What is Pain and What is Happening When We feel It?

What is pain? It might seem like an easy question. The answer, however, depends on who you ask.

Pain doesn’t originate at the site as most think, it’s created by the brain so we protect the area that’s in danger.

Some say pain is a warning signal that something is damaged, but what about pain-free major trauma? Some say pain is the body’s way of telling you something is wrong, but what about phantom limb pain, where the painful body part is not even there?

Pain scientists are reasonably agreed that pain is an unpleasant feeling in our body that makes us want to stop and change our behaviour. We no longer think of pain as a measure of tissue damage – it doesn’t actually work that way even in highly controlled experiments. We now think of pain as a complex and highly sophisticated protective mechanism.

How does pain work?

Our body contains specialised nerves that detect potentially dangerous changes in temperature, chemical balance or pressure. These “danger detectors” (or “nociceptors”) send alerts to the brain, but they cannot send pain to the brain because all pain is made by the brain.

When you’re injured, the brain makes an educated guess which part of the body is in danger and produces the pain there.

Pain is not actually coming from the wrist you broke, or the ankle you sprained. Pain is the result of the brain evaluating information, including danger data from the danger detection system, cognitive data such as expectations, previous exposure, cultural and social norms and beliefs, and other sensory data such as what you see, hear and otherwise sense.

The brain produces pain. Where in the body the brain produces the pain is a “best guess scenario”, based on all the incoming data and stored information. Usually the brain gets it right, but sometimes it doesn’t. An example is referred pain in your leg when it is your back that might need the protecting.

It is pain that tells us not to do things – for example, not to lift with an injured hand, or not to walk with an injured foot. It is pain, too, that tells us to do things – see a physio, visit a GP, sit still and rest.

We now know that pain can be “turned on” or “turned up” by anything that provides the brain with credible evidence that the body is in danger and needs protecting.

All in your head?

So is pain all about the brain and not at all about the body? No, these “danger detectors” are distributed across almost all of our body tissues and act as the eyes of the brain.

When there is a sudden change in tissue environment – for example, it heats up, gets acidic (cyclists, imagine the lactic acid burn at the end of a sprint), is squashed, squeezed, pulled or pinched – these danger detectors are our first line of defence.

They alert the brain and mobilise inflammatory mechanisms that increase blood flow and cause the release of healing molecules from nearby tissue, thus triggering the repair process.

Local anaesthetic renders these danger detectors useless, so danger messages are not triggered. As such, we can be pain-free despite major tissue trauma, such as being cut into for an operation.

Just because pain comes from the brain, it doesn’t mean it’s all in your head. 

Inflammation, on the other hand, renders these danger detectors more sensitive, so they respond to situations that are not actually dangerous. For example, when you move an inflamed joint, it hurts a long way before the tissues of the joint are actually stressed.

Danger messages travel to the brain and are highly processed along the way, with the brain itself taking part in the processing. The danger transmission neurones that run up the spinal cord to the brain are under real-time control from the brain, increasing and decreasing their sensitivity according to what the brain suggests would be helpful.

So, if the brain’s evaluation of all available information leads it to conclude that things are truly dangerous, then the danger transmission system becomes more sensitive (called descending facilitation). If the brain concludes things are not truly dangerous, then the danger transmission system becomes less sensitive (called descending inhibition).

Danger evaluation in the brain is mindbogglingly complex. Many brain regions are involved, some more commonly that others, but the exact mix of brain regions varies between individuals and, in fact, between moments within individuals.

To understand how pain emerges into consciousness requires us to understand how consciousness itself emerges, and that is proving to be very tricky.

To understand how pain works in real-life people with real-life pain, we can apply a reasonably easy principle: any credible evidence that the body is in danger and protective behaviour would be helpful will increase the likelihood and intensity of pain. Any credible evidence that the body is safe will decrease the likelihood and intensity of pain. It is as simple and as difficult as that.

Implications

To reduce pain, we need to reduce credible evidence of danger and increase credible evidence of safety. Danger detectors can be turned off by local anaesthetic, and we can also stimulate the body’s own danger-reduction pathways and mechanisms. This can be done by anything that is associated with safety – most obviously accurate understanding of how pain really works, exercise, active coping strategies, safe people and places.

A very effective way to reduce pain is to make something else seem more important to the brain – this is called distraction. Only being unconscious or dead provide greater pain relief than distraction.

In chronic pain the sensitivity of the hardware (the biological structures) increases so the relationship between pain and the true need for protection becomes distorted: we become over-protected by pain.

This is one significant reason there is no quick fix for nearly all persistent pains. Recovery requires a journey of patience, persistence, courage and good coaching. The best interventions focus on slowly training our body and brain to be less protective.

This article was originally posted on https://theconversation.com/explainer-what-is-pain-and-what-is-happening-when-we-feel-it-49040

For more information and audio recordings discussing pain, follow this link.

