Ep 37: Understanding Pain Beyond Tissue Damage

Pain is a complex and often misunderstood experience because it doesn't always correlate directly with tissue damage. Instead, pain is influenced by the nervous system, emotions and psychological factors, which can cause people to experience significant discomfort, even when there's little to no physical injury present.

Graded exposure therapy offers one solution by gradually reintroducing the person in pain to the activities they fear & helping to retrain the nervous system and reduce pain perception. 

By understanding the non-correlation between pain and tissue damage and utilizing graded exposure therapy. People in pain can effectively manage their pain, reduce their fear, and regain their quality of life.

In this episode, I'll explain why pain is complex and multi-dimensional, and I'll explain how graded exposure therapy can be used to help alleviate the sensation of pain in the body. 

Yoga for Injury Management: 8-week Mentorship
https://www.enhanced-body.com/yoga-for-injury-management

Transcript

0:00

Pain is a complex and often misunderstood experience because it doesn't always correlate directly with tissue damage. Instead pain is influenced by the nervous system emotions and psychological factors, which can cause people to experience significant discomfort, even when there's little to no physical injury present. This disconnect between pain and actual tissue damage can lead to chronic and persistent pain conditions where fear and avoidance of certain activities further exacerbates the problem. Graded exposure therapy offers one solution by gradually reintroducing the person in pain to the activities they fear Helping to retrain the nervous system and reduce pain perception. By understanding the non-correlation between pain and tissue damage and utilizing graded exposure therapy. People in pain can effectively manage their pain. Reduce their fear and regain their quality of life. These two concepts are deeply intertwined as addressing the psychological components of pain through gradual exposure can directly influence how someone perceives and responds to pain. Leading to more effective and holistic pain management strategies. In this episode, I'll explain why pain is complex and multi-dimensional, and I'll explain how graded exposure therapy is used to help alleviate the sensation of pain in the body. For sure. You're going to want to get your journal so that you can jot down this information and refer back to it when you need. Welcome to the Essential Conversations for Yoga Teachers podcast with me. I'm Monica Bright, and I've been teaching yoga and running my yoga business for over a decade. This is the podcast for you if you're a yoga teacher, you're looking for support, you love to be in conversation, and you're a lifelong student. In this podcast, I'll share with you My life as a yoga teacher, the lessons I've learned, my process for building my business, and helpful ideas, tools, strategies, and systems I use and you can use so that your business thrives. We'll cover a diverse range of topics that will help you whether you're just starting out or you've got years under your belt and you want to dive deep and set yourself up for success. I'm so glad you're here. Listen, I don't take myself too seriously, so expect to hear some laughs along the way. Now, let's do this together. The conversation around pain, pain, science. Injuries healing and movement is so deep. We could spend a good deal of time on it. And what's amazing is that what we're learning evolves every day? In recent years, the field of pain science has undergone significant advancements transforming our understanding of pain. And how it affects the human body. Traditional views that equated pain directly with tissue damage have evolved leading to more nuanced insights into the complex interplay between the nervous system, psychology and physiology. So let's build on the previous episode, number 36, titled advancements in pain science, comparing current understanding versus. 2018 and how these recent discoveries inform coping strategies and recovery processes. That will. prove to be more beneficial when it comes to healing, nervous system regulation and connecting to your body over the long-term. Historically pain was seen as a straightforward signal. From the body indicating injury or damage. However, research has revealed that pain is a much more complex phenomenon involving your brain, your nervous system, and various psychological factors. This shift has led to the development of several important concepts. The first. Pain as a protective mechanism, pain is not merely a direct response to injury, but a protective mechanism. That the brain uses to alert the body to potential threats. This means that pain can persist. Even after your tissues have healed. If your brain continues to perceive danger. The second is central sensitization. This phenomenon occurs when the nervous system becomes more sensitive to stimuli. Amplifying the perception of pain. Central sensitization explains why some individuals Experience chronic pain long after an injury has healed and why pain can sometimes spread beyond the original site of injury. And then finally neuroplasticity and pain. The