going through what they did yesterday, they’ll start off with pain medicine and then take it easy again the rest of the day. This slowly turns into pain medicine and decreased daily activity over the course of weeks, months, and often years. The compensation patterns have now built up to the glute muscles being weak, the back (extensor) muscles not turning on to work properly, and the hip flexors tightening. The brain is telling the body this pain is very real and very disabling and a fear grows that if we do anything out of the ordinary we’ll cause greater damage. In this day and age, people also often refer to the internet when searching for the cause of pain. This opens up a whole new can of worms because they’ll read awful things such as bulging discs, sciatica, cancer, etc. The mind is interpreting this information as negative and associating it with the current perceived physical disability, which has been shown to increase the pain level intensity experienced.

When treating patients in this similar scenario, two common events often occur to help them recover. Some patients eventually do end up seeing their primary care physician or specialist who orders an MRI. Once the MRI comes back showing no major structure damage, the patient’s fear diminishes knowing there is no tumor present or other major pathology. This decreased fear correlates to decreased pain since the brain has had a huge stressor that’s just been lifted off.

The second occurrence happens when seeing a physical therapist (PT). Skilled clinicians can properly diagnosis the tissue structures involved and initiate a program to help reduce the restriction pattern and improve the dynamic mobility of the entire body. We work with the patient to re-train the body to move properly and recognize how much can be done without pain. This concept transfers to movement patterns utilized throughout the day. This leads to improved confidence, increased activity, and regaining a higher level of function without pain.

This second option, in my experience, tends to be a better, more effective choice at fully recovering and preventing this type of event again in the future.  For one, the patient is thoroughly educated on what is going on with the physical structures connected to the low back. Education does a load of good to a person that has been living fearfully for many years. Secondly, a full course of therapy helps address all physical impairments involved so that your body is better equipped to handle daily and exercise activities. This reduces the likelihood of you suffering from another bout of back pain down the road. Lastly, it’s a much cheaper option than paying for pain medication and an MRI. One MRI, a 30-minute procedure, can easily cost a few thousand dollars today. That’s on top of co-pays for each doctor and specialist you see. Then, if they refer you to PT after that procedure, you pay for your therapy as well. Starting with PT saves everyone a lot of time, money, and days filled with pain.

If you’ve been suffering with pain, why continue down this awful path? Seek assistance from someone who knows how to look at movement from head to toe. Pain is often caused by improper tissue mobility, improper joint mobility, or improper motor control of movement. A great PT will diagnose and improve any of these in order to assist you in reaching your optimal physical function!
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If you have any questions, please leave a comment below or call our office at 512-207-0368 to speak with a pain specialist today!

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