Understanding pain : acute, chronic, neuropathic, Dysfunctional, nociceptive ...

Understanding the mechanisms of pain, understanding why it hurts is in itself therapeutic.

In addition to this, you need to know more about it.

Explaining it to you is the aim of this brochure.

The International Association for the Study of Pain defines pain as “an unpleasant feeling and emotional experience in response to or described in actual or potential tissue damage”.

All pain includes

- Sensory elements (intensity, type of pain, associated sensations) but also

- Emotional and affective reactions (anxiety, irritability, anger, depressive elements) associated. Some pains are more difficult to bear due to their nature (electric shocks, tingling burns…).

There are different types of pain depending on their origin. It is important to identify them properly.

Neuropathic pain: is linked to damage to the nerves and nerve fibers that carry the painful influx. When these nerve fibers are damaged they can trigger very particular pains giving the impression of burning, tingling or electric shocks. These sensations are in addition to the pain itself. They are found, for example, during shingles, during nerve damage after surgery, during chemotherapy which can affect the nerves. It is, in a way, an attack on the electrical circuit of pain.

The nerve has been damaged and is carrying the painful message abnormally. Neuropathic pain can be due to a virus, surgery that damaged the nerves, or when drugs that are toxic to the nerves have been suggested. Neuropathological pain is more difficult to endure than nociceptive pain. To treat them, antiepileptics or antidepressants are used even if there is no depression in order to regulate the dysfunction of the nerves. Pain indeed involves a large number of mechanisms in the brain, spinal cord and nervous system. Certain drugs which initially are not proposed for pain but for diseases of the nervous system, have shown their interest. Antiepileptics are used in neuropathic pain and in chronic pain to decrease the hyperexcitability of neurons in pain. These drugs act on the mechanisms of regulation and control of pain. They strengthen a system of inhibition of pain mechanisms. They do not act immediately, you have to wait ten days.

Peripheral or nociceptive pain :

In addition to this, you need to know more about it.

This type of pain begins following a physical injury, an attack on the body by trauma. The small nerve fibers which are used for the painful sensation and which are present everywhere (on the skin, the joints, the bones, the viscera…) are then activated and trigger a sensation of pain.

Dysfunctional pain

In this case there is no lesion in the body, nor in an organ, nor is there any damage to the nerves. It is the brain that no longer regulates pain. The brain is constantly activated and sends pain messages continuously.

There are two types of pain: acute pain and chronic pain.

This distinction is very important because the physiological mechanisms involved are different. The pain is said to be "chronic" when it persists beyond 3 to 6 months. This duration corresponds to the period of tissue healing: after an operation for example.

Unlike acute pain which aims to protect the organism ( chronic pain has no protective function.

It's a bit like a bad habit the brain would have taken.

Initially, pain is a signal the brain sends to your body to signal danger. The brain can make a mistake and send a signal when it is not, or no longer, necessary.

Chronic pain is like a failure of the alarm system. The brain is wrong in evaluating the estimated situation. There is no danger but he thinks a warning message.

To define chronic pain, we now use the terms “inappropriate pain and fear”. In addition, it seems that the mechanism that creates chronic pain uses neural circuits and cellular mechanisms common with those of memory. (Sandler and Lee, 2013)

In short, chronic pain is both an emotion and a memory (the brain "gets scared", and remembers that it has already had pain) a reflex, (it then sends a danger signal which results in pain. pain).

In addition to this, you need to know more about it.

Chronic pain is therefore a form of memory .

This explains, for example, the pain of a phantom limb during an amputation. The member no longer exists but the pain is still felt. The severed hand no longer exists, but the brain mapping is not up to date. For the brain it still exists.

We have indeed a physical body but also a virtual body, that is to say an image, a map of our body engrammed in our brain.

From a physiological point of view, pain is a signal produced by different circuits of neurons called "neurotag" or

"Neuronal activation model". There is no pain center in the brain.

This is important to understand because pain uses different circuits of neurons which, in turn, connect several subsystems of other neurons. As a result, there are many situations that can trigger pain.

Chronic pain is therefore the result of an analysis that is done in our nervous system. This analysis is unique, specific to each one, linked to their history, strictly individual. The important thing to remember is that chronic pain is a signal from the brain that it thinks there is danger. The good news is that if the brain can make a mistake, you can trick your brain ...

