A Mind-Body Connection

If you have a basic understanding of pain or if you read my previous blog post, you will know that pain deals with signals and connections between nerves in the body and the brain. We now have scientific insight to a whole other side to “mind-body connection” and the sensation of pain. In the last decade or so, there is a new popular idea backed by research that your brain sends signals alarming your body is in pain when the body never sent nerve signals that the body was in danger. This would mean that the brain is perceiving pain that may or may not be necessarily triggered at that moment or to a greater or lesser extent! There is a big element of pain that is made up in your mind! Let me be clear about a few things; pain that is made up in the brain does not mean that the person tries to convince themselves that they are hurting and then all the sudden – poof—there is pain. This idea is legitimate, proven, and effects everyone. Your mind has control over your health and how your body feels. This “mind-body connection” could help explain why everyone has a different pain threshold, pain in nonexistent limbs, and chronic pain in many cases. If you have 15 minutes, I highly suggest watching this TED Talk Lorimer Moseley gave on why things hurt, or rather, why some things hurt when they shouldn’t necessarily hurt. In his video, he talks about his own experience with this complex phenomenon. He describes as he walked through a bush the first day, twigs and branches scratched and cut up his legs, yet he was in no extreme amount of pain. His pain changed when he was bit by a snake and almost died. The next time he walked through the bush, he perceived extreme pain. There was no way that the sensations on his skin from the bush put him in that amount of pain, so what did? His brain rewired itself to produce massive amounts of pain while in the bush because that previous experience was linked to the event of the snake bite in those bushes. From an evolutionary stand point, this rewiring mechanism could have saved us from many dangers out in the wild, but today, in our lives now, many of these rewiring scenarios may be less necessary, or even a nuisance, and cause sensations of pain triggered by these experiences. Another more common example of this phenomenon is often seen when old people bend down to pick something up and they “throw out their back.” When the person bent down and felt extreme sharp pain, they probably didn’t break a vertebrae or dislocate their spine. If there was no serious tissue damage or measurable tissue damage at all, a rewired brain would perfectly make sense. The person could have had an injury that rewired the brain to cause pain to warn the body to stay out of that position because it could be dangerous.

So if real sensation of pain can be made up in the brain, can the brain also be taught or trained to alleviate pain? In short, science says yes. We often have a number of options to treat the brain-triggered pain, though it can be very difficult. The most common has become medication like narcotics; this method will not help the underlying problem, it can only mask the pain and could cause other harmful side effects. The next method is to retrain the brain that it doesn’t have to produce the sensation of perceived pain. I will explore this method later on in my blog. The last option is another fascinating phenomenon that deals with the “mind-body connection”; I will call this the placebo effect.

https://www.youtube.com/watch?v=gwd-wLdIHjs  - Lorimer Moseley’s TED Talk on why things hurt.

Meditation for pain

What is meditation?

“Meditation is a practice where an individual trains the mind or induces a mode of consciousness, either to realize some benefit or for the mind to simply acknowledge its content without becoming identified with that content, or as an end in itself.”- (Lutz, 2008)

The way I define meditation is either focusing on one thing or nothing at all. The most essential things to focus on during meditations are your breathing, your surroundings, or one thought that is in your mind. Often, when you meditate, you are called to focus on your breathing and to try not to think about anything else that is on your mind, just the way your lungs fill up and then collapse down again. Some might call this “a grounding experience” or “enlightening”. For some people this type of diction scares them away or makes them feel like this practice is illegitimate, but in reality it is just a relaxation method.

Meditation for pain relief

Recently I went to a Buddhist themed meditation group that meets at the Federated Community Church here in Flagstaff. The group does guided meditations, breathing meditations, self-meditations, and even walking meditations. When I decided to go to this meditation group for the purpose of the project, I did not know what to expect. As we sat down, we started with some deep breathing. After we were calmed down from our day, we started a discussion about our inner peace. For this particular section, it is helpful to know a little bit about Buddhism to understand the nature of this meditation group.  Buddhism cannot only be classified as a religion, but also a philosophy. Some sects of Buddhism don’t even believe in a god. A main idea throughout Buddhism is to be at peace with the present. In our culture today, our lives are plagued with regrets of the past and worries for our future. Our minds are hardy in the present moment. And even when they are in the present moment, we often have a discontentment and feel the need to change something, or we are unhappy. When one is in pain and in the moment, they often wish they could change the fact that they are in pain. This person is not at peace.

When I was with this group, they explained something to me. First of all, it is hard to always be at peace. No one is going to sit there and say to themselves, “I am fine with being in pain. It doesn’t bother me; I am at peace.” You might be uncomfortable; that does not mean you cannot strive for peace. If your hand is in pain, our society might be quick to focus on it and yell, “Where’s the icepack? Where are the pills? Where’s the pain relief?” At this group, they sought to focus on something else. If your hand is in pain, focus on your feet, or wherever, wherever’s not in pain. Keep your mind locked on the fact that your toes, your foot, your leg have no sensation op pain at all; be at peace with that while trying to ignore your hand. This is not easy and takes self-mastery over your mind and thoughts. Because it was my first real time “meditating”, I was not very proficient. I can definitely see how this can be used as a tool for pain relief, especially for those who are good at meditating. I don’t think that this alone could