When it comes to pain, and when it comes to the way that pain is processed, one thing that you might not know is that pain is 100% produced by your brain. So, even though you feel it in a particular body part, it's your brain that produces the feeling of pain. Pain is like another sense. There's a lot of information that comes in through our senses, through our eyes, our ears, our skin, and so forth. It's the brain's job to process all of those signals, before you then experience what you might see as a colour, what you might hear as a sound, what you might feel as a sensation. The experience of pain can be different for everybody. This is why some people feel pain more than others; why some people can have a very minor feeling, as opposed to others that have a major feeling, to the same input. Let me explain briefly what goes on when you have pain... You have a whole stack of nerves that go into your spinal cord. All of these nerves, for example the ones that run from your hand, your feet, are what we call the peripheral nerves. They all filter in and meet in the spinal cord. The signal goes up the nerves, up the spinal cord, and then sent up to your brain for processing those signals. So remember, when signals are sent from your body to your spinal cord it's not pain yet, it's not even a feeling yet. It's basically electricity that your body is taking in, through special channels called nociceptors. Your brain then needs to process these signals, along with all of the information that's going on around it at the same time, in order for the "electricity" to become a sensation of any type, like pain. Let's talk about a really easy example. Let's say I am in the kitchen, and I'm cooking, and my finger touches the frying pan... This is what happens in your brain, in real time. My brain goes, "Oh, okay. There's something happening, but I'm not sure what. Let's go through the process." When the finger touches the fry pan, my thermal receptors in my finger start to activate, and sends signals up my nerve, into my spinal cord, and then shoots up through my spinal cord and up to my brain. My brain then asks the question, "What does this mean? What happens here?" Then, my brain starts to take in some more information about what's going on around the place, to form a decision: Visual Cortex: "What am I looking at right now?" "Well, My finger is touching a black shiny surface, next to some bacon, I'm in the kitchen, there's fire underneath this shiny glass surface." Auditory Cortex: "What am I hearing?" "I'm hearing the crackling of the bacon underneath it, hearing a couple of birds outside in the kitchen, but it's mostly the crackling that I'm hearing." Planning Cortex: "What am I doing tomorrow?" "I need to have these fingers for tomorrow for work, it's actually really important for my fingers to be working" Past Memory Cortex: "What do we remember about situations like this?" "My mum burnt her finger like this years ago, and she would not stop complaining about it, there was a blister on her finger, it must have really hurt." My brain takes in all of the information! From the nociceptors coming from my finger, all of these other inputs, pretty much everything that can possibly be causing a physical issue, and everything that's going on in, and around you. The brain then asks a very important question: Do I need pain now? Or do I not need pain now? My brain will go, "Hey, this is potentially dangerous. So therefore pain is the outcome." That is the decision, and that’s what is going to happen. What's important to note – is that this whole process from the signals going up your nerves and into your brain, happens EXTREMELY fast. So, the response after all of that is ‘ouch!’ and my brain has decided to change my behaviour and take the finger out of the frying pan. That’s normal pain. That's how normal pain generally works to protect us, so that we're not stepping on roads and burning our feet, we're not chopping our fingers off, we're not getting frostbite at the end of our nose, and we're not doing things that are actually, inherently dangerous to us, because pain protects us from danger. Now, I know what you're thinking, what's happening with people that have pain all the time, or what's happening when you have pain that's there when it's inconvenient, and it's not useful anymore? You might've hurt yourself 5 - 10 years ago, and now you're getting pain all the time - it might be after a car accident, it might be after hurting your back a long time ago, and yet the pain is still there. What we now know is that persistent pain is less about tissue damage, and more about the sensitivity of your system. When we've got a bit of sensitivity in the system, what can happen is that the spinal cord can crank up the signal by up to 100 times. It's like you get a normal signal coming in, and then this other signal comes up that’s much stronger than what it should be. With all things being equal, your brain is going to look at that signal and go, "Wow, that's a really big signal." It's then going to go, "Wow, this is dangerous." Therefore, we're going to get some pain as a result of that. What can also happen, is your brain may decide the signal is dangerous for an illogical, or an irrational reason. It’s important to know, that it's not your doing. For example, this might be why you're able to do some gardening, but the moment you vacuum, your back is really sore. This is caused by the context under which you're doing it. The vacuuming, for whatever reason, is causing your brain to say "Yeah, I don't like that" and give you pain as the output, but gardening may be more "Yeah, I enjoy this!" When everything should be normal - there's normal movement, the past injury has healed and scans are clear, but this awful pain is still there - means the signals coming in are being cranked up in the spinal cord, and causing a sensitization process to occur. The third thing that can happen is, a