Responses to this supposed danger signal are varied. It can be: a pain response, fatigue, stress, inflammation, a state of dissociation. It's like a kind of braid that ties together different elements. It may seem very surprising but we do not suffer in the same way depending on the cultures, the times, the words used, the moments in our history. Chronic pain is a complex phenomenon that involves the whole person, their culture, their beliefs.

It suffices for an element of the neurotag (of the neural circuit) to be activated (whether the conscious or unconscious memory of a bereavement is reactivated, the memory of a stressful anniversary date, etc.) for the painful episode in its entirety is triggered .

The mind and the body are linked. Everything is always in the head. There is no such thing as pure thought. Our perception of reality is created by our neurons, always.

In addition to this, you need to know more about it.

Pain management

In addition to this, you need to know more about it.

Pain management has long been deeply influenced by a Cartesian view. This led to a regimen where analgesics (pain medication) depended on the degree of pain the caregiver attributed to the patient. This model, which we now know to be erroneous, has led to disproportionate confidence in medical imaging (radios, MRIs, scanners). Chronic pain has nothing to do with biological tissue.

Awareness

Pain that persists beyond the time needed for optimal tissue healing means the brain has forgotten to turn off the alarm system. This is called “awareness” .

Persistent, chronic pain is due to a sensitized nervous system. In other words, the body's alarm system remains in "alarm" mode while the tissue is repaired and the pain is no longer needed. Some cells become hyper-excitable and remain so beyond the period necessary for tissue restoration. A kind of memory of pain is created which is self-sustaining in a vicious circle, in a loop.

This is also called neuroplasticity which is a form of memory. The brain has learned, through learning, to trigger the alarm signal and especially not to turn it off.

On the contrary: not only does it stay lit but it gets louder and louder. This pain memory is strengthened by the development of new synapses in response to repeated stimulation. The nervous system changes its wiring.

Understanding the sensitization mechanism is important in learning how to use desensitization techniques .

Neuroplasticity works both ways. If we receive many danger signals, we learn to amplify the danger and our nervous system becomes sensitive. At the same time, if we know how to amplify the pain, we can also decrease it and gradually deprogram our brain, re-educate our nervous system.

To start desensitizing yourself it is important to know that the brain needs you to constantly remind it of the existence of your real body. You have to learn to see your body more finely .

This will make your brain feel safe and mute pain messages. It is essential that you learn to develop the perception of your body.

Remember: this is about "reassuring" your brain, convincing it that there is no danger and therefore no need to be on alert.

Some tracks :

In addition to this, you need to know more about it.

- Psycho-bodily therapies that use touch will help you become aware of your body, your skin, your organs. This will help to "reassure" the brain. Massages help, for example, to produce oxytocin which is a chemical that soothes and decreases stress.

- You have to develop your capacity to feel the deep inner and physiological activity of your body. It is equally important to be aware of your joints and muscles In other words it is about learning how to refine your body mapping.

- Also remember that the words and metaphors you use have a direct impact on your painful perceptions. Certain expressions send a threatening message to your brain. So you can change the pain neurotag by speaking differently. Say, for example, “discomfort or inconvenience” instead of “pain. Say “I'll get there soon” instead of “I can't”. You probably already do this intuitively. Go ahead and make it a goal to do it systematically.

- It is important that you get in motion and visualize your movement to visualize it. Remember: the brain does not differentiate between an executed movement and a visualized movement. The same areas of the brain activate if you walk or if you see yourself walking ...

- Remember too: your brain needs to feel safe. Learn with a hypnotherapist or a sophrologist to create a place of safety through breathing and visualization exercises. Learn with a professional so you can do it again yourself. It will take some regular training, but the results are worth it.

- If the movement is painful, move differently by progressing little by little in the difficulty. Gradual visualization is a very powerful tool for this. Every move you make safely (visualizing first) will help re-educate your nervous system. The nerves will gradually become desensitized.

This reconditioning work should be initiated with trained therapists but it is important that you become independent. Becoming independent means learning the techniques of self-hypnosis, sophrology, cerebral rehabilitation, mindfulness meditation.

This reconditioning work will allow you to create more feelings of security so that the pain alarm system gradually turns off and the nervous system becomes desensitized.