brain's ability to rewire itself. Known as neuroplasticity plays a crucial role in chronic and persistent pain. Pain can become a learned response with a brain creating and reinforcing pain pathways. This understanding has led to new approaches in pain management. retraining the brain to diminish these pain signals. I mentioned these in episode 36 as well. So again, go back and have a listen to that episode. If you haven't already. The more you expose yourself to this information, the more the pieces start to come together and make sense. In the first half of this episode, I'm going to hone in on this newer revelation, that pain in the body doesn't always correlate with tissue or bone damage. And this is because we're learning more about the complex nature of how pain is perceived. And processed by your nervous system. First the role of the nervous system in pain perception. your nervous system plays a central role in pain perception acting as your body is complex communication network that processes and interprets pain signals. Pain is not just a straightforward response to injury, but a multifaceted experience shaped by how your nervous system detects, transmits and modulates these signals. Pain is essentially a warning system designed to protect you from harm. When your body experiences, potential damage sensory nerves called nociceptors send signals to your brain, alerting it to the threat. However pain is not a direct measure of damage. Rather it's the brain's interpretation of these signals in the context of the overall situation. Once the nociceptive signals reach a brain, a brain processes them alongside information from other sources, including past experiences. Emotions and environmental context. This means that the experience of pain can be influenced by many factors beyond just the physical state. Of the tissues. There's so much more detail I could go into with this whole process from the detection of pain to the processing. Of pain in your brain, but once your brain processes, then your brain modulates the pain by either inhibiting or enhancing pain signals Based on one, the release of endorphins or to psychological factors you're experiencing such as stress and anxiety. In chronic pain conditions, the nervous system undergoes changes that can make it more sensitive to pain signals. A phenomenon known as central sensitization, which we've talked about quite a bit. Neuro-plasticity or your brain's ability to reorganize itself. Also plays a role in this process. Over time, your brain and spinal cord can learn pain leading to persistent pain. Even after the original injury has healed. Central sensitization can lead to amplified pain responses. In some cases, the nervous system becomes more sensitive to pain signals. This condition can result in pain being experienced, even without ongoing tissue damage The nervous system essentially turns up the volume on pain. Making normal sensations feel painful, which is why learning ways to regulate your nervous system. And calming things down can be an excellent piece of the puzzle when navigating pain. The role of your nervous system in pain perception is a key component of the bio-psycho-social model of pain, which acknowledges that pain is not purely a physical phenomenon. Psychological factors such as emotions and thoughts and social factors, such as support systems and cultural influences interact with your nervous system to shape your overall experience with pain. Here's some examples of pain without the correlation of tissue damage. An excellent example of pain without injury is Phantom limb. Pain. My mother's leg was amputated and she complained about pain in her lower leg, which was not there. All the time. Even though the physical limb is no longer there. Her brain continued to generate pain signals because it's still remembered the limb and the associated pain. She was going through this experience before I knew anything about Phantom limb pain or Phantom leg syndrome. So I was thinking, what is going on here? Obviously, the doctors told us all about it, but it was the first I had ever heard of such a phenomenon. Uh, Nexstar psychological and emotional factors and how your brain modulates pain. So your brain interprets pain based on more than just. Physical signals. Psychological factors such as stress. Anxiety and depression can amplify the perception of pain. For example, if you're anxious or fearful, you might experience more intense pain from a minor injury than someone else who is calm. Your brain has the ability to modulate pain through various mechanisms, such as releasing endorphins, those natural painkillers, or by focusing attention elsewhere. Meaning that the same injury can feel different depending on the situation such as feeling less pain. In an emergency when your adrenaline is high. And chronic pain conditions like fibromyalgia. irritable bowel syndrome or chronic lower back pain people often experience significant pain. Without corresponding tissue damage. The pain in these conditions is believed to be due to dysfunctional pain processing in the nervous system rather than ongoing physical injury. Over time, the brain and spinal cord can learn to pain. Leading to persistent pain. Even after the original injury has