What does pain management entail? And how can your brain alone help you reduce, manage, and even get rid of the pain completely?
If you are experiencing pain always check with your doctor first. I am not a doctor. Therefore my content does NOT substitute professional medical advice, diagnosis, or treatment. You should always consult your physician or other qualified healthcare provider. Never disregard professional medical advice or delay in seeking it based on anything I say.
Why manage pain without medication?
The reasons why people look for ways to manage pain without taking any medication can widely vary.
Some people experience intolerances or allergic reactions to painkillers. Others cannot use specific meds in particular situations because they might alter the results of medical tests. In some cases painkillers might interfere with other drugs that are more critical for their health. For instance, some mental health drugs can be dangerous if used inappropriately in combination with painkillers. “For women, 7 in 10 drug deaths include painkillers.”
There are also individuals who do not want to use medication because of personal choice. It can also go against their religion, culture, or beliefs.
In other cases, one might experience side effects from a medication that they can’t or don’t want to cope with. For example, some opioids side effects include:
- slowed breathing
Last but not least, more than 67,000 people died of an overdose in the US in 2018, 70% from opioids. Thus, developing a dependency on a medication aimed to help them with pain management is a concern to some people.
Always consult with a doctor before taking any decision on pain management.
Alternative Ways to Manage Pain
How much relief can you expect by using the techniques explained further in these articles? This is not a very simple question to answer. There are many variables in play that can determine different results, for example:
- Type of pain you experience
- Demographics (e.g. age)
- Comorbidities (i.e. the simultaneous presence of two or more diseases or medical conditions)
- Individual context (e.g. mental state, emotional situation)
- Personal predisposition (e.g. ability to focus)
- Environment (e.g. social support)
Because of such complexities there it’s not easy to evaluate the effectiveness of these techniques. You can experience the pain management techniques yourself or rely on clinical research. The most relevant studies will be those conducted across different individuals and that control for these differences as much as possible (e.g. removing bias, randomized samples, statistical relevance).
Mindfulness for Pain Management
The first pain management technique we are discussing is Mindfulness. Mindfulness has showed positive effects on a vast variety of people practicing. You can find several definitions of what Mindfulness means. A simple one I like is “the ability to focus your consciousness on the present moment without judgment”.
For example, imagine you were reading this article mindfully. That means that you would just think that you are receiving some information reading the words in this article. Nothing else. No judgement on yourself or the information.
Therefore you are not thinking of anything that happened in the past, nor in anything that will happen in the future. You are also not judging if you agree or disagree, like or dislike what you are reading. Mindfulness is simply about the “what”, not the “how” or the “why”.
You can experience Mindfulness at any time simply by focusing your attention on what you see. For example, you can notice this article is made of words, written in black on white. Some words are longer and some are shorter. There is punctuation in between them, and they are organized in paragraphs.
You could do the same exercise by focusing on sounds you can hear right now. Or you can focus on the sensation of parts of your body. Focus your attention where your body makes contact with the floor, the chair or the couch, or the feeling of your clothes on your skin or your tongue in your mouth. You will be simply making note of those images, sounds, or sensations. Notice them at the very moment you are experiencing them, with a pure objective and non-judgemental attitude.
Mindfulness removes the judgment and the emotional burden of past and future, providing a “breather” to your brain. This breather can help very much with pain management.
Mindfulness for Pain Reduction
“Mindfulness meditation engages multiple unique brain mechanisms that attenuate the subjective experience of pain.”
The good news is mindfulness for pain reduction is also a skill you can pick up rather quickly. Putting it into practice for as little as one week can give the same results as what more seasoned meditators achieve.
In fact, an article published on the Annuals of the New York Academy of Science reports that “meditation after brief training (less than 1 week) produces significant reductions in pain intensity and unpleasantness ratings”
The difference between newbies and experienced meditators is in the mechanics of how the brain lowers the pain perception. We will go into more details in the section on this article about how the brain proceses pain.
In this experiment a group of subjects got their skin heated to 49 °C. Then they were given a placebo cream (made of petroleum jelly). They applied the cream several times while the temperature was covertly lowered. The subjects were convinced that the cream actually worked in anesthetizing them.
One group trained in mindfulness meditation, and another in sham meditation. The control group was simply asked to sit and listen to a book chapter that was read to them. When exposed to the pain stimulus “mindfulness meditation was significantly more effective at reducing pain than both placebo groups”.
