New Pain Management Research - What do we know?
What is Pain?
Imagine hitting your hand with a hammer. Since the discovery of the nerve, pain has been portrayed as an impulse traveling from hand to head, with concrete implications: if you can stop the transmission in the hand, as with anesthetic, there is no pain.
If you can block pain in the spine, the brain is blissfully unaware. And most recently, if a medicine blurs the reception of pain in the brain, the problem is solved. Pain is an alarm system that can be short-circuited.
New Pain Management Studies
New MRI studies have changed the way we understand noxious stimuli, such as tissue injury and temperature extremes. Instead of an all-or-none pain bolus from the periphery in a tidy 0-10 rating, pain is a nuanced interpretation of both the stimulus and the context.
Being knocked to the ground in an attack can be a terrifying, painful experience. When you’ve just caught a rugby ball and you’re tackled on the try line, pain is irrelevant. When a child is awaiting their third injection, the screaming may begin with a quick swipe of an alcohol wipe.
New theories of pain have recast the nature of the sensation itself. The notion that “Pain is the brain’s opinion of how safe it is” maintains the alarm system metaphor, adding the nuance that alarms can be muted. The idea that “Pain is an emotion” elevates the brain’s role in mitigating pain, and acknowledges that it’s quite real while underscoring the factors that make emotions stronger: fatigue, hunger, fear, repetition.
Putting these concepts together allows for clinical advances and hope for those with chronic pain. Pain Care Labs’ believe that modern pain management should address physiology, fear and focus.
Physiology Pain Management
There are four touch receptors – light touch, deep pressure, position sense, and
stretching. Researchers used to think that any of these “mechanoreceptors” sensations would outrace pain to the spine to shut it out. Our “Gate Control” understanding has grown more sophisticated. When someone smashes their thumb with a hammer, light stroking doesn’t help. Instead, vigorous shaking does the trick, and we now know the frequencies to mimic position sense Pacinian nerves.
Focus Pain Management
Previous pain research concentrated on measuring pain often, with the unfortunate side effect of drawing attention to injury or disability. Just as your hearing becomes more acute concentrating on the sound of a possible intruder, focusing on pain enhances the sensation.
Instead, new therapies like Acceptance and Commitment Therapy (ACT) focus on making movement and activity goals. By gauging success on enjoyment goals, pain is lessened more than it is when using traditional pharmaceutical protocols.
With acute pain, activating the executive function (anterior cingulate cortex) diminishes the perception of pain. Simple visual counting tasks, such as using Distraction Cards or virtual reality are equally effective: the important components are rapid task resolution, visual engagement, and matching tasks. The next time you get a vaccine, concentrate on any sentence and count the number of letters with a hole in them. “It’s going to be fine” has seven.
Fear Pain Management
If you’ve heard of the amygdala, it may be in the context of anger or fear. MRI studies show that pain lights up the amygdala like a beacon. When the brain is trying to assess safety, it makes sense that putting fear on high alert would increase pain perception.
What may not be as intuitive is that control is the natural counterbalance of fear. When a person knows they have a pain reliever in the other room, they can tolerate pain longer. Suffering pain becomes a choice, allowing them to decide when the annoyance outweighs the effort to obtain relief. We have a choice, is it worth the effort to remove myself from the couch and find Panadol in the first aid kit?
Chronic pain patients say over and over that they want options – what they want is some control and hope to smother fear. With chronic pain, areas of the brain involved in meaning also light up to ask questions, such as:
“Will I always be like this?”
“What if I can’t stand it and sneak a pain pill early, what does that mean?”
“Is it supposed to hurt this much?”
“Is it damaged?”
By giving patients options, letting them know when to expect maximal pain, and with therapeutics they control (hot, cold, intensity, position) the amygdala can stand down and pain is reduced.
Opioid Alternative for Managing Pain
There is only so much a pain pill can do. By teaching patient's tools, using empowering multimodal solutions, balancing expectations, and putting the focus on activity, we’re translating research into great patient care.