Pain Science 1: Explaining Pain & Context

: Pain Science 1, explaining pain and context. Welcome to the podcast helping you overcome your proximal hamstring tendinopathy. This podcast is designed to help you understand this condition, learn the most effective evidence-based treatments, and of course, bust the widespread misconceptions. My name is Brodie Sharp. I'm an online physiotherapist, recreational athlete. creator of the Run Smarter series and a chronic proximal hamstring tendinopathy battler. Whether you are an athlete or not, this podcast will educate and empower you in taking the right steps to overcome this horrible condition. So let's give you the right knowledge along with practical takeaways in today's lesson. Similar to the last couple of episodes, this is, and what the next episode will be, a snippet from the Run Smarter podcast and trying to tweak it to make it more relevant for proximal hamstring tendinopathy. Whether you've had pain for a couple of weeks to a couple of years, we need to understand what pain means. We need to understand what influences pain. And Just to give us an advantage moving forward and I won't delve too much until I'll just dive straight into this snippet. But come in with an open mind and let's get ready to learn about pain science. Approach this season with a bit of an open mind, because in the past people get very defensive when it comes to their pain. And why do we need to talk about this? Well, everyone experiences pain. and we need to give meaning to pain and we need to know the science of pain in a way that relates to you so that you can appreciate, recognise, understand all those pain signals that are happening with every injury that you have because there is a lot of emerging science out there relating to pain that people just don't understand and it took me a long time once I graduated from physio to get a grasp of this but when it's taught in the right manner, it's actually very simple and very easy. So hopefully this journey is a bit of an eye-opener for you, but it's an easy process to digest, and hopefully you can relate to some of your past injuries or something you're going through now, if it's quite chronic, to help make sense of the experience you're going through. So episode number one, I wanna discuss, just explaining pain to start with, a very surface level idea of pain science and how it can relate to you as a runner. Episode two, we're gonna talk about chronic pain and what changes happen in the body and the changes that happen in the brain when it comes to chronic pain. And then episode three, we kind of take the lessons that we've learned episode one and two and apply it to a runner specifically. And so hopefully after these three episodes, you're well informed about the pain science and we can move forward into the next season. I want to start off this episode with explaining pain and what context means and how relevant the context is when it comes to pain signals and the severity of pain. And I want to play you a video which is a TED Talk from Lorimer Mosley who is one of the authors out of the book called Explain Pain and I'm going to be referencing that book mainly in this season, as well as some other books that I've been reading and the research that I have read in the past. And he has a TED Talk which is explaining pain. And I want you to kind of ignore the scientific words about nociception and the different parts of the brain that he talks about. He describes the moment when he is, he trips over going for a walk. And so when he's demonstrating that you don't get the visual, but just so you know, he is tripping over and the rest is just quite verbal. So you don't really need to see anything. So I want you to put aside all those complicated scientific terms that he uses and the different parts of the brain. And I just want you to get an overall respect for the brain when it comes to context. He does it in a very funny, very entertaining style. So... I'll play that for you now and enjoy. Very cool, this is what happened. Did you see that? Hang on, this is what happened. Biologically, I'm gonna tell you what happened just then. Something touched the outside of my left leg in the skin. That activates receptors on the end of big fat, myelinated, fast conducting nerve fibers. And they stream straight up my leg, straight into my spinal cord, up to this part of my brain, and they say, you've just been touched on the outside of your left leg in the skin. And meanwhile, whatever it was, is sufficiently intense to activate free nerve endings. We call them nociceptors. They're thin, unmyelinated, slow conducting lardoneva. Someone knows what a lardoneva is. Nerve fibers, and that message travels up to my spinal cord and it gets to my spinal cord and that's as far as it goes. And it says to a fresh neuron in my spinal cord, you've just been, something dangerous has happened on the outside of your left leg in the skin, mate. And the spinal nociceptor takes that message up to the thalamus, which sits in there somewhere, and says, there's danger on the outside of your left leg in the skin, mate. Now the brain has to evaluate how dangerous this really is. So it looks at everything. And the way that I make sense of this, of what happened to me, is the brain thought, Have we been anywhere like this before? Hang on, I'll just ask the posterior parietal cortex. Have we been in this environment before? Yes, we have. Has it happened at this stage of the gait cycle? Yes, it has. Is it coming from the same location? Yes, it is. What is it? Well, your whole life growing up, you used to scratch your legs on twigs. This is not dangerous. I'm gonna give you the organism, just something so you can kick off the twig and continue on your merry way. And that's what happened to me. I can't show you now, but I took off my sarong, got in the river, got out of the river, and that's the last thing I remember, having been bitten by an Eastern brown snake. Survivor. Thank you very much. Now for some reason, the Eastern brown snake works by poisoning you, clearly. And one of the things that it does is activates nerve fibers. So actually my brain would have got all these messages saying danger, danger. And in its wisdom it said, no, no. Six months later, I'm walking in the bush with a boring talker. You know what a boring talker is? Those people, it doesn't matter what they say, it's boring. That's irrelevant, but we'll call her Naomi. because