How does the brain deal with pain?

How does the brain deal with pain?

I often get asked how does the brain deal with pain? The brain is a highly complex organ so lets not think of the brain regions as an entity; more like a highway of networks communicating. To understand how the brain makes pain, I will use the analogy of networks like a map. You may come to have some gratitude towards your brain, as your brain is only doing it’s absolute best to protect you.

 

So how does your brain deal with pain? Here’s an everyday analogy

Keeping to the network analogy: lets say you are meeting a friend for a coffee at a new unbeknownst location. You lock in the coordinates in your mobile app, and away you go. You start briskly walking and come across a busy pedestrian crossing. Of course you wait until the green logo flashes for you to safely cross.

As you continue to walk a cyclist rings their bell to notify you of their passing. The initial noise was alarming, which caught you by surprise. However the cyclist speeds on by, and you are back to absorbing the beautiful sunshine.

Further up the road you notice a branch impeding the footpath from the previous days storm. You decide to live a little, and jump over the branch thanking your exercise physiologist for the strong bones. Your heart rate settles back down, and your mobile app notifies you that you are five minutes from your destination.

As you see the coffee shop in the distance you close down the app taking your eyes briefly off the footpath to put your mobile phone away. Within a matter of milliseconds a car pulls out of the driveway while your head is still down. You put on your own breaks, by contracting your muscles with great force to prevent walking into the red jeep.

The driver gives you a wave in courtesy, and takes off. Still feeling a little startled, a memory comes up of your one and only bike accident. Five years ago with a red sedan, while you were training for your maiden triathlon. You consciously rub your right shoulder. Your friend meets you with a warm smile and hug. You both sit down, and your friend notices that you look a little ‘stiff’.

 

Breaking down the perceive threats so that we can understand how your brain deals with pain

The following analogy contains many contexts that I am going to break down with you, and most importantly reduce the threats. In my analogy I constructed a few events during the walk to the coffee shop that all have contextual meanings that the brain must process. Most are safe, with a couple having more meaning, can you guess which ones?

The pedestrian crossing is a safe means to cross the road. Although the crossing is busy with traffic. The brain likes the safety of the green light. What about the speeding cyclist? Although the cyclist bell would have been initially startling- fast acting areas in your brainstem enable you to respond quickly, the cyclist was also being courteous, while speeding off, which your brain processes the comforting visual information of safety.

What about the branch on the footpath? Haven’t you been strength training with your exercise physiologist? and feeling confident and strong? The quick jump activates the fight and flight system to release adrenaline to contract your muscles quickly, the brain enjoys these types of acute stress.

Now, how about the red jeep pulling out in front of you without any warning? Now here is an acute threat. However there are some added contexts to consider. The colour of the jeep is significant (remember the red sedan?), along with the colour red meaning: stop, hot and danger! And what about the significance? Weren’t you training for your first triathlon before being knocked off- with a subsequent right shoulder injury?

That is a pretty significant event that your brain ought to remember with great detail to protect you. However, the accident happened five years ago. Still, every time you see a red car, you notice that you hold onto your breath.

Lastly, your friend used the word “stiff” to describe your seated posture. What comes to mind when you think of stiff? Stiff can be in reference to your muscles tightening up reducing mobility, and maybe activating that neat fight and flight response again. But do you need it this time?

Can you see how everyday events can trigger the networks in the brain to communicate on: sound, vision, memory, colour and muscle tone? And how the significance of the event, even though it happened five years ago, can still alarm the brain to protect you? 

About the Author

Strength Train Your Blues Away

Strength Train Your Blues Away

Can we use Strength Training for depression?

Any keen gym goer would have heard of the film “Pumping Iron” – and the subsequent revolution of Bodybuilding. Besides from being built like Hercules and having a positive-B sample, Strength Training has a lot of wonderful benefits for men and women. But what about Strength Training for depression?

Well, a recent meta-analysis published in the journal: JAMA Psychiatry may have just eluded some neat findings for Strength Training as an adjunct for reducing depression. The meta-analysis included: 33 clinical trials, with 1,877 participants. Gordon and colleagues found: “resistance exercise training was associated with a significant reduction in depressive symptoms.”

Promising news. However, there are limitations to consider… “total volume of resistance exercise training, health status and strength improvements were not associated with an antidepressant effect”.

So what could be some potential hypothesis that are contributing to the antidepressant effects experienced by the participants?