Hypnosis for Pain Management
Another process that has been demonstrated to be effective in reducing or even eliminating pain is hypnosis. Hypnosis is a state of high focus and suggestibility that allows the brain to selectively enhance or ignore thoughts and sensations.
Hypnosis can help you ignore pain or interpret it as a different feeling not as unpleasant.
A literature review of studies conducted in the last few decades reports that “hypnosis was generally found to result in significant reductions in a number of key pain-related outcomes (e.g. pain intensity, duration, frequency, analgesic medication use)”
Stanford professor Dr. David Spiegel, has devoted his career to understand the effects of hypnosis on the brain. Some uses he has researched are how to use it to overcome things like smoke addiction, fibromyalgia, and chronic pain. In this presentation, he summarizes the results of a randomized trial of patients undergoing medical procedures. Hypnotized patients experienced one-fifth of the pain compared to the ones relying on opioids.
Placebo Effect in Pain Management Clinical Trials
Some techniques, like mindfulness meditation and hypnosis, seem to be particularly effective on people presenting high suggestibility. Therefore one might wonder if the effectiveness is a result of the technique or simply the subject being very suggestible.
If suggestibility is considered to be a similar phenomenon to a placebo effect, we can get some clarity from experiments that were explicitly designed to test meditation and hypnotic techniques against results to the ones from placebo.
First of all, what is a placebo? Placebo is a substance or treatment that has no therapeutic effect. “In general, placebos can affect how patients perceive their condition and encourage the body’s chemical processes for relieving pain and a few other symptoms, but have no impact on the disease itself”. In randomized trials, the control group receives a placebo treatment to use as a baseline to evaluate the actual treatment.
Imagine for example you want to test the efficacy of a new pill to cure headaches. You could give the actual pill to the first half of the subjects and a pill with no therapeutic effect to the control group. This way if you see a statistically significant amount of subjects improving only in the first group and not the control group, you can make a case for the pill working. But if you were to see similar effects in both groups you could not conclude that the pill is better than a placebo.
Placebo vs Hypnosis
There are many studies that compare hypnosis to placebo quantitatively, as discussed in the example above. But with current technology is actually possible to do even better. You could look at what happens inside the brain of the subjects and see if the ones receiving hypnosis react differently than the receiving a placebo treatment.
The “signature“ of the areas active (and inactive) in the brain during placebo effects seems to be different from the one observed during hypnosis. “Research using Transcranial Magnetic Stimulation (TMS) suggests that placebo effects require the involvement of the prefrontal cortex whereas hypnotic suggestibility is increased when the prefrontal cortex is hypoactive”. In other words, placebo and hypnosis seem to be activating different parts of the brain.
This should give you a clear idea of how these powerful tools can help you reduce your pain without the use of opioids leveraging only pain management natural techniques that revealed to be effective across pain types and individuals with diverse backgrounds.
In the next posts, I will cover the scientific principles behind these techniques. The goal is for you to understand why they work before jumping into the actual exercises.
How does the brain interpret pain?
First of all, what is pain? The definition of pain in medical papers is “a complex, biopsychosocial phenomenon that arises from the interaction of multiple neuroanatomic and neurochemical systems with a number of cognitive and affective processes”.
In more simple terms, the International Association for the Study of Pain offers the following definition of pain: “Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”
Notice that in both definitions there is a reference to, not only the physical and chemical aspect of pain, but also the psychological and emotional one. For example they both mention “or potential tissue damage”. Why would you feel pain for some damage that did not even really happen? This might sparkle an intriguing thought: if damage and pain perception can be dissociated from one another maybe there is a way we can manipulate the perception when the damage is there. Which is precisely what you want.
This is a key point that we will explore in depth including the actual techniques you can use to achieve that. But before elaborating more on this important point let’s see what are the different types of pain.
