Tissue damage is neither sufficient nor necessary to cause pain. – Lorimer Moseley

I just watched multiple videos of Lorimer Moseley talking about the information gained from the years of pain research conducted by him and his team. This information is very interesting and provides some food for thought on some aspects of pain that may be new to many people.

When something (pretty much anything!) happens to the body, the brain must try to work out what is going on, is it dangerous, and what should be done about it. If the brain determines that the situation is dangerous, it will send pain signals as a protection mechanism to that part of the body that experienced the event. Pain is an output of the brain that is designed to protect you. The tissue damage itself, if any, is not the true source of the pain. For example, if you sprain an ankle, the pain is not coming from the torn tissue in the ankle even though you feel it there. The pain sensation comes from the brain.

In determining whether to send a pain signal, the brain takes many things into account from many sources – verbal inputs, visual inputs, memories, etc. Research has shown that it is possible to cause a person to “feel” pain in a plastic prosthetic limb (similar to phantom pain in an amputee), and to cause a person to “feel” pain in another person’s arm by tricking the brain with mirrors and special goggles.

This may partially explain how viewing a diagnostic report or film such as an x-ray and having someone with authority communicate a “diagnosis” to us can potentially exacerbate a pain issue. These are additional inputs that the brain will draw on to determine whether the situation calls for a pain signal.

There are many, many examples of people with very mild structural or tissue changes who experience significant pain and people with multiple severe structural issues who have no pain. Studies have been done on people without pain and they have been found to have the same exact structural variations in the same percentages as those with pain.

Could the verbal input of a diagnosis or visual input of an x-ray film be influencing the brain’s decision as to whether a situation warrants a pain signal? Pain is all about protecting the tissues, not measuring the status of the tissues. The pain is very real; it’s just not necessarily correlated with the tissue trauma. Anything that suggests you need protecting takes pain levels up and anything that suggests you are safe brings pain levels down.

This means that anything that changes your brain’s evaluation of danger will change your pain.

When pain duration continues and becomes long-term, the problem is that the neurons that keep producing the pain become better at producing the pain from smaller and smaller inputs. This basically means that the nervous system is somewhat in overdrive – overreacting to inputs that shouldn’t result in pain signals. Also, the neural networks over time lose their capacity for precision, so the pain spreads and becomes more generalized. Furthermore, stress alone causes increased resting nerve impulses, and what person in pain doesn’t have stress? This is how chronic pain evolves from a symptom that might indicate a tissue injury to becoming the disease itself.

Some questions to think about: what in my life, my thoughts, my beliefs, my behaviors, my diet, my relationships, etc. implies threat? Then think about the same questions with regard to safety. The goal is to reduce the threat associated with any answers to the first part and increase the safety associated with any answers to the second part. The body and brain are adaptable and they will change if you train them. Respondents who eat inappropriate food, smoke, consume alcohol and have sedentary jobs not balanced by other physical activity, experience a higher level of pain.

We also need to stop correlating our pain with our diagnoses. Who cares if you have stenosis or a bulging disc or facet joint arthritis or a meniscus tear if you have no symptoms? As noted above, many people live normal, pain-free lives even with these issues. The goal is to be pain-free and functional in spite of the pathologies that appear on an x-ray or MRI.

Yet with regard to treatment, thirteen years of experience as a D.O.M. and manual therapist, has clearly shown me that attention to structural issues such as muscle tension, fascial restrictions, tendon and ligament strains, joint capsule adhesions and joint malalignments has a significant positive effect on pain levels. So if pain is purely an output of the brain as a protection mechanism, it is likely that input from the proprioceptors in the tissues are one piece of how the brain is determining the danger level which then determines the pain level. It seems that sometimes there is a vicious cycle going on whereby the proprioceptors in the tissues communicate to the brain that something is wrong, the brain determines there is potential danger and causes pain, the tissues restrict further in response to the pain, which then communicates more negative input to the brain.

According to Moseley, movement is the key to retraining the brain. It gradually suppresses the pain signal, helps you learn, protects your body against other problems, and is the best way to recover. However, the movement itself must not be painful or it will simply exacerbate the danger signals. Even imagining movement is helpful and may be one way to begin retraining when actual movement is too painful.

Acupuncture and manual therapy are uniquely capable of addressing both the tissue dysfunctions that started the process as well as the nervous system itself. Acupuncture in particular can help calm the nervous system and restore constitutional balance. Treating the structural issues at the same time can help the patient regain some range of pain-free motion so that the brain can trust that there is no danger in the movements. Then the movement therapy can effectively do the job of retraining the brain.

~Carol McGlauchlin, DOM

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