relatively normal signal comes in, but there are other contexts that are coming into your system which are tricking your brain into giving pain when it doesn't really need it. It’s very important to understand the pain that you're experiencing is very real, however the reason why your pain is there, may be different to what you think that it might be. Most of the people we treat here at The Headache and Pain Management Centre have one of two things, when it comes to their long-term, undiagnosed, pain condition. The first thing is: most people have been to see everyone and have tried everything. They’ve been to a physio, chiro, doctor, and tried all of these different treatment methods, so much so that they start to believe their pain will never go away. A lot of the time, when it comes to Headache and Migraine, it might be a stiff joint in the neck that hasn't been moved in the right way, or in a neck or low back, it could be a muscle that hasn't had the treatment that it has needed. It's unfortunately, somewhat common for these things to be missed. This is why we always do a full assessment on all the things that might be causing the issue. Often by removing the issue, things are much better. However, more commonly, when people that have fibromyalgia, chronic regional pain syndrome, post whiplash or persistent low back pain, it's more this sensitization process that's happening which we explained above. Instead of being able to remove the issue, we have to focus on doing things to wind th e system down, so that those signals aren't being amplified quite as much. Therefore, by the time the signals get to the brain, it's not as bad and the brain doesn’t send pain inappropriately. Secondly, we need to consider all of the other inputs that are coming in that’s causing your brain to produce pain unnecessarily. Common things that could be causing this, are things like anxiety, or fear. However, the biggest one is probably a lack of knowledge about why their pain is there in the first place. Our brain really likes to have an explanation for why things are happening. A lot of the time, our brains take a shortcut, or they take the information that best suits them, or it could be the repetition of incorrect information that has been given over time. What I can tell you categorically is, this is actually how pain works. To simplify, there's three levels. There's the peripheral, where it's all the nerves going into your spinal cord. So through your arms, your legs and your feet, the skin, things of that nature. There’s the spinal cord, which takes the signals in, and those signals can be amplified. Then there’s the brain, which receives the signals and needs to make a decision - if something is dangerous or if it's not dangerous. If your brain concludes that, based on all the things around it, that it is dangerous, then it will give you pain. Even if the reality is that it's not dangerous… The education around how pain works is really interesting, and for people who do have a long-term chronic pain condition, it's really important to get to know the principles which we have outlined, and really understand it. The more awareness you have about how pain is prescribed and why it has presented in a certain way, the more comfort and control you will have in managing the pain. Whether, that might mean, engaging in movement, a stretch, or perhaps changing your mind set or knowledge base, it’s important that you know what is happening and what can be done to rectify the issue. Which of course, is what we do every single day. We assess, we diagnose, and we organize a treatment plan tailored to you and your needs – to ensure your pain management is on the right pathway to long-term relief. Click here to see if we can help you too.

If you are trying a new treatment or health professional, it's a very big step. I'm often asked by colleagues about how I would speak to a patient who has seen many different health professionals, but has had some very negative experiences. Unfortunately, sometimes the messages given are not the messages that are heard, by either party. Pain can be scary, and can inadvertently be made worse by well-intentioned health care professionals. So, you may have heard of the Placebo Effect before. It's where an inert treatment causes symptomatic improvement, with the power of suggestion or context. But what is this Nocebo Effect? Well, it's the exact opposite. It's where inert treatment causes a worsening of symptoms, with the power of NEGATIVE suggestion or context. Pain gets *worse* from a treatment that has no impact on your body's tissues. So, if you have had an experience in a clinical setting where: - you don't feel listened to - you don't feel comfortable - you don't quite understand the reason for assessment, the diagnosis or treatment - the bedside manner isn't great - you've heard bad things about the clinician or the treatment - something has reminded you of a previous negative experience ...then its possible that those factors alone can make your symptoms worse! In other words, the more sure, confident and certain you are of your condition and the environment around you, the more likely you are to symptomatically improve...! Incredible how the brain works, huh? Be sure that when you are brave enough to start a new course of treatment with any health care professional, that the language they use *empowers* you to try new things, and that the treatments are aimed towards putting you in control of your management in the long term. (We pride ourselves on this!)

Firstly, it doesn’t mean that you are making it up – your pain is real. What it means is that the signals coming from your muscles, joints and nerves of your back, is being interpreted by your brain as being really dangerous, rather than being normal. The new Pain Neuroscience discoveries are reshaping our knowledge of how back pain works, and there have been some amazing leaps forward recently.