Understanding Pain, A Ten Week Ecourse: Part 3
by Jonathan Blood Smyth
Week 3 - The Body and The Mind - Separate?
This is Jonathan Blood Smyth, Founder of The Physiotherapy Site and author of Secrets of Pacing, and welcome to the third instalment of my Ten Week Ecourse, I hope you find it interesting and stimulating.
Part Three covers the ideas about the roles of the mind and body in pain and whether we can isolate one from the other or not. It is an important point in that it guides us in our strategies for helping people in pain.
You are welcome to publish this course in your newsletters or on your web site, on condition you do not alter it and that you keep the resource box at the bottom of each instalment.
Over the last two weeks we covered the ideas underlying the ways we understand pain in our lives. It is essential to grasp the differences between acute and chronic pain if we are going to figure out what’s going on in pain syndromes and help the people who suffer.
Understanding chronic pain shatters the link between pain and damage, injury or harm. This allows us to turn away from tissue based diagnoses and interpretations and frees us to think new things. From this has come new theories of pain, coping, assessment, treatment and the whole discipline of pain management.
Well, that’s a lot of stuff and for another time. When I think about all that, I wonder if the 10 week email course will actually turn out to be the 17 week ecourse! Perhaps it will.
Today we review philosophical ideas of what pain is and what has been thought to be the role of the body versus the mind in pain experiences.
The Mind-Body Split
We often think of ourselves as body and mind. Two things, but completely different. The body is an amazing, intricate machine which is understandable and which science can investigate more and more.
The body has a nervous system which collects information about what is going on around the body and puts it all together for the mind to deal with.
The mind, however, is often seen quite differently. It accepts the information and makes sense of it using perception, moods, memory, consciousness and output (action planning). Mysterious, the mind works on different principles.
But does the mind work on entirely different principles from the body? Will the investigation of the mind never turn up the underlying scientific reasons why we think? Some think so.
It makes more sense to see the body, mind and the sensory nervous systems as an integrated whole. The unified whole looks after the biological needs of the organism, with the same processes tending to occur throughout.
Whenever there is a discussion about pain, there is just no getting away from Rene Descartes. His ideas and the illustrations from the time always accompany historical reviews of the understanding of pain over the centuries.
Descartes was a famous french philosopher and one of the world’s great thinkers. His view of how pain works was followed for many years. This idea is dualism, the split between mind and body.
Descartes had a well-known explanation for pain, with the feeling affecting the skin and being transmitted by “threads”:
The idea that the mind and body are completely separate is one which is naturally attractive and intuitive. It just seems to make complete sense. However, it means the mind is merely a passive receiver of incoming signals, rather than an active participant which gives orders about what to find out about and which can make one part of the incoming information more important than other ones as it wishes.
We also assume that the body has nothing to do but put up with the damage or injury and transmit the pain passively up to the central nervous system for processing.
In reality the body has significant effects on the pain before it ever gets to the nervous system, for better or worse. The body can generate much greater pain in certain circumstances and make the pain much less troublesome in others.
Nor is the mind just the passive receiver of pain signals. It can analyse and make sense of the pain and order the body to seek out solutions to its problems. It can affect itself, it can control its own input.
Our senses are directed by the active involvement of both the mind and the body. Pain sensations we feel are not just the mental interpretation of a stimulus coming in. Pure pain can never be detected in isolation, it always goes along with emotions about the pain and an interpretation by us of the meaning of the pain. Each of us suffers our own unique pain, and interprets it differently.
In response to pain, an individual person is capable of taking part in a complex analysis of what’s going on and can perform a series of complex responses, some automatically.
This analysing and action is a dynamic response to pain, making a difference to the pain experience. We take steps to alter the way the pain affects us and to find information and solutions which help us understand and deal with the pain.
Even though this instalment seems quite short, it gives us a lot to think about. Considering the content carefully will lead to a better understanding and a more complete approach to pain problems
The main lesson is that pain, the way it is noticed, understood and acted upon, is not just a mechanical process. The mind and the body influence the sequence of events at all stages, adjusting the nervous system’s input and output mechanisms to best understand and cope with the incoming pain. This gives us many avenues to explore to find helpful therapies for pain sufferers.
Secondly, pain is an emotional experience, and never felt in isolation in normal people. It always MEANS something to the sufferer, and it’s vital to find out what that meaning is if you are going to be a successful therapist of any kind.
This also reminds us that all our pains are unique and cannot be understood by other people in a real sense. This should encourage us to always believe our patients when they describe their pain problems to us. After all, they are describing their reality to us and it is just as valid as our reality.
Oops. I’m straying into interpretation, assessment and therapy options. Let’s stick to the pain story and not get ahead of ourselves. Next up is the acute pain story in more detail. What happens when we have an injury and feel pain. What goes on the nervous system? Well, a surprising amount of surprising things is what goes on. That’s what we are going to cover in the next email instalment.
Check out the fourth instalment of the Pain Ecourse.
Understanding Pain, A Ten+ Week Ecourse by Jonathan Blood Smyth.
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