Why Does Your Body Twitch As You're Falling Asleep?

If you’ve ever found yourself drifting off to sleep only to be woken by a vigorous, full-body twitch or jerk, then do not feel alarmed. You’re among the estimated 60 - 70 % of Americans who regularly experience a phenomenon known as a hypnic jerk—also known as a hypnagogic jerk, or sleep start—which strikes as a person falls into a deep sleep. Here’s what to know about it.

What do sleep jerks feel like?

Hypnic jerks—involuntary twitches or jolts which occur during the night—can affect people in different ways. Many people will sleep right through them, but for others, they are vigorous enough to wake them up.

Although there is no definite explanation for what causes hypnic jerks, people are more likely to suffer from them when they’re sleep deprived or anxious, or when they do sleep-impairing habits before going to bed, like drinking caffeine or doing exercise close to bedtime, says James Wilson, a U.K.-based sleep behavior and sleep environment expert. “For people who suffer from hypnic jerks, it’s awful,” he adds. “They worry about it before they go to bed, which makes it worse.”

Jacqui Paterson, who is 44 and lives in the U.K., says she has experienced these kinds of twitches on an almost-nightly basis for about three years.

“When I was about 41, I started getting insomnia, which I’d never had in my life before,” she says. “Initially, I was staying awake all night, but I now get these annoying jerks which wake me up exactly an hour after I fall asleep, like someone has set an alarm in my head. I seem to have replaced one evil with another.”

Paterson says the jerks come more regularly when she feels concerned or preoccupied. If she worries about them happening before she goes to bed, then it “almost guarantees” that she will suffer from them that night.

The jerks feel like a jolt or an electric shock, Paterson says. “I’ve heard people talk about getting a falling sensation when they drop off to sleep,” she says. “To me, the feeling is like that but on steroids. It’s like someone has come and slapped me. It’s a really shocking feeling, like jumping into freezing cold water. I always wake up feeling totally alert.”

What causes hypnic jerks?

Put simply, hypnic jerks are caused when one part of the brain tries to go to sleep more quickly than other parts of the brain.

“The complexity of going to sleep and waking up is incredible, and sometimes—particularly when we are sleep deprived—our brain doesn’t shut down normally, which means we get this sort of jerking movement when we’re in a light sleep,” says Wilson. Often, he adds, the brain tries to make sense of it, “which is when we imagine ourselves falling off the sidewalk, a cliff or in a hole.”

The reason why some people experience the twitches at such a predictable time is due to their circadian rhythm, or body clock, Wilson says. “Normally when we go to sleep, about half an hour later we go into a deep stage of sleep during which we wouldn’t get these hypnic jerks,” he says. “If someone is sleep deprived, as they go through the process of falling asleep, the brain will get stuck at the same point in time. Usually if we can help people address their sleep deprivation, the instances decrease or disappear altogether.”

How can you prevent sleep jerks from happening?

There are ways to limit the effects, particularly by making a conscious effort to sleep better. “Try and get in a good routine around sleep,” Wilson says. “Wake up at the same time every day, and wind down properly before going to bed, making sure the activities you do in the hour before going to sleep are relaxing to you. Like most issues surrounding sleep, preventing hypnic jerks is all about trying to solve that sleep deprivation.”

Wilson also suggests that if a person suffers from them at the same time every night, they could ask a housemate or family member to disturb their sleep about five minutes before the jerks tend to occur, either by encouraging them to turn over in bed or rustling something near them. Often, that will help stop the twitches from happening, he says.

This article originally appeared on time.com and was written by Kate Samuelson

What is Stress? How Does It Affect Us?

Have you ever found yourself in a situation where your to-do list seems endless, deadlines are fast approaching and you find yourself saying ‘Eek! I feel stressed!’? But what is stress really, and how does it affect us?

Firstly, let’s debunk one myth: stress is not necessarily a ‘bad’ thing. Without this brilliant ability to feel stress, humankind wouldn’t have survived. Our cavemen ancestors, for example, used the onset of stress to alert them to a potential danger, such as a sabre-toothed tiger.

Stress is primarily a physical response. When stressed, the body thinks it is under attack and switches to ‘fight or flight’ mode, releasing a complex mix of hormones and chemicals such as adrenaline, cortisol and norepinephrine to prepare the body for physical action. This causes a number of reactions, from blood being diverted to muscles to shutting down unnecessary bodily functions such as digestion.

Through the release of hormones such as adrenaline, cortisol and norepinephrine, the caveman gained a rush of energy, which prepared him to either fight the tiger or run away. That heart pounding, fast breathing sensation is the adrenaline; as well as a boost of energy, it enables us to focus our attention so we can quickly respond to the situation.

In the modern world, the ‘fight or flight’ mode can still help us survive dangerous situations, such as reacting swiftly to a person running in front of our car by slamming on the brakes.

