Pain researcher Lorimer Moseley tells this story: he was hiking in the Australian Outback with friends, and felt something scratch his left ankle. It was painful enough to make him pull his leg away a little bit, but he just kept walking, figuring he’d scraped his ankle on a stick, and forgot about it – until he woke up two days later in the hospital. Doctors told him he’d been bitten by an eastern brown snake, and was lucky to be alive.
Dr. Moseley tells this story to illustrate how contextual our experience of pain is – even with a pretty severe injury, if the brain has reason to think it’s no big deal (ankles get scratched all the time, and it’s not dangerous), we probably won’t feel the sensation very strongly.
Here’s the interesting part of the story, though: Six months later he was out hiking again, and was stopped dead in his tracks by a searing pain in his left ankle. He buckled under the pain and fell to the ground, screaming for help. His friends called an ambulance – everyone assumed it was a snake bite – and then they surveyed the damage: a twig, stuck in his sock.
Amazingly, even after he saw what had happened, his ankle continued to hurt. In fact, he had groin pain for about a week, just as he had after the actual snake bite. He couldn’t talk himself out of it. And this is a PhD who researches pain perception for a living!
The Physiology of Pain
Researchers like Dr. Moseley have been learning a lot about what actually happens in the tissues and the nervous system when there is pain. There is still a ton to learn, but pain theory has come a long way since the push-button system I learned in high school biology: there is tissue damage, the nerves relay the message to the brain, the brain says ‘ouch’.
Pain sensation is actually a very complex process involving nerve impulses, inflammation, chemical changes, and – as in the story of the snake bite – the brain’s decision about when this input can be ignored, and when it warrants setting off a major pain alarm.
When pain becomes chronic, various parts of this system become more sensitized, and begin to signal the brain that things are worse than they actually are. At this point, the pain is often more related to nervous system changes than to the tissue damage that may have started the whole thing.* And unraveling or changing this pain response becomes more difficult and complicated.
*This is different -so different – from it being “psychosomatic” or “all in your head”, by the way. In case you’ve ever heard any of that BS.
How Acupuncture Works for Pain
I believe this is the reason acupuncture is so often effective for chronic pain: because it works with the whole system, and not just the area of injury or pain.
From a Chinese medicine perspective, points are chosen to relax the muscles, remove excess “heat” or “dampness” from the channels, “calm the spirit” and “move qi” in order to restore normal flow and functioning.
From a Western perspective, acupuncture has been shown to decrease the level of activity in the areas of the brain that process pain stimuli. Acupuncture also changes levels of neurotransmitters and neurohormones in the body, increases pain-killing endorphins, and has effects on the immune system, hypothalamus, and pituitary gland – all of which are involved in the pain process.
By repeatedly bringing these systems back to a more normal, desensitized state, acupuncture can help train the nervous system out of its chronic pain default setting.
My experience with patients who have chronic pain is that acupuncture treatment has a cumulative effect. At first, the pain is relieved by acupuncture, but returns again soon after. Over time, as the pain response is brought down again and again, the results last longer and longer; often, over time, pain relief can be maintained even after treatment stops.
Chronic pain is a stubborn, complex medical situation that usually requires a multi-pronged approach to manage or resolve. It helps to learn about how pain works (see the links below). Research shows that understanding the mechanisms of chronic pain in the body is, by itself, an effective way to decrease pain and manage it better.
Most important, though: be gentle with yourself, recognize that it’s really, really hard to live in pain, and accept all the support you can find! Oh, and please call me if you think I can help in any way.
Resources
Click here to hear Lorimer Moseley’s TED talk on pain physiology (including the snake story in his own words).
Lorimer Moseley is also the author, along with David Butler, of Explain Pain, an excellent book for laypeople on the physiology of pain. You can find it on Amazon or download an electronic version.