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Many different parts of the brain help process the pain response, including areas that govern emotions, past memories, and future intentions. Therefore, pain is not an accurate measurement of the amount of tissue damage in an area, it is a signal encouraging action. When a professional musician hurts his hand, his brain might consider very different actions than a soccer player with the same injury. And therefore you can believe that he may get a very different pain response. If you are in pain, you are not necessarily hurt.
And if you are hurt, you will not necessarily feel pain. A very dramatic example of tissue damage without pain occurs when a solider is wounded in battle, or a surfer gets an arm bitten off by a shark. In these situations, there is a good chance the victim will not feel any pain at all until the emergency is over. Further, many studies have shown that large percentages of people with pain free backs, shoulders and knees have significant tissue damage in these areas that can be seen on MRI, such as herniated discs and torn rotator cuffs.
On the other hand, many people suffer from pain when there is no tissue damage at all. Allodynia is a condition where even normal stimuli such as a light touch the skin can cause excruciating pain.
This is an extreme example of something that might occur quite commonly on a much smaller scale — the nervous system is sensitive to potential threats, and sounds the alarm even when no real threat is present. The most dramatic example of this is phantom limb pain, when the victim feels pain in a missing body part. Although the painful limb has been gone for years and can no longer send signals to the brain, the part of the brain that senses the limb remains, and it can be mistakenly triggered by cross talk from nearby neural activity.
When this occurs, victims might experience incredibly vivid and painful sensations of the missing limb. Amazingly, phantom arm pain can sometimes be cured by placing the remaining hand in a mirror box in a way that tricks the brain into thinking the missing arm is alive and well! This is an extraordinary demonstration of the fact that the true target for pain relief is often the brain, not the body.
There are many other more commonplace instances where the brain does not know what is going on in the body and causes pain in an area that is clearly not under threat. Any kind of referred pain, where pain is felt a distance from the actual problem is an example of this. Allodynia is another example. One unfortunate aspect of pain physiology is that the longer pain goes on, the easier it becomes to feel the pain. This is a consequence of a very basic neural process called long term potentiation, which basically means that the more times the brain uses a certain neural pathway, the easier it becomes to activate that pathway again.
This is the same process by which we learn habits or develop skills. In the context of pain, it means that the more times we feel a certain pain, the less stimulus is required to trigger the pain. You may have heard the phrase that neurons that fire together wire together. What happened at the neural level is that the neurons for hearing the bell became wired to the neurons for salivating, because they fired together consistently for some time.
The same thing can happen with pain. After a while your brain will start to relate the work environment to the pain, to the point where you can start feeling the pain just by showing up, or maybe even just thinking about work.
It is no surprise that job dissatisfaction is a huge predictor of back pain. Further, it has also been shown that emotional states such as anger, depression, and anxiety will reduce tolerance to pain.
Although it is hard to believe, research provides strong evidence that a significant portion of chronic back pain is caused more by emotional and social factors than actual physical damage to tissues. Pain can be the same way, getting triggered or recalled by certain social contexts, feelings or thoughts that are associated with the pain.
Ever notice that your pain went away went you went on vacation and came back when you returned? There are numerous mechanisms by which the CNS can increase or decrease its sensitivity to a stimulus from the body. The most extreme example of desensitization occurs during an emergency situation as described above, when pain signals from the body are completely inhibited from reaching the brain. Most of the time an injury will increase the level of sensitization, presumably so that the brain can more easily protect an area that is now known to be damaged.
When an area becomes sensitized, we can expect that pain will be felt sooner and more strongly, so that even normally innocuous mechanical pressures can cause pain. Author manuscript; available in PMC Sep 1. Eric L. Garland , Ph. Author information Copyright and License information Disclaimer.
Copyright notice. The publisher's final edited version of this article is available at Prim Care. See other articles in PMC that cite the published article. Abstract This selective review discusses the psychobiological mediation of nociception and pain. Introduction Pain is a complex, biopsychosocial phenomenon that arises from the interaction of multiple neuroanatomic and neurochemical systems with a number of cognitive and affective processes. Functional Neuroanatomy and Neurochemistry of Pain Pain processing in the nervous system When noxious stimuli impinge upon the body from external or internal sources, information regarding the damaging impact of these stimuli on bodily tissues is transduced through neural pathways and transmitted through the peripheral nervous system to the central and autonomic nervous systems.
Neurochemistry of Pain Nociception is mediated by the function of numerous intra- and extra-cellular molecular messengers involved in signal transduction in the peripheral and central nervous systems. Descending central modulation of pain The brain does not passively receive pain information from the body, but instead actively regulates sensory transmission by exerting influences on the spinal dorsal horn via descending projections from the medulla.
Cognitive, Affective, Psychophysiological, and Behavioral Processes in Pain Perception and Regulation In addition to the somatosensory elements of pain-processing described above, cognitive and emotional factors are implicit within the definition of pain offered by the International Association for the Study of Pain. Open in a separate window. Figure 1. Attention to pain In the brain, attention allows salient subsets of data to gain preeminence in the competitive processing of neural networks at the expense of other subsets of data.
Cognitive appraisal of pain Pain involves a process of cognitive appraisal, whereby the individual consciously or unconsciously evaluates the meaning of sensory signals emanating from the body to determine the extent to which they signify the presence of an actual or potential harm. Emotional and psychophysiological reactions to pain The aversive nature of pain elicits a powerful emotional reaction that feeds back to modulate pain perception. Behavioral reactions to pain Pain is not only a sensory, cognitive, and emotional experience, but also involves behavioral reactions that may alleviate, exacerbate, or prolong pain experience.
Conclusion The foregoing review attests to the multidimensionality of pain. In the case of chronic low back pain, the magnitude of tissue damage may be out of proportion to the reported pain experience, there may be no remaining structural impairment, and physical signs that have a predominantly nonorganic basis are likely to be present. Footnotes Publisher's Disclaimer: References 1. Merskey H, Bogduk N. Brodal P. The central nervous system: Oxford Univ Pr; Loeser JD, Melzack R. The Lancet. Evidence for a Double Peripheral Pathway for Pain. Sherman SM, Guillery R.
Functional organization of thalamocortical relays. Journal of Neurophysiology. Willis W, Westlund K. Neuroanatomy of the pain system and of the pathways that modulate pain. Journal of Clinical Neurophysiology. Tracey I, Mantyh PW. The cerebral signature for pain perception and its modulation. Melzack R. From the gate to the neuromatrix. The neurobiology of pain. Yaksh TL. Pharmacology of spinal adrenergic systems which modulate spinal nociceptive processing.
Pharmacology Biochemistry and Behavior. Nociceptive stimulation activates locus coeruleus neurones projecting to the somatosensory thalamus in the rat.
The Journal of Physiology. Opioid receptor systems and the endorphins: Journal of neurosurgery. Endogenous pain control systems: Annual Review of Neuroscience. Analgesia and hyperalgesia from GABA-mediated modulation of the cerebral cortex. Descending control of nociception: Specificity, recruitment and plasticity. Brain research reviews. Melzack R, Wall PD. Pain mechanisms: Reynolds DV. Surgery in the rat during electrical analgesia induced by focal brain stimulation.
Sensitization of pain-modulating neurons in the rostral ventromedial medulla after peripheral nerve injury.
Introduction Pain is a complex, biopsychosocial phenomenon that arises from the interaction of multiple neuroanatomic and neurochemical systems with a number of cognitive and affective processes. Mental state is the biggest modulator of physical pain. Pain emotion and homeostasis. For more about this odd idea, see The Art of Bioenergetic Breathing. These are not simple answers, but with a little explanation about how the nervous system works, you should be able to understand the basics.
The Journal of Neuroscience. Desimone R, Duncan J. Neural mechanisms of selective visual attention. Annu Rev Neurosci. Corbetta M, Shulman GL. Control of goal-directed and stimulus-driven attention in the brain. Nature Reviews: Implicit affective cues and attentional tuning: An integrative review.
Psychological bulletin. Emotion and the motivational brain. Biol Psychol. Involuntary orienting of attention to nociceptive events: Journal of neurophysiology. Eccleston C, Crombez G. Pain demands attention: A cognitive—affective model of the interruptive function of pain. Psychological Bulletin. Attentional modulation of spatial integration of pain: Mental stress inhibits pain perception and heart rate variability but not a nociceptive withdrawal reflex.
Acta physiologica scandinavica. Neurocognitive aspects of pain perception. Trends in Cognitive Sciences. Attentional bias towards pain-related information in chronic pain; a meta-analysis of visual-probe investigations. Clinical Psychology Review. Perceived intensity and unpleasantness of cutaneous and auditory stimuli: An evaluation of the generalized hypervigilance hypothesis. Rollman GB. Perspectives on hypervigilance. Dissociation of sensory and affective dimensions of pain using hypnotic modulation. Pain affect encoded in human anterior cingulate but not somatosensory cortex.
Price DD. Central neural mechanisms that interrelate sensory and affective dimensions of pain. Mol Interv. The cognitive control of emotion. Trends in Cognitive Science. Kalisch R. The functional neuroanatomy of reappraisal: Neurosci Biobehav Rev. Pain coping strategies predict perceived control over pain. Therapeutic mechanisms of a mindfulness-based treatment for IBS: Journal of Behavioral Medicine.
Pain catastrophizing predicts pain intensity, disability, and psychological distress independent of the level of physical impairment. The Clinical journal of pain. Pain Catastrophizing and Kinesiophobia: Predictors of Chronic Low Back Pain.
American Journal of Epidemiology. Tousignant-Laflamme Y, Marchand S. Sex differences in cardiac and autonomic response to clinical and experimental pain in LBP patients. European Journal of Pain. Assessment of stress-related psychophysiological reactions in chronic back pain patients.
Jun 24, Pain science has learned a great deal in the last fifty years, but most of this If you feel pain, it means that your brain thinks the body is under. A thorough understanding of the effect of pain on the different body systems helps nurses to choose the most effective pain management strategies. This article is accompanied by a self-assessment questionnaire so you can test your knowledge after reading it. Bite-size learning.
Journal of Consulting and Clinical Psychology. Psychophysiological stress responses, muscle tension, and neck and shoulder pain among supermarket cashiers. Journal of Occupational Health Psychology. Pain-related emotions modulate experimental pain perception and autonomic responses. Cannon WB. Organization of physiological homeostasis.
Physiology Review. Benarroch EE.