The challenge is when our body goes into a state of stress in inappropriate situations. When blood flow is going only to the most important muscles needed to fight or flee, brain function is minimised. This can lead to an inability to ‘think straight’; a state that is a great hindrance in both our work and home lives. If we are kept in a state of stress for long periods, it can be detrimental to our health.  The results of having elevated cortisol levels can be an increase in sugar and blood pressure levels, and a decrease in libido.

Fight

When your body goes into a state of stress, we may feel agitated and aggressive towards others; this can be due to our bodies’ natural reaction being “fight”. This can be a helpful reaction to ward off predators, but in unnecessary situations, it can negatively affect relationships and ruin reputations.

Flight

Some of us avoid our stressors, removing ourselves from the situation instead of tackling it. This can be a sign of the “flight” survival instinct; a function that can save our lives if we find ourselves in dangerous surroundings. However, in everyday life, this natural instinct can lead to a stressful situation escalating, and increase our stress levels when we realize that the stressor isn’t going away and we need to face it.

Freeze

Unknown by many, there is a third mode that stress can cause; freeze. For some people, becoming stressed sets the stage for ‘dysregulation’. The energy mobilized by the perceived threat gets “locked” into the nervous system and we ‘freeze’. This  response sometimes reveals itself when we breathe. Holding our breath and shallow breathing are both forms of freeze. The occasional deep sigh is the nervous system catching up on its oxygen intake.

Understanding Stress

Stress is a condition or feeling experienced when a person perceives that:

“Demands exceed the personal and social resources the individual is able to mobilise.”

Here at The Stress Management Society we use a bridge analogy to approach the topic of stress.

When a bridge is carrying too much weight, it will eventually collapse. It is possible to see the warning signs before this happens, the bridge would bow, buckle and creak.

The same principle can be applied to human beings, with excessive demands and challenges placed on our bridges. There may be early warning signs. However stress can creep up on some of us, resulting in an unexpected breakdown.

That ‘bridge collapse’ in a human being could take many forms:

• Mental and Emotional Breakdown
• Taking one’s own life
• Serious health issues including:
   
  • Cardiovascular disease: The heart is the first organ in the body to experience stress. The No. 1 killer on the planet today is heart disease and it’s no coincidence that as we find ourselves living under higher and higher levels of stress the instance of heart disease is increasing.
  • Stress has a profound impact on how your body’s systems function, Health experts are still sorting out whether stress actually causes cancer. Yet there’s little doubt that it promotes the growth and spread of some forms of the disease. Put simply, stress makes your body more hospitable to cancer.
  • Stress can cause a rise in blood pressure – the main cause of haemorrhagic stroke is high blood pressure, which can weaken the arteries in the brain and make them prone to split or rupture.

The key message is that if we are able to recognize when we have too much demand on our bridge then we can take action to prevent ourselves from getting anywhere near the bridge collapsing which thankfully most of us will never experience or see.

How It Affects Us

One of the difficulties with stress is that people experience stress in different ways. This contributes to stress manifesting itself differently. So it would be wrong to over generalise when giving advice on how to identify stress in others. However, what we can say is that because stress has negative effects, it will usually manifest itself one way or another.

Stress targets the weakest part of our physiology or character; if you are prone to headaches or eczema, this will flare up.  If you have low levels of patience or tolerance for others, this will be the first area to present under times of stress.

Stress isn’t avoidable but it is manageable. A key action in order to minimise risk is to identify stress-related problems as early as possible, so that action can be taken before serious stress-related illness occurs.

There will be changes in the stressed person.

These changes may be emotional, physical or behavioural, or a combination of all three. So, the key thing is to look out for negative changes of any kind. Bear in mind that the negative changes are also likely to have knock-on effects e.g. reduced performance at work.

Of course, we all experience ‘bad days’, so we are really talking about situations where people display these negative changes for a period of time (e.g. 5 days in a row).

Prolonged stress undoubtedly makes people ill. It is now known to contribute to heart disease, hypertension and high blood pressure, it affects the immune system, is linked to strokes, IBS (Irritable Bowel Syndrome), ulcers, diabetes, muscle and joint pain, miscarriage, allergies, alopecia and even premature tooth loss.

Cognitive

• Memory Problems
• Poor Judgement
• Inability to Concentrate
• ‘Brain Fog’
• Indecision
• Starting many tasks but achieving little
• Self doubt

Emotional

• Depression
• Moodiness
• Irritability
• Fatalistic Thinking
• Panic
• Cynicism
• Anxiety
• Feeling Overwhelmed
• Frustration

Physical

• Chest Pain
• Rapid Heartbeat
• Aches and Pains
• Frequent Colds
• Skin Complaints
• Indigestion
• High Blood Pressure

Behavioral

• Increase Intake in Alcohol, Cigarettes and Caffeine to Relax
• Isolating Yourself from Others
• Sleeping too Little or too Much
• Demotivated
• Loss of sense of humour

10 Step Stress Solution

• Prioritise Your Health
• Get a Good Nights Sleep
• Practice Deep Breathing
• Stay Hydrated
• Eat for Wellbeing
• Get Moving to Combat Stress
• Adopt a Positive Mind Set
• Master Your Time
• Don’t be a Slave to Tech
• Learn to Say No

This article originally appeared on stress.org.uk

Feeling Sleepy? Have a Nap. It's Good For you!