 

Filling in the gaps for using Strength Training for depression

First and foremost – we are born to move! When are ancestors became bipedal – moving to find food, water and shelter was essential.

And what happens when there is an unexpected reward? Dopamine is released, which causes a surge (reward dependent) of this wonderful catecholamine increasing the likelihood that the behaviour will be repeated – such as moving to find more resources, or more dumbbells!

Secondly, Strength Training has noteworthy benefits in the release of particular growth hormones and hypertrophic increases in muscle tissue. It would be plausible that an increase in testosterone, along with bigger muscles, would most definitely increase motor behaviour (going to the gym), along with libido (I will leave you with your own imagination). Which would equate to more energy being utilized, while also affecting higher cognitive regions in the frontal lobe improving: attention, motivation and reduced impulsiveness. The same areas of the brain that are inhibited by depression!

Lastly, although are ancestors missed out on dubstep, listening to music whilst exercising greatly activates many brain regions, along with an endogenous release of natural opioids that increase euphoria. I can see Hippocrates prescribing dubstep for his melancholic patients…

So hopefully I’ve filled in some missing gaps in the aforementioned meta-analysis that would be difficult to quantify.

 

Key take home points when using Strength Training for depression:

  • Work with an accredited Exercise Physiologist/Scientist – to move with confidence. While also being guided about specific exercise prescription for your current goals, or medical condition.
  • Make a sweet as music-playlist to increase baseline mood when Strength Training.  Creating your own playlist will likely increase adherence to Strength Training along with enjoyment and motivation.
  • Lastly, always consult your GP – if you are currently inactive, and wanting to increase your physical activity levels. The team at iNform can assist you from there onwards.

James

About the author

Exercise your “blues” away!

Exercise your “blues” away!

Exercise to improve mental health and well-being comes across as rhetorical. And to throw a pun in: it’s a no-brainer!

A recent study published in the American Journal of Psychiatry has found exercise can reduce depression globally by as much as 15%! Now, 15% does-not sound like much. However, with data collected worldwide – with a population cohort of 266,939, 15% starts to sound pretty darn good; or for you statistical nerds out there: a neat reliable confidence interval.

 

Take me through the interrogatives and detail James!

The authors didn’t elude how much physical activity is required to elicit an anti-depressant effect. If you read my last blog, you would know what the recommended physical activity guidelines are. What is more important, is the neuroprotective effect(s) exercise has. And from interpreting the paper: participants were followed longitudinally over six to eight years, which correlates nicely that exercise has a protective buffer to continuous stress. Depression is highly complex; interacting with genes the immune system and the environment. However the solution is simple: all one needs to do is-to huff and puff a little bit – from day to day, to statistically decrease depression!

Tips for using exercise to improve mental health: 

Exercise needs to be enjoyable!

  • A brisk walk on the beach..
  • Kicking the footy with the lads/lasses..
  • Or, hitting the gym for a workout or group-fitness class..

The list goes on..

When you choose the exercise that resonates with yourself the likelihood for adherence is higher. Enjoyable activity results in more brain regions becoming active – and neuromodulators releasing sweet beneficial chemicals, affecting your mood, motivation – and thus well-being!

So what are you waiting for? – Lets get moving together!

James 👨🏼‍⚕️

About the Author

Physical Activity For The Gold

Physical Activity For The Gold

With the Gold Coast Commonwealth Games starting this blog is a timely reminder to endorse the benefits of physical activity.

As the Australian public cheer on their favorite athletes from the comfort of her/his living room an oxymoron of sorts is this:

People are likely to be sitting on their glutes all day rather than getting out and using them! So while the Commonwealth Games is displaying the epitome of fitness, we are more likely to be sedentary and less physically active while we watch the athletes.

 

An evidence to practice gap in physical activity

A recent perspective paper in the Medical Journal of Australia discusses an “evidence-practice gap” of physicians. This means that while the evidence is strong in regards to the benefits of physical activity, there is an inadequacy in discussing and prescribing it to patients.

NOW, in no way am I slanting a bias towards exercise physiologist/scientists. However, physicians are typically the first line of contact for patient care, and thus, with physical inactivity being the fourth leading cause of morbidity/mortality worldwide (1) my premise is thus justified right?

The authors found that physicians who were themselves physically active, were more adept at discussing exercise over physicians who are physically inactive (3).

The benefits of physical activity are very well known (2). I am an evidence based analytical thinker, so when the evidence is very strong and robust – the likelihood for adherence is highly likely. Of course, there are “health professionals” and unfortunate reality television shows; that promote unhealthy physical activity.

