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PAIN – The bigger picture

There is more to pain than simply a mechanical injury. Have you heard of the Biopsychosocial model of pain? Did you know that diet can also impact your pain?

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When one feels pain, your immediate thought tends to be that there is something wrong with your body.  Pain is a warning signal created in the brain to alert you to a potential threat or danger.  Pain is protective and without pain we would damage tissue without knowing about and potentially have disease going un-noticed.  

So what impacts our pain?

Many of my clients may have suffered an injury and have since had scans, physiotherapy, medication, diagnoses etc but still feel pain and have no answers as to why they are feeling pain.  It is clients like these, in Chronic Pain, that other factors need to be considered.  This is where I’d like to introduce the concept of the Biopsychosocial Model.  Pain does not always equate to tissue damage.  Why do some people continue to experience pain well after 3 months which is the time frame in which most tissue heals?  The answer is in the Biopsychosocial model.

Biopsychosocial Model

Biological – The biological aspect of pain referes to factors such as tissue damage, disease, abnormalities in the anatomy which would be clearly seen in a scan.  Examples include muscle tears, sprains and strains, and fractures.  With scans and various orthopaedic tests it can be easy to diagnose the biological aspects of why someone is feeling pain but this doesn’t always take into account other factors causing pain.  Why do acute injuries lead to persistent pain?

Psychological – This is where it gets interesting.  Do not think for one minute that this means you are making up your pain – you are not! Your pain is real.  In describing this element of the model I’d like to use the following analogy.  

A man was walking in the outback in Australia.  He felt what he thought was a blade of grass brush past his leg.  A few hours later he felt extremely ill and ended up in hospital with a life threatening snake bite to his leg.  What he thought was a blade of grass brushing past was actually a snake bite.  Some time in the future he was feeling much better and was walking in the outback.  He felt something brush past his leg.  Due to his past experiences he freaked out thinking it was a snake bite and felt immediate pain.  Now let’s consider the science.  The first occasion his sensory nerves picked up the sensation in his leg and transmitted a nerve impulse to the brain.  The brain assessed this information and immediately dismissed it.  The next time his sensory nerve did exactly the same thing and sent a signal to the brain. The brain assesses it and taking into account where he was and what happened last time.  Only this time the brain catastrophizes the information and makes the person feel more pain than normal.  

This could explain why we feel more pain the older we get. You watch a child fall over and thinks that it looks really painful, yet they bounce back up and feel fine.  How we react to injury and pain can affect the amount of pain we feel.  Think back to the child who has fallen over.  If you as the adult make a huge fuss over them and act very worried, the child is likely to feel your anxiety and feel more pain – ‘catastrophizing’. Change the scenario and the adult responds “ oh dear, up you get, you are fine”, the child will less likely feel as much pain.  You’ve hurt your back….. what are you immediate thoughts? “I’ve done some serious damage”, “I’ve slipped a disc”, “I won’t be able to work”. These thoughts are all negative and will enhance your pain response.  A more positive way of looking at it would be “I’ve hurt my back but I’m sure with the right exercise and treatment I’ll be feeling fine in a few days”.  This positive attitude is likely to reduce the amount of pain felt.

Emotion, worry, anxiety and pain have a very interesting relationship.  Depression can be linked to Chronic Pain and vice versa.  Stress, anxiety and depression can have a significant impact on back and neck pain and the increased pain can further lead to a lower mood.  A viscous cycle. One important factor on emotions not to be forgotten is hormones.  These can play havoc with our emotions and thus our pain.

Social – and economic status can impact on pain too.  Unfairly, pain tends to favour the poor, lower educated and unemployed.   This may be inadvertently linked to stress levels.  Ones work environment and home environment can impact on pain.  

Diet – Eating a clean diet free from inflammatory foods and high in anti-inflammatory foods can improve pain. Also reducing Ultra-processed foods and sugars can reduce pain by reducing inflammation.  Remaining well hydrated and having a good source of omega 3 can improve the fluidity and flexibility of fascia.  There are also a number of foods such as turmeric, green leafy vegetables, nuts like almond and walnuts, fruit and fatty fish like salmon, mackerel and tuna that can reduce inflammation which in turn would reduce pain.  But, and this is a big ‘but’, don’t stress about your diet as this would adversely affect your pain as discussed earlier.

The BEAT pain methodology covers the many factors that contribute to pain and can help you unpick the cause of your pain and therefore give you actionable steps to move towards a pain free life.