healed. It's common for medical imaging, like x-rays or MRIs to show little or no structural damage in areas where. People report significant pain. Conversely many people have imaging findings such as disc herniations or arthritis that looks serious, but do not cause them any pain. This highlights that structural changes do not always correlate with pain, intensity or presence. Your brain can learn pain. Meaning that over time, the pathways associated with pain can become more entrenched, leading to ongoing pain. Even after the original injury has healed. This is a result of neuroplasticity, which again is your brain's ability to reorganize itself, which can sometimes lead to maladaptive changes in pain processing. The bio-psycho-social model of pain recognizes that pain is influenced by biological factors like tissue damage, psychological factors, like emotions and thoughts and social factors like support systems and cultural beliefs. This model helps explain why pain can persist without physical damage and why it can be so varied between. Individuals. So how can you help a student or maybe even a private client cope with pain? First understand that there are psychological and behavioral approaches to alleviating pain. The realization that pain is not just a physical experience, but also of psychological one has led to the development of various strategies to cope with and manage pain. I'm going to focus on one. Which is called graded exposure therapy. Graded exposure therapy is a psychological and physical intervention used to help people gradually confront and overcome fears, anxiety, or pain related avoidance behaviors. It's based on the principle that avoiding activities due to fear of pain or injury can reinforce the perception of pain and disability leading to further physical and psychological decline. The goal of graded exposure is to slowly reintroduce the person in pain to activities that they either fear or avoid in a controlled and systematic way. Which allows them to build confidence and reduce fear over time. Let me explain how graded exposure therapy works. The first step is to identify the specific activities or movements that the person in pain fears or avoid due to pain. These might be activities that the person believes will cause harm. Or exacerbate their pain. Once these activities are identified, they're ranked in order of difficulty or the level of fear they provoke. This hierarchy helps guide the progression of exposure, starting with less challenging tasks and gradually moving to more difficult ones. The person in pain then begins to engage in the activities at the lowest level of difficulty or fear. As they become more comfortable and experienced less fear or pain, they gradually progressed to more challenging activities. Positive reinforcement, such as acknowledging success is important throughout the process. The individual needs to regularly reassess their pain and fear levels Adjusting the plan as needed. Slow progression and even regression of movement is key throughout this. Here are two examples of how to incorporate graded exposure therapy in pain management. In the first example, let's talk about chronic lower back pain and lifting objects. So the fear or the avoidance is someone with chronic lower back pain. Who might avoid lifting objects because they fear it will cause further injury or pain. Over time. This avoidance can lead to muscle weakness, reduced movement and increased pain. Sensitivity. To utilize graded exposure therapy. They can one start with very light objects, such as lifting a small book or an empty box while focusing on proper lifting techniques and breathing. And noticing. How they feel. And they might only lift the object, just a few inches off the ground. They don't have to lift it all the way up. The next step, they would gradually increase the weight of the object over time. Such as moving from a paperback book to a hard cover book or a thicker book or a slightly heavier box. While they continue to focus on technique and monitoring their pain levels. Moving on. And as their competence grows, they might begin to lift objects from a lower height. Eventually progressing to lifting moderate weight items from the floor. By gradually increasing the challenge. The outcome is that they reduce their fear. They build strength and improve their ability to lift objects without experiencing significant pain. This experience and this feeling of going through these movements without having pain. Does wonders on pain management and taking the fear out of movement. Okay. Let's talk about another example. The second example is knee pain and stair climbing. So the fear and the avoidance would be someone with knee pain. Who might avoid going up the stairs because they feared that it's going to worsen their condition or cause intense pain. This avoidance might lead to further deconditioning. And difficulty in daily activities. So what's the plan. The plan is number one, to start with a small number of steps or a low step height, for example, they might practice stepping. Onto a low step stool or climbing just one or maybe two steps The next, as they become more comfortable, they can gradually increase the number of steps they climb. Maybe it's three or four. And