Here's a very valid case to have a power nap. Experts say an after-lunch snooze is good for you and your productivity.

If you’ve ever felt the need to rest your head on your work desk to secretly get a few minutes of post-lunch shut-eye while the boss wasn’t watching, it turns out you’re not lazy or disinterested. In fact, you are very normal.

According to Moira Junge, sleep psychologist and member of the Sleep Health Foundation, we were designed to require an afternoon kip to get through the day.

“We are all pre-programmed to need a little nap in the afternoon, explains Junge. “What happens with our body’s sleep mechanisms is that we have a post-lunch dip in our system and have a propensity to sleep.”

Junge explains the ‘post-lunch dip’ in our 24-hour circadian rhythm is like a sleepy switch that just flicks on in the afternoon. It’s independent of what we eat and of the amount we’ve slept the night before. This dip also gets repeated at night around 11pm and is the reason why some of us ‘crash out’ around that time.

“We are all pre-programmed to need a little nap in the afternoon. What happens with our body’s sleep mechanisms is that we have a post-lunch dip in our system and have a propensity to sleep.”

But, says Junge, what’s unique about this afternoon napping signal is that it’s temporary. It lasts 30 minutes to 1.5 hours before we go back to feeling alert again.

“If you don’t get an opportunity for sleep, say if you are at work, you can cycle through this dip quickly as your body’s systems will rise again, with or without a sleep if you can just manage to stay awake through it.”

Professor Leon Lack from the School of Psychology at Flinders University is pro-power napping and says if we can, we should. He reminds me that our need to nap in the afternoon is the reason why siestas are an accepted practice in many countries and explains that napping is a natural human habit dating back hundreds of years.

“We’ve become so fixed in our cultural habits of having a single nighttime sleep,” Prof Lack tells SBS. “This idea is a reasonably recent cultural adaptation from the industrial revolution and because of the advent of electric lights.

“Over 300 years ago, when most people were rural farmers, you probably had naps in the middle of the day and stayed up a little later at night but only so long as the fires burned in your house.”

So let’s say one day, our workplaces radically changed to become pro-napping zones. How long a kip should we have on our desk before the alarm rings? Junge says the trick is for the nap to be very short: 20 minutes is ideal, with time dedicated for you to fall asleep.

“If you sleep more than 20 minutes, you get into that deep slow wave of sleep where you can’t hear anything or wake up and don’t know where you are,” says Junge.

“That’s because the first 20 minutes of sleep are very light, stage one and two of sleep, and if you sleep for longer, you are more likely to have sleep inertia, where you wake up and feel worse or take a long time to ‘wake up’ and get going. Longer naps might also affect your sleepiness and ability to sleep at night. So short, sharp naps are recommended.”

Prof Lack goes even further to suggest that the average adult should be having 10 minute power naps in the afternoon, as needed, with a few minutes added to fall asleep.

He co-conducted research in 2006 comparing no naps with naps of five, 10, 20 and 30 minute durations. The 10-minute adult nap gave participants the biggest rise in alertness with the minimal amount of post-nap grogginess.

“With the 20 and 30 minutes sleeps, performance was impaired a little bit immediately after waking up for the first half hour or so,” says Prof Lack. “But the 10 minute naps produced significant benefits in cognitive performance.”

"Stop the struggle and have a quick kip so you can be more productive at work for the rest of the day.”

The moral of this dreamy story, Prof Lack suggests, is that if someone is really struggling with sleepiness in the afternoon, it’s likely they will continue on struggling for up to 90 minutes until they come out of ‘that dip’.

“So managers should find out what’s better for the worker. Is it better for them to be below par at work for 1.5 hours [during their afternoon dip] and potentially make mistakes? Or allow them 15 minutes – five minutes to relax and fall asleep and 10 minutes of napping – to increase the productivity for the remainder of that 1.5 hours?

“Napping could be considered beneficial if you are struggling with sleepiness in the day, commonly in afternoon and have a decline in alertness. Stop the struggle and have a quick kip so you can be more productive at work for the rest of the day.”

Both experts stress that this advice is general and that sleep needs vary according to individual needs and circumstances. They recommend that people with sleep disorders consult a GP and, if needed, see a sleep specialist.

This article originally appeared on sbs.com.au and was written by Yasmin Noone