that is her name. Anyway, this is what happened, right? Yow! Waaah! And I am in agony. I have got a white hot poke of pain screaming up my leg. I'll tell you biologically what's happened. Something touched the outside of my left leg in the skin. That activates big fat myelinated nerve fibers which send a message up to here. Just me touching the outside of your left leg in the skin. It's sufficiently intense to activate these three nerve endings, danger receptors. Take the message to my spinal cord. just been something dangerous has happened on the outside of your left leg in the skin. Yes. Well done, you weren't planted. That goes to the thalamus and says the same thing, something dangerous has just happened on the outside of your left leg in the skin. So the brain says, thanks very much thalamus. Kids are right, good, anyway. Frontal cortex, anything to tell me about this? Hang on, I'll ask the posterior parietal cortex, where are we? We're walking in the bush. Oh. You're a bit mate happy. This stage of the gait cycle, where's it coming from? Have we been here before? Oh yes we have. Last time we were here you almost died. I'm gonna make this hurt so much that you can do nothing else. And I was in absolute agony for what seemed like minutes. Screaming pain. Until one of my mates looked at my leg and there's a little scratch from a twig. The pain in those situations was totally different because of meaning. This podcast is sponsored by the Run Smarter series. If you want to take your knowledge building to the next level, I have built out a proximal hamstring tendinopathy video course, which compliments the podcast perfectly. Sometimes it's tough delivering concepts and exercises through an audio format. So the course brings a visual component full of rehab exercise examples, graphs, and visual displays to enhance your understanding. Even if you sign up now, you'll have access to all current and future modules that I create. Sign up through my link in the show notes, then download the Run Smarter app, and you'll instantly have unlimited access to all the course resources on any device. And to say thanks for being a podcast listener, I want to give you a VIP offer. There will be a link in the show notes in every episode that will provide you 50% off the course price. just click on the link and it will automatically apply your 50% discount. Bit of an entertainer, isn't he? And good Aussie humor in there. So I want you to understand that the amount of pain that you experience, even if it's acute, even if it's chronic, any sort of pain that you experience, it doesn't necessarily relate to the amount of tissue damage that you are susceptible to, whether that be an ankle sprain, whether it be a hamstring strain. um, some kneecap issues. It all relates to context and what the brain makes the pain mean. And there's a lot of pain stories, just say a soldier in World War II. Um, in the explained pain book, there was a paragraph of a couple of pain stories and there was this soldier in World War II who, uh, had a routine like chest x-ray when he was 60 years old and found that they or they revealed a bullet that was lodged in his neck that he had no idea about. And when he was in service in World War II, he must have been shot, shot in the neck, had no idea. And it's only 40 years later in his 60s that he realized this and he had no idea. So most people would agree with me that being shot in the neck is quite a life-threatening. situation but if the brain doesn't know it, brain doesn't realize it, there's no pain. There's also the concept of a placebo effect which is putting context into things and let's just apply this to say a certain treatment approach. It will work if you believe it to be true. It is believed that acupuncture works best if performed on a female by a male who is Chinese. and he is in China. So if it's a male Chinese acupuncturist in China, the effects of that are perceived to be greater versus the least effect if it is performed by a non-Chinese female on a Chinese man somewhere outside of China. And these are treatment effects. They have different effects. The physiology is exactly the same. The nature of just... performing acupuncture, but the context is completely different. So that's placebo and that's got to do with the brain and whether it thinks it's getting better and the treatment that is happening to the body is going to be more effective or less effective if it actually believes it to be true. But then there's the opposite effect. This concept that we called nocebo, the nocebo effect. And by definition, a nocebo effect is said to occur when negative expectations of the patient. regarding treatment caused the treatment to have negative effects than otherwise would have. So if the body perceives it to be detrimental or ineffective, the brain's going to know that or the brain's going to realize that and will have that subsequent effect. So outside of treatment effects, this could occur if you think of certain movements or certain activities that you think are dangerous following an injury and you have fear of movement. which the brain thinks is dangerous and will produce pain. So an example that I can think of that I see a lot in clinics is someone with low back pain who was injured bending forward to pick up a pot and as a result experienced a lot of low back pain. And then thereafter, the brain can start to perceive bending forward is dangerous. And once all the tissues in the back start healing, the thought of bending forward is still there, it's still there in the brain, and so there can still be pain with bending forward, even though there's no structural damage that's all healed in the back, but the brain starts to think, okay, this is dangerous, this happened before, I've experienced pain, let's take that as a lesson, let's not bend forward anymore. And you can see this in a patient and it can start to manifest a lot of fear of movement. So when we talk about pain, explaining pain and the relevance of context, not many people make that association and it's the lack of knowledge and the lack of understanding also in its own right creates a sense of fear like if you have knee pain and you don't know why that knee pain is occurring and you don't understand why that knee pain is occurring that can start to enhance fear and enhance worry especially if that pain that you're experiencing is ongoing but it may increase the risk of threat for the brain. The