Farrin Foster is a freelance writer and co-author of Permission to Move.
Pain has purpose. It’s a protective mechanism – a frontline defence standing between our bodies and all the possible harm our brains can imagine. This essential function endows feelings of pain with an incredible amount of power. We can’t ignore pain. It shapes our behaviour no matter how little we acknowledge or think about it. We respond to it instinctively.
While we often process pain subconsciously, it isn’t difficult to understand it on a more intellectual level.
Pain acts to draw attention to a part of the body. It’s a pre-emptive measure – a finger held close to a candle flame will trigger feelings of pain before any burn damage is done to the skin, prompting us to move the finger away from the heat. As a result, harm to the body is avoided.
When the body is healing, pain swings into a flurry of preventative action. To protect parts of the body that are weakened by existing damage, the pain system creates extra sensitivity that guards against movements or exposure that could do more damage. Walking on a broken leg is excruciating. This intense unpleasantness encourages us to rest the leg so the bone can begin knitting back together. Touching an open wound is similarly uncomfortable, and so - without even thinking - we stop our burn or cut from making contact with possible sources of infection.
When understood as a feeling system that protects us from potential dangers of which we might not even be aware, pain becomes (particularly for those not experiencing it right now) almost wondrous. It’s a potentially life-saving shortcut – a way for your brain to parse thousands of years of knowledge about possible harm in a single moment then take swift protective action, without bothering your conscious mind with arduous analysis.
Persistent pain operates with the same purpose as acute pain. In these cases, the brain is still drawing attention to a part of the body it believes is under threat. But, like fear, pain is a protective feeling that is fallible. We’re often afraid of the dark, but it’s rare that terrible things lurk within it. Similarly, our pain system can become over-protective and give us danger signals even when danger isn’t present.
This is when pain turns from wondrous to destructive.
Prompting deep instinctive reactions, over-zealous feelings of pain become a dominating force in our lives. It changes our choices – tasks that were easy and automatic become anxiety-ridden or completely avoided. Far from just stopping athletes from jumping higher or running further, the full weight of pain’s impact is found in the day to day. Parents no longer pick up their children. Friends sit out the social football match they’ve played in every week for the past decade. Those who love to cook are no longer able to stand at the stove.
As pain limits our task choices - diminishing our lives - it also changes our feeling system. The focus pain creates on a particular part of the body can result in a self-reinforcing feed-back loop. First, attention is focused on the painful part. As a result of the intense attention, tolerance for stimulation decreases and pain occurs more readily. Consequently, protection is applied even more thoroughly as the body strives to double down on keeping itself safe. Over time, our expectation that pain will occur actually creates a higher likelihood that it will, resulting in the pain system constantly becoming more and more sensitive.
As our pain system learns this sensitivity, the constructive steps we take to solve the problem are hampered. When we seek or provide treatment for painful parts of our bodies, we are wary of provoking even more pain we restrict ourselves to conservative choices, reducing or eliminating exercise. The likelihood of triggering true change in the body or the pain system as a result of these minimal interventions is low. Still, any relief that does occur is often attributed to these specific treatments, which can leave patients tied to the clinic for ongoing treatment. Even though the improvements might be due to more general causes – such as the body’s natural healing patterns - patients become trapped in an appointment cycle where they feel they have no control or agency, making it even more difficult for them to recover.
Powerless in the face of pain, we begin to lose hope. The tasks we had temporarily stopped performing slowly morph into things we believe we will never do again. The future fades away. Life begins to shrink – travel, certain jobs, joyful movement all seem out of reach.
Our sense of what is possible is limited by the boundaries of our pain. Only the creation of a new relationship with pain can return us to our full potential.
Permission to Move is a set of tools to treat chronic pain. It is an online course for patients looking to overcome their chronic pain, and it is a collection of resources for clinicians to use in practice.