then they can continue to practice, on slightly higher steps. They might also incorporate going down steps, which sometimes can be more challenging for knee pain. Eventually they can progress to climbing an entire flight of stairs, perhaps starting with holding on to a handrail for support. And gradually moving to climbing without assistance. But again, all of this happens with constant awareness of, okay. I went from two steps to four steps to six steps and back down, how does it feel? Should I stay with six steps? Should I progress and move on to eight steps? Or should I regress and go back to two steps for a few days? This gradual approach. Helps people in pain gain confidence. Reduce fear and improve their knee function. Allowing them to climb stairs more easily and with less pain. Again, slow progression and even regression of movement is key throughout. By slowing down and working in a range that does not hurt. They learn to correlate movement without pain. Tuning into their bodies, more and more along the way. Although we're learning more and more each day about pain and how we respond to it right now. We know that pain does not always correlate with tissue damage. We know that pain is a complex experience influenced by the nervous system emotions and psychological factors, rather than being a direct indicator of physical injury. Your brain can amplify or diminish pain signals based on various factors, including stress. Past experiences and even fear leading to situations where people experience significant pain despite minimal or no tissue damage. Graded exposure therapy addresses this disconnect by gradually reintroducing people in pain to activities. They fear. Or avoid due to pain. By starting with manageable tasks and slowly progressing patients can reduce their fear, improve their physical function and ultimately gain greater control over their pain. This approach is particularly valuable in breaking the cycle of avoidance and inactivity that often exacerbates chronic and persistent pain conditions. These insights into pain science, not only enhance our understanding, but also empower Practitioners to take a more proactive, informed approach to managing and overcoming pain. So ask yourself these questions. If you've ever had an injury. Did you think about how your nervous system contributed to your pain? Did you use graded exposure techniques, whether you knew it or not, if you think back, did you incorporate. some progressions and some regressions in your movement. And then finally, did you use yoga practices, like intentional breathing meditation? Or restorative classes or practices to help with. Nervous system regulation. And did you teach. Any of these. Techniques. And finally just remember, if you get injured in the future or work with a student in pain, you can apply these techniques to moderate the pain. I hope this episode gave you some food for thought. Because that's always my intention. If you can't already tell, I love talking about anatomy, pain, injuries, and pain science, and I want all teachers of movement to understand how a working knowledge of it affects your teaching. I don't think we talk about the importance of anatomy enough, and if this conversation feels uncomfortable or overwhelming, don't worry because this is exactly where change happens. Pick up an anatomy book, flip to any page and learn something new. Watch a video series. Talk to your students about their bodies and really watch them move and notice what you see. And find trusted teachers and accounts on social media that will teach you. Just keep taking the steps to be more informed. I hope that this episode sparks some deeper thought around why knowledge of pain, understanding and recovery is so important as a movement educator. I've added a link in the show notes for you to send me a quick text message about your thoughts on this episode. Or any other, I won't know your phone number. It's just a cool addition to the platform I use. That allows for this super easy way for you to communicate with me. Once you click on it, it will take you to your messages. Don't delete the code. That's how your message will get to me. And I would love to know your thoughts on this topic. I love diving into these conversations because there are so many important discussions to be had. In the teaching world. You know that my goal is for you to love the yoga teaching life and allow it to be fulfilling and rewarding. And sometimes it takes some work and a few conversations to get there. If you love this episode, let me know, subscribe to the podcast. So you always in the know when a new episode drops and share it with another yoga teacher who you think would love to be in on these conversations. Thank you for helping to spread the word about this podcast. And if you've been taking notes in your journal, as you listen to these episodes, I'm so glad you are. And I'd love to hear about it. Finally. Don't forget to join my newsletter. That's just for yoga teachers. I've got some exciting teachings coming soon. Centered around pain management. So I want to tell you all about them. The link is in the show notes below, and I would love for you to join it so we can always stay connected. All right. That's it for now. Bye. Mhm.