brain might start to process that as a threat because they can't actually see what's going on. And without a health professional talking you through the diagnosis or the cause of the pain, it can start to manifest itself and increase the pain because the brain starts to realize, I don't know what's going on. It's deep, I can't see it, it must be bad. There's no change in the tissues, there's no change in the severity of the structure. All that's changing is the context. and the relevance that the brain is creating. So just to recap, so all pain that you experience is a normal response to what your brain thinks is a threat. The amount of pain you experience does not necessarily relate to the amount of tissue damage. The brain relies on many sensory cues in order to process the experience and determine what level of pain to produce. And so those sensory cues can include things like memory, like uh, Laura Ma Mosley was describing before what your past experience have been like, whether someone you know has had a similar pain that is also count as memory and experience. The sensory cues such as reasoning and emotional processes, what emotional attachment are you giving that experience? I like to think of someone who's playing a sport and they injure themselves in a grand final in the dying seconds of the game, but they end up winning the grand final in those last moments. They're not going to experience the pain to the extent that someone who has that same injury in the dying seconds and loses the grand final would have, again, same amount of damage, but the context and the emotional process that you give that experience. is completely different and therefore the brain experiences that is completely different. So reflect on this yourself. What are your emotional attachments? What are your memories and experiences when it comes to your running injuries? In the past, what have you told yourself about your running injuries? Perhaps you are creating some unhealthy attachments to the brain when it comes to processing that pain. So that's all I want to talk about today. It's just one lesson. but it's a key one. Hopefully I've explained enough. Hopefully, Lorimar Mosley has done his job of making it entertaining, but also educational in a way that you can understand. Like I said, when I first started learning about this, when I first graduated, started reading explained pain in a couple of these YouTube videos, it was hard for me to totally grasp, but hopefully I've done my job at explaining to you at the service level, exactly what's happening so that you can relate that to your everyday experiences. Interesting topic, right? I found a sudden fascination with explained pain and I have appeared on Other podcasts as a guest just talking about pain and the science behind pain It's it's been just like a special interest of mine just after reading a couple of books and doing a couple these podcast episodes So my key takeaways would be self-reflecting on context And the meaning you have attributed to proximal hamstring tendinopathy potentially what memories or experiences you have created. I know I've said a couple of times before, social media posts are like a bit of an unbiased sample, which can create its own anxieties in itself. Potentially, if in the past you've had a misdiagnosis for quite a long period of time, like Michelle in our last episode, not getting the answers you want or having these puzzling questions where you might be getting contradictory information between doctors and between health professionals to say yes surgery, no surgery, yes running, no running. This does create a bit of a context which provokes a lot of worry or just like uncertainty. A couple of like talks about language that we use that can be quite threatening and contribute to this context that we give this proximal hamstring tendinopathy pain. Language like sciatic nerve, scar tissue, surgery, sitting causes tendon damage. Hearing people say I can no longer sit with this condition. I have had chronic pain. This is like sort of language like that. It does highlight or it does give relevance to the brain and that type of language will be processed in the brain and can manifest itself in an unhelpful way. The other key takeaway is just knowing about placebos and nocebos. People like to say if you hear success stories or if you hear me saying that this has worked for one person in the past, we do need to keep an open mind. Maybe it's a placebo. And if something doesn't work for someone, it might be a nocebo. It might just be totally psychologically driven, which can be a good thing. Like placebos are very real. It's not that it doesn't work. It's just how powerful the brain can be. So we keep that in mind when we hear success stories, unless it's a, some modality or some exercise or some surgeries or operations work for some people. not knowing the science behind it, you might think that there can be some placebos in place, which is perfectly fine because they're a lot better because of it. So from this, I guess, topic, just recognizing the importance of placebos and the importance of nocebos and the science when they do particular studies, particularly blinded studies or blinded randomized control trials, they try and remove this placebo bias as much as they can. Still in the real world, it can be very powerful and yeah, something we need to keep in mind. My key takeaways next time we're going to delve into chronic pain and talk about how like just go into a deeper level, how now we know the context and emotions and experience can change our experience or our behavior around pain. Now it's sort of once pain persists, how those similar things that we taught we will learn today can brew into something that can be quite chronic and unhelpful. So let's dive into that next time. Like I said at the start, we're approaching this with an open mind and potentially some self-reflecting practices and I'll see you then. Thanks once again for listening and taking control of your rehab. If you are a runner and love learning through the podcast format, then go ahead and check out the Run Smarter podcast hosted by me. I'll include the link along with all the other links mentioned today in the show notes. So open up your device, click on the show description and all the links will be there waiting for you. Congratulations on paving your way forward towards an empowering, pain-free future and remember knowledge is power.