Which is why I challenge the reader to ask her/his medical/health professional about the recommended physical activity guidelines. Do you know yourself? What the minimum physical activity guidelines are? What if your job entails eight hours of sitting a day… how much physical activity should one be achieving, based on evidence?

So many interrogatives!

 

So in summary, here’s some tips to help you increase your physical activity:

  • Query your medical and allied health team about the physical activity guidelines.
  • Ask your medical and allied health team – “am I safe to move”? 
  • Lastly, trust your source of information, including mine – by doing further research, while being mindful for confirmation biases.

 

Enjoy the games, and cheers to moving more!

James 👨🏼‍⚕️🏅

 

References:

  1. Lee IM, Shiroma EJ, Lobelo F, et al. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet 2012; 380: 219-229.
  2. Pedersen BK, Saltin B. Exercise as medicine – evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports2015; 25: 1-72.

About the Author

Hide & seek. Pain may not be hiding where you think it is…

Hide & seek. Pain may not be hiding where you think it is…

Following on from the great work from my colleague Dr. Nathan Harten’s last blog; I will continue educating you on the latest neuroscience on persistent pain.

You may have been allluded to our brains wonderful capacity to protect to a ‘perceived’ threat.

Perceived you say?

Lets delve into this further…

There needs to be credible evidence of danger over safety for a pain experience (1).

Let’s pause and reflect on that for a moment…

Danger or safety in pain circumstances

It is advantageous to have fast acting danger messages to make us pull our hand away from a hot pan right? Danger over safety is highly relevant here. What about an ankle that had been sprained ten months ago? That ankle is still hurting to load, difficult to localize the pain, and you have exhausted Google & the pharmacist for an answer. Not advantageous at all is it?

Pain is not a true marker of tissue damage…

Let’s pause and reflect again on this statement…

Pain is an output constructed by the brain (1), by many contextuals. Contextuals ranging from:

Is this pain going to interrupt my job?

Is this what an ankle sprain feels like?

Can I still play in the football grand final?

How long am I going to be out for?

Should I just rest?

All of these constructs add to a pain experience (3); storing memories, emotions and motor patterns in a highly organised network, AKA your central nervous system. Even your immune cells (microglia) and endocrine system (HPA axis) are activated! (3) plus more!

Persistent pain is more than just where it hurts

So you see pain isn’t all just about where it hurts. Especially persistent, chronic pain (1). Somehow, your brain is still warning you. It still wants to protect you from a perceived threat and make you hurt.

This may sound like a rhetorical question, but is this protection advantageous at all?

Please take the time to reflect on your own experiences of pain…

Maybe the threat of losing your job is adding to a pain experience?

What if you are a professional athlete, trying to protect your pain from the coaching staff, perhaps because your contract is up at the end of the year?

Are you still blaming the driver who hit the back of your car?

All of the highlighted words are ‘threats’, and thus the brain will scrutinise all of the aforementioned and will decide whether it’s important or not to let you know; and to make you hurt.

Becoming aware of perceived threats and dangers are so important to understanding your pain (1, 3).

I hope now you think of pain as a biopsychosocial paradigm (Bio meaning the biological tissues, psycho meaning thoughts, feelings and beliefs; social meaning the environment) and not just about the tissue that hurts (2).

So I challenge you to challenge your beliefs on pain. This may be a line in the sand that you are willing to make.

Address what threats are in your life (work, financial). Learn how your stress system works. All of this is great at assisting you in the short term, but it can get a bit much if it’s 24/7 (think of having to listen to your car alarm all day!). However this is a topic for another day and another blog!

Feel free to seek help from someone else! Know that you are safe to move when you are experiencing chronic pain (even better with an exercise physiologist!).

Finally, know that we are neuroplastic and bioplastic… meaning that you can heal!

 

References

  1. 1. Butler, DS & Moseley, GL 2013, Explain pain, 2nd edn, Noigroup Publications, Adelaide, South Australia.
  2. 2. Gatchel, RJ, Peng, YB, Peters, ML, Fuchs, PN & Turk, DC 2007, ‘The biopsychosocial approach to chronic pain: scientific advances and future directions’, Psychological bulletin, volume 133(4), pp. 581-634.
  3. 3. Moseley, GL & Butler, DS 2015, ‘Fifteen Years of Explaining Pain: The Past, Present and Future’, The Journal of Pain, vol16, no. 9, (pp. 807-813).
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