Types of Pain
Pain can be classified in several different ways considering:
- The region of the body involved (e.g. head, visceral)
- How frequently or how long it lasts (e.g. acute vs chronic)
- The system involved in the dysfunction (e.g. gastrointestinal, nervous)
Internationally a proposed classification of pain suggests classifying it in three main major classes:
- Nociceptive pain: too hot or cold, acid, too much stretch or pressure
- Inflammatory pain: derived by tissue damage or inflammatory cells
- Neuropathic pain: involves a dysfunctional or damaged nerve
Original image: www.researchgate.net
Pain pathway transduction, transmission, modulation, perception
These three types of pain classify where the stimulus or the issue starts. To fully understand what happens from that initial phase to when we actually perceive pain you need to understand the main steps in the process of how pain information travels through your body. While you read the steps think at which one looks more promising for you to tamper with (without using medication).
- Transduction: the afferent nerves (i.e. bring information to the central nervous system) that are involved in “sensing” the three types of stimula described before are transducing (i.e. converting) that information into an electric signal that can travel in the nerves
- Transmission: the signal is then transmitted to the Dorsal Horne (located in the spinal cord) which carry it up the spine to reach the brain (through the Medulla and the MidBrain)
- Perception: In the brain, the sensation is elaborated and interpreted by different areas including:
- The somatosensory cortex – providing information on the intensity and the location of the noxious stimulus (i.e. the pain stimulus)
- The cingulate and insular cortexes (via the Amygdala) contributing to the pain experiences
- Modulation: The efferent nerves (i.e. carry information away from the central nervous system) bring the “resulting” outcome from the processing that happened in the brain back to the periphery where the stimulus first started in order to trigger the appropriate reaction (e.g. contract muscles in the area)
Pain Pathway FlowChart
As you might have noticed, the third step in this process involves the brain. Specifically higher brain centers to modulate the pain sensation before reacting to the stimulus. This is where the “magic” happens. The brain can “interpret” the same exact noxious stimulus (i.e. pain stimulus) in different ways based on a number of factors.
And if we can influence those factors we can then change how the brain reacts to the stimulus. All the techniques explained in the next article will detail what can amplify or reduce the pain sensation and what exercises you can do to train your brain to reduce it. I hope you are getting excited as I was the first time I have learned this!
Effects of Uncontrolled Pain
Before interfering with anything in the way your body functions it is usually a good idea to ask yourself if it is a good idea and if there are any risks involved. After all, our species has evolved for about a couple of million years to get our bodies to be and function the way they do. So it seems appropriate to evaluate if that evolution is still responding to a need we have or something has changed that we should compensate for, at least while evolution “catches up”.
In a general sense, pain is a defense mechanism designed to keep you safe. When you start drinking your coffee or tea and it is too hot you feel the burning painful sensation that discourages you to continue. This prevents you from burning your mouth and digestive system.
Another example is if you overuse a joint and it hurts, the pain will help you “remember” to avoid moving it too much. That will allow time for the inflammation to wear out and you won’t get injured by putting too much load on a swollen knee.
These are examples of when pain is actually on your side to keep you safe and healthy. Then, when do you want to interfere with it?
Pain Management: when to interfere
We said millions of years of evolution preserved pain. But only recently our species (and unfortunately not even everybody) started to have the luxury of procedures like surgeries that can fix your issues and allow you to go back to your normal healthy life. Because some of these procedures are invasive they might cause pain even after the procedure is complete and the effect of the anesthesia wears out.
This is different than what was happening tens of thousands of years ago because today you are in a controlled environment (e.g. a hospital) and the doctors will tell you for how long you need to be resting and recovering, so pain has less of a vital role in these cases, in fact, it can be generating more problems than it would solve if not managed appropriately.
Unmanaged pain can cause several threats to people experiencing it. Generating stress and anxiety is one of the first results that can disrupt people’s lifestyles. And after some time it can even get to the point of having some deciding to take their own life.
But even for the ones who do not go that far, the risk is that pain creates issues to an important part of your life like limiting social relationships with friends and partners, disrupting sleep, or preventing you from keeping a job. These issues can in turn create a vicious cycle that brings depression and even more pain as a result.
Aside from that, on a more physiological level, pain stimulates the sympathetic nervous system (responsible for the “fight or flee” reaction) which produces a variety of unwanted effects like increased heart rate, blood pressure, and oxygen demand. Things that are critical for example after surgery to prevent further complications.
Finally, there are also pathologies that do not have a cure yet. There are some we don’t understand their root cause well enough to fix them. In some instances, patients may not have access to the structures or meds that would cure them.
For all these reasons it has become clear how important proper pain management is. In the next article, I will focus on how you can manage pain using simply the power of your brain.