To recap: Yes- the pain is in your head- but you’re not crazy. In Part I, we discussed how it’s the brain that actually processes pain. This is why the medical model’s approach is to give pain killers or medications that alters the patient’s brain’s ability to process or perceive pain. We discussed “nocioception” the process of stimulated nerve cells that perceive pain stimulus (burns, inflammation, infection, traumatic wounds, etc.) to send signals to the spinal cord and brain that usually- but not always- cause the perception of pain (acute or chronic) in the brain. We discussed that overwhelming pain (the chronic pain of Fibromyalgia and all chronic pain conditions) goes to an area of the brain called the Cingulate Gyrus. This is where the human brain must be activated and perpetually stimulated to create the perception of chronic pain. Lastly, we discussed how this area makes chemicals (5HTP, Melatonin, Seratonin, Endorphins, and other “morphine like chemicals”) to inhibit chronic pain mechanism. We will now go on to the how and why of what overwhelms this protective mechanism and causes it to break down and not allow it to resynchronize itself to stop the pain.
Causes of pain in general are exhaustive. For sake of discussion let us focus on the most common of the 80 or so neurological and biochemical causes that break down the brain’s pain filtering mechanism, and let’s do so by focusing on those who experience pain all over their bodies (i.e. Fibromyalgia, Rheumatoid arthritis, Lupus, Crohns, Scleroderma suffers etc.) Unfortunately, their pain is often severe. So severe that these patients develop something called super sensitivity or more scientifically “central sensitization”. In other words “fibro” and other chronic pain suffers may exhaust the pain filtering mechanism due to perpetual “nocioceptive” stimuli i.e. those listed above and develop the ability to perceive pain ten times more acutely than the average person would experience from the exact same stimulus. This is not an ability one wants to develop. While they may have “arthritis” in their back, neck, or hands, the “arthritis” diagnoses alone does not necessarily explain the magnitude of the pain and suffering they experience.
It is now known that there are many, many biochemically and neurologically mediated factors that can cause pain. Let’s discuss some of the most common i.e. stress, adrenaline, and inflammation.
Let us first start with stress as a neurological cause of pain. Stress can serve a good purpose but more often than not, it creates a rather negative force in our physiology. Stress hormones, which are secreted from the now “infamous” adrenal glands located on top of the kidneys, come in two different components. One is termed cortisol and the other is adrenaline.
Adrenaline is important to pain sufferers as it causes nocioceptive “pain carrying” fibers terminating in the spinal cord to become much more sensitive. This shifts the nervous system’s balance away from not feeling pain to now feeling pain more readily. This occurs because adrenaline will cause more of the pain signals to be sent to the brain.
Unfortunately, many Americans are under chronic stress. Humans still have a primitive stress response in order to allow us to “fight or flee” from the bear or the lion. Today many Americas are under perpetual stress relative to work deadlines, finances, relationships, academic and work performances to name just a few. A book Dr. Gates and I consider a must read for any chronic pain sufferer is “Why Zebras Don’t Get Ulcers” by Rob Sapalski Ph D. Dr. Sapalski is the world’s foremost researcher on stress via his work at Stanford University. In this book, he clearly describes the ravaging effects of stress on the human body and brain.
In our clinical experience, it becomes clear that a subgroup of chronic pain sufferers have been exposed to extremely high levels of stress for long periods of time. The research confirms this fact. Many have been exposed to physical, emotional, or sexual abuse, and chronic pain, which is a stress mechanism in and of itself. Investigators believe that the chronic stress of these extreme circumstances “prime the system” toward feeling chronic and increased sensitivity to pain and our clinical experience would confirm that indeed they do. This is particularly true with “fibro” sufferers.
Now let’s talk inflammation as just one physiological aspect of chronic pain. Inflammation is indeed a cause of chronic pain. Inflammation has become a “catch all” term in our society. Many products purport to be antioxidants and to decrease inflammation, and they may do this temporarily or possibly if you take them forever. But do they actually get to the true cause as so many claims? No. Inflammation is complex and can be created by “scores” of factors. The fact is most of these factors can be resolved without drugs and in most cases even without herbs, botanicals, or antioxidants.
Inflammation in many chronic pain patients is frequently immune in origin, meaning the immune system is overactive! As a result, this inflammation can cause Nocioceptive neurons (remember? Pain carrying nerve cells) coming into the spinal cord to –again- become more sensitive and then cause other pain carrying fibers in the spinal cord to also become more sensitive. The end result: again the balance of the nervous system is shifted away from preventing these signals from reaching the brain, to instead having increased pain signals flood the brain, overwhelming its pain filtering mechanisms, and resulting in the individual experiencing an increased “probability” of pain and suffering.
Today we have relatively accurate and valuable lab tests to test for inflammation. Five to ten lab markers can be run by physicians to assess for a wide variety of different types of inflammation that may be due to the immune system, vitamin deficiencies, autoimmune disease, blood sugar problems, adrenal dysfunction, gut dysfunction, and more often than not, a combination of the above and other conditions. It can get complex. But find the true root cause and resolve it and you can generally rescue or control the pain without drugs or even many supportive herbs.
So back to Gina, our fibro patient in Part I. There should now be a greater understanding of the poorly understood brain and neurological components of pain and how “it’s not pain until it reaches her brain”. And also why Gina was correct in thinking the pain was in her head. Never assume that you or a friend is crazy or “making up” pain. You know what you feel. Instead, bring parts I and II of this article to your medical or alternative doctor and have them explore what are the true undiagnosed neurological or biochemical causes for what you’re feeling. You’ll have a much better chance to get well.