Comments by Dr. Daniel Lewis of The Lewis Institute. With permission, October 2016. Dr Lewis is a rheumatologist, a member of the Dragon Claw team and is the founder of The Lewis Institute.
The Experience of Pain
Numerous patterns and brain pathways influencing the development of chronic pain are being discovered. Chronic pain is a personal individualised subjective experience. It cannot be objectively measured.
For a given pain stimulus, pain tolerance between individuals varies widely.
The experience of pain is determined by individual characteristics and reflects the operation of multiple mechanisms.
About 40% of the experience of pain is influenced by genetics. However, this is only part of the process. Psychological and environmental factors contribute significantly. The near future will see the development of specific treatment protocols based in part on an individual's genetic make up.
Pain can persist even after the initial cause of the pain (eg. arthritis) has been treated. 1/10 people will experience pain after surgery and 1/100 will have severe chronic pain. The question as to why this occurs and how to prevent it is slowly being solved. New treatment protocols to prevent this are encouraging.
The unpleasantness of pain influences an individual's behaviour and responses.
Take home message: For every individual's chronic pain is a unique experience and is a disorder in its own right and requires individualised therapy.
The mind body connection
Neuroscience, the study of the brain, is demonstrating multiple areas in the brain where there is a malfunction leading to chronic pain.
Depression and anxiety over time can sensitise the brain to be more sensitive to pain.
Fibromyalgia is an example of a group of conditions due to central nervous system sensitisation and dysregulation of pain processing pathways. The biological and pathological processes underlying these conditions are now more certain.
Treatment
The statement, "I have pain" is technically incorrect. A more accurate statement is "I have an experience of pain" It is known that the experience of pain can be altered by a variety of therapies.
The best treatment outcomes occur when pain is managed by addressing biological, psychological and social factors that all contribute and interact with the pain experience.
The 12 components of the Pathways To Wellbeing Program are all valuable components of a treatment plan. eg diet, managing stress and enhancing sleep quality are frequently overlooked but effective treatments.
A daily meditation practice is now recognised as an essential aspect of multimodal therapy. Meditation provides participants with a set of tools to manage many aspects of the experience of pain.
- Pain education and an understanding of the emotional triggers for the experience of pain are very helpful approaches.
- Medications only provide benefit for about 30% of individuals. Integrating pharmacological therapies,
- lifestyle strategies, mindbody techniques, interventional therapies and surgery (where relevent)
- in a co-ordinated way is the most effective treatment plan.
- Such a plan requires perserverence, the willingness to experiment and to partner with knowledgeable health practitioners.
Take Home message : Your health is an investment. Spending time understanding pain and developing a comprehensive treatment plan will pay dividends in the short, medium and long term. Health is a journey and perseverance is the key.
