Picturing Pain: Is Pain all in the Mind?

Professor Irene Tracy

Is pain all in the mind?

A lot of patients are confused by this and get worried that the doctor does not believe the pain is real. But in the world of neuroscience the mind is the brain. Damaged tissue messages are sent to the spinal cord, but it is the brain that puts all the signals together and gives you the experience of pain. All the factors that people associate with the mind are real factors and play out through brain regions and chemicals, so it is just as real as signals being sent from the damaged tissue, and the brain can turn the volume up and down.

Is there a region in the brain that specifically deals with pain?

There is no single spot responsible for experiencing pain, but about 10 different regions that are part of a network. It is a flexible system that has the ability to potentially turn off pain completely, during the fight or flight response for example. Different parts of the system activate depending on the pain and the situation, but there are some parts of the system that are permanently on, and these are the areas to target for pain relief.

Fibromyalgia and the brain

Brain imaging has shown that people with Fibromyalgia demonstrate very different brains to their counterparts in age and sex who do not have the condition. The systems responsible for experiencing pain in the brain are active and dysfunctional without any signals being sent to them. What this shows is that the pain is real, but its origin is not located in the limb or area that the damaged tissue is. This is important as now treatment can be focused on the right place.

How do we know this?

There are several different brain imaging tools which can look inside the brain and spinal cord which are non-invasive. These provide data from the brain about its structure and chemistry. Think of it as looking behind the scenes at what is really going on that contributes to what the patient is saying. Often the description of the patient and their behavioural symptoms are difficult to understand, but with these tools it is possible to see the brain in action while it is experiencing pain.

Anxiety and pain

It is not just the location of pain that can be tracked in the brain. Anxiety and fear of pain can be seen to activate certain regions of the brain. In certain patient groups anxiety and fear are key factors for their pain, and that is turning the volume of the pain up. This shows that changes in anxiety and depression levels switch certain brain systems on and this changes the way pain is processed, making the pain worse. So psychological and emotional factors that are particularly associated with people living with chronic pain for years, are not just changing the way people describe their pain, but actually changing the way the brain is working. This often makes the pain worse or at least different.

How can this research help those with chronic pain?

This research can help to diagnose what is underlying someone’s pain, and that can guide where the therapy should be focused. It can also be used for predicting the outcome of surgery or a certain drug. This does not mean that all patients will be referred for scans because it is specialised and quite expensive. What it will do is to lay the foundations for the next step which is to reverse engineer the information into simple tests that can be performed by a GP in a primary care environment. Brain imaging has also greatly contributed to making such conditions more widely recognised as it can be seen and measured.

Are Cognitive Behavioural Therapies and relaxation techniques still useful?

Brain imaging has shown that these therapies use the power of the brain to modulate a person’s management of their pain. These therapies train people to access different parts of the brain which can help reduce the pain, help them cope better and think differently about what pain is and means. An example of how to do this is based on the principle of pleasant pain. Some people enjoy the sense of pain during extreme exercise or eating hot and spicy food because it is associated with something good. So it should be possible to train people to change the meaning of the pain in order to alleviate it while they are waiting for drugs to block the pain. Ideally, controlling pain using these methods should be used at the same time as trying to get the right drug.

Listen to an interview with Prof Irene Tracey on Airing Pain Programme 17, available from painconcern.org.uk and ableradio.com

[Hidden]

I totally believe that pain can be controlled by both the environment and internal thought patterns.

One example - I had to have a needle biopsy a few years ago. I told myself that a needle is small and will only cause some discomfort for a short while (compared to the chronic pain I suffer daily). The needle was in, wiggled about, suction applied as the surgeon tried to drain non existent fluid, needle removed - all without a flinch from me.

Many operations are completed under hypnosis in Italy without any anaesthetic or patients waking up half way through.

I use meditation and my favourite is thinking of the pain as a colour and changing the colour to turn the pain off. Depending on my activity levels I could have reduced pain for up to 2 hours.

It might not suit everyone, but taking 20 mins out to meditate for 2 hrs pain reduction instead of popping pills can only be better for you long term.

Making friends with your pain helps too. A lot of my pain is from trigger points so the two main areas of pain are called Delboy and Rodney (because they have a mate called Trigger?) And like the characters on TV, my pain is disruptive, chaotic and funny.

Removing the word pain by one step is also therapeutic. You can call you pain anything you like as long as its positive. You say pain to somebody and they immediately think of negative things both emotionally and physically. You say Delboy and Rodney to someone and they think of a couple of clowns who can't get anything right, their perception and their attitude to your pain changes too. In simple terms its called accepting it.

[shazita in reply to Hidden]

Hi zanna, I am so glad I came across your post, an I smiled I did actually name something once but it wasn't my pain. It was my aids in a letter to the benefit people. I am on a cope management programme to do with my pain amd will be sharing your ideas would like to keep in touch. I have chronic back pain....

[Hidden in reply to shazita]

Please message me if you need more info.

Glad to be of help.

[itsmecathie in reply to Hidden]

wow wished i could think like this but i recently was told think your pain away ,, got the feeling she was saying its in your mind ,,, didnt like it thought she thinks im loopy lou ,, bad injury s a major issues for many years nerve damage were the start, spinal injections have made matters far far worse had six month,s of physio and accu putch nothing helped was told she was able to release me but without fail would automatically tighten up again i have so many pain issues have rebuilt left leg with stainless steal unsalvageable it reads on all my reports but i can be feeling ok , move to turn and get some thing or say something thats it cant move for weeks can happen any time any place , my neck has been a major issue for years keep sending me for bone xrays so many even i tell the g,p its not bone xray comes back saying wear and tear get no further ,, now the cramps the movements the throbbing in neck buttocks hips groin is some times enough to send me crazy made far worse with spinal nerve injections siactica was recent thing mentioned by a new hospital nerve damage was clearly still the reasons for mobility hurting movement bending walking electric shooting from my big toes water hearing and feeling at times in one leg burning on fore stabbing pains blar blar blar ok inject again ..more issues ,,not allowed any more injections by one hospital given a further three two weeks later by another but this time some thing is so wrong whilst in treatment i was pulled up and down violently by nothing more than my spine nerves left so much pain falling over jumping nerves takes me to the floor and huge pain omg so im sure the offer of learn to send your pain away is not what i should be offered be nice to hear ur option infact i await patiently thank you

[itsmecathie in reply to Hidden]

hmm sorry to come across as rude because i know it will you are either some one with magic power or a mental health patient sorry did say ,,if you have this ability you really should bottle it and make your million how on the world can any one by pass huge banging almost part of ur very being pain and shut it off no mater how hard i try its more powerful than my brain it always win,s and i can assure you my mind is very strong this is the girl that managed to get to seven in a count down from knock out gas pre op no one else on the ward got to eight even, took sixteen op i have to say but i did it but shutting off to the pulsating pain ,, no no no i cant been trying for years but impressed you can interesting

[johnsmith]

Is Pain all in the Mind

This is popular because it is easier for a medical consultant to consider that pain is in the mind than to look at a person's muscular usage.

Some basic anatomy which most medical consultants seem to have forgotton.

nutrients and oxygen are delivered to the muscles by capilaries. The width of a capilary is about one blood corpusal. Most people are famiar with cramp. Many people do not consider the posibility of a micro-cramp. In a micro-cramp only a few muscles fibres go into cramp rather than the entire muscle.

If the muscle fibres going a micro-cramp squeeze a nerve fibre for an extended period the nerve fibre is going to complain. This complaining than set of a respnse through feedback mechanisms to generate pain. This generated pain is definitely not in the mind.

If the micro fibres going into a micro-cramp seal a capilary or group of capilaries. Tissues are going to starved of oxygen and nutrients, not only this waste products produced by tissues are less likely to be removed. The result pain.

By some medical consultant saying it is all in the mind and ignoring the way the body is designed as an engineering system with feedback mechasims patients can have there pain made much worse.

How do you treat micro-cramps. It is not possible to give a general answer. There is a skill involved in removing a micro-cramp. A good chiropractor would know. An Alexander Teacher would know. A good faith healer would know. Many Gp's and Reumatolgists would not, an Othopeadic Consultant would no. I say this this because laying on hand techniques are not something that is taught in medical school and these people refer patients to others for this type of treatment if they knew of its existance.

[nedd in reply to johnsmith]

Thankyu for validating my PAIN!

[itsmecathie in reply to johnsmith]

finally a word for word explaining why i know the people that administer all the things they understand could help and have nt have just fresh out of options tablets last resort cant go any further with the nerve damage not able to respond as to badly damaged then say try with your mind to send your pain away its coming from deep within your mind working only you can fix it here,s some classes to attend in order to help you show you how ,,excuse my french un lady like next move,,,, bollocks ,, you just cant do that rubick cube f it ,, toss that ill try another without looking or feeling i failed so so sorry but i need to hear that some one else knows there own mind and body better than any one and not willing to be pulled into the feeling its your fault syndrome excellent sorry if i came across offensive never my intended action a bloody men is all i can say

[Joanzoe]

I went to pain management for my lower back ,The consultant wasn't nice very rude... I had injections they didn't work only a short time three days ,The consultant told me he couldn't give me injections every three days,I said I didn't get pain for nothing ,!!! His answer was yes you can sometimes it is in the mind...I was totally disgusted , I went to my doctor and he referred me to another pain management clinic,,,Well this consultant was just as bad ,,,,He was rather upset and asked me why I travelled 100 miles to see a back specialist, I told him my doctor referred me.Then he asked me if I was on benefits don't ask me what it had to do with him but I said no,,Then I was asked how do I live !! I said I am sorry but when your husband has a good wage you don't get benifits...It was after wards I thought wat a cheeky man I didn't go for that I went for my back.He put me on Amitriptyline which makes me like a zombie, He said my back is alright I am sick of this the pain is constant ,,I take Tramadol, Solpadol, Gabapentin, and diclafenic, When I was going he said I can give you another injection,Sorry if there isn't anything wrong with my back why do I need another injection....!!!Sorry to be a moaner. .

[Lara82]

I did a course in Pain management, and the first thing we were taught is, the phrase 'it's in your head' is incorrect, Pain is real, as simple as that.