Pain
and psychotherapy
All felt pain has physical and psychological components. Sensory and emotional signals are sent up and
down the body/brain systems. Suffering and agony are fear related to pain. They are intrinsic to pain. Fear, in a deep body/brain sense, is a
requirement. It manifests as muscle guarding which tenses the muscle areas
surrounding the pain. This increased
tension can cause more mechanical pain, leading to more muscle guarding, and
more pain. I will explain pain in the brain/body, its relationship to involuntary contraction of muscle, and what to do about it to suffer less.First let me clarify the basic working components of the nervous system. I have found my clients need this information in order to understand anxiety, depression, pain, medicines, anger, and impulsive behavior.
Nerves have three different types of dendrite receptors: mechanical, thermal and chemical. The brain interprets pain signals. Psychological processes have physical effects. Physical processes have psychological effects. There is no separation between psychological and biological. The cell wall of a neuron is made up of proteins, large molecules, whose shape and content determine the character and function of each protein. The outfacing end of the long cell wall protein can be thought of as a key hole, it is the receptor site. Neurotransmitters are the keys that fit in these locks. Overly simplified, when a neurotransmitter lodges in these proteins they bond changing the electrical potential of the whole cell a tiny bit. The nerve cell generally sets at -70 millivolts, when it reaches -40 millivolts it triggers the cell wall proteins to flip over, bring the cell to +30 millivolts. Neurotransmitters are discharged out of the axon end of the nerve, into the synapse between that axon and the dendrite of the next cell. They diffuse into the area where the dendrite end of the next nerve has many receptor sites for them. The electrical process causes the protien to flip, (actual Sodium-Na and Potassium-K, negatively charged (-) chemicals are pushed out while Chloride-Cl, positively charged (+) is drawn in). Those two nerves are now wired together.
The more a pathway in the nervous system is used the more it becomes
resupplied with the necessary chemicals for it to operate. Blood veins,
arteries and the muscles that surround them are strengthened and developed. It
gets easier and easier to use that pathway.
This is part of the way chronic pain gets habituated in the body/brain.
As a pain sensation is felt in the body it sends a signal of the pain to the spinal column. As the signal arrives, the spinal column quickly makes available more receptor sites for noticing pain. The surrounding neural dendrites are quickly tuned to receive the same pain signal. Therefore, the signal is amplified, literally increasing magnitude of the pain signal. The brain can also send signals back down the spinal column to interfere with the use of some of the receptor sites or add more. After the spinal column has processed it, the pain signal heads up to the brain. There the signal goes through an amazing and complex matrix of receiving areas.
One of the first and most powerful matrixes for pain identification is located in the Amygdala. The Amygdala can decide to pass the signal on up to more complex areas for evaluation, or the Amygdala can take over if it determines the signal to be life threatening. If it feels life threatening all of the smooth muscles contract to force all the blood near the heart for rapid use where need. This creates a lot more tension throughout the body. At the same time in 40-60 milliseconds directions are sent to the heart to speed up, lungs to work faster using only the top parts that are closer to the heart, the stomach and other organs to shut off, the adrenal gland to secrete adrenaline, and many other systems
If a person has an exaggerated sense of endangerment due to life threatening experiences in their past, it is easier for the Amygdala to take over. So, when the body sends a signal that is similar to the signal sent during an earlier life threatening event it is more likely a fear response will be initiated.
So, how can we talk to someone about all of these complications with pain? I have never explained all of these concepts to any one client. Even though several of my client knew more about some the pain related processes in their body/brain. Many of them have been much smarter than I am. Joining the client in where they are at with their knowledge of their pain and their hard fought strategy for dealing with, is the answer. In a sense I am a knowledgeable person they are bouncing their plans off of. My job with either depression or anxiety is to help the client relax in many layers of their organization of themselves. When their pain coping strategies sound and feel like the way they dealt with the deficits in their early life care-giver environment, I need to help them soften those ideas. These defensive strategies invariably make pain worse in the long run, so helping them see what ideas help them and what ideas hurt them illuminates relaxing with the pain and focusing on how they want their life to be.
As a pain sensation is felt in the body it sends a signal of the pain to the spinal column. As the signal arrives, the spinal column quickly makes available more receptor sites for noticing pain. The surrounding neural dendrites are quickly tuned to receive the same pain signal. Therefore, the signal is amplified, literally increasing magnitude of the pain signal. The brain can also send signals back down the spinal column to interfere with the use of some of the receptor sites or add more. After the spinal column has processed it, the pain signal heads up to the brain. There the signal goes through an amazing and complex matrix of receiving areas.
The following brain areas are some of important functions in the way we
experience pain:
SENSORY CORTEX
This is a strip of brain tissue on both sides of the brain about the width of your index finger. It processes our body sensations. How pain is felt depends on how cells in these strips are organized. Every part of our body has an area represented on the brain’s sensory strip. It is a mini version of our body mapped onto our brain. The size of the space dedicated for different body parts is related to that area’s degree of sensitivity. Therefore the mouth, face, finger, genitals and feet are related to much bigger areas than their physical size is. This increased sensitivity allows us to feel two toothpicks pressed on our fingertip a quarter of an inch apart and it will feel like one toothpick on our backs. These areas can all get bigger or smaller depending on use. If you have chronic pain in your right elbow the space related to it in the sensory strip enlarges and becomes more sensitive. (In recovery from suffering from pain the reverse of this process will be utilized. The client learns many systems to focus on the non-painful areas of their life.)
This is a strip of brain tissue on both sides of the brain about the width of your index finger. It processes our body sensations. How pain is felt depends on how cells in these strips are organized. Every part of our body has an area represented on the brain’s sensory strip. It is a mini version of our body mapped onto our brain. The size of the space dedicated for different body parts is related to that area’s degree of sensitivity. Therefore the mouth, face, finger, genitals and feet are related to much bigger areas than their physical size is. This increased sensitivity allows us to feel two toothpicks pressed on our fingertip a quarter of an inch apart and it will feel like one toothpick on our backs. These areas can all get bigger or smaller depending on use. If you have chronic pain in your right elbow the space related to it in the sensory strip enlarges and becomes more sensitive. (In recovery from suffering from pain the reverse of this process will be utilized. The client learns many systems to focus on the non-painful areas of their life.)
LIMBIC SYSTEM
One of the first and most powerful matrixes for pain identification is located in the Amygdala. The Amygdala can decide to pass the signal on up to more complex areas for evaluation, or the Amygdala can take over if it determines the signal to be life threatening. If it feels life threatening all of the smooth muscles contract to force all the blood near the heart for rapid use where need. This creates a lot more tension throughout the body. At the same time in 40-60 milliseconds directions are sent to the heart to speed up, lungs to work faster using only the top parts that are closer to the heart, the stomach and other organs to shut off, the adrenal gland to secrete adrenaline, and many other systems
If a person has an exaggerated sense of endangerment due to life threatening experiences in their past, it is easier for the Amygdala to take over. So, when the body sends a signal that is similar to the signal sent during an earlier life threatening event it is more likely a fear response will be initiated.
SITTING WITH THE RIGHT AMOUNT OF
PAIN
So, how can we talk to someone about all of these complications with pain? I have never explained all of these concepts to any one client. Even though several of my client knew more about some the pain related processes in their body/brain. Many of them have been much smarter than I am. Joining the client in where they are at with their knowledge of their pain and their hard fought strategy for dealing with, is the answer. In a sense I am a knowledgeable person they are bouncing their plans off of. My job with either depression or anxiety is to help the client relax in many layers of their organization of themselves. When their pain coping strategies sound and feel like the way they dealt with the deficits in their early life care-giver environment, I need to help them soften those ideas. These defensive strategies invariably make pain worse in the long run, so helping them see what ideas help them and what ideas hurt them illuminates relaxing with the pain and focusing on how they want their life to be.
The problem and solution with chronic pain is neural plasticity. Nerves. being able to add new connections to
other nerves, leads to ever greater intensity, frequency and duration of
suffering. Allowing the overgrown areas
to atrophy is facilitated by growing new more dynamic connections in other
areas.
Knowing the overall cascade effect, that is most obviously demonstrated by the either/or bifurcated functioning of the Amygdala, (flight or fight triggered on the left; empathy and frontal lobe connection on the right) helps patientss plan ways incremental progress in many areas of pain modulation, rather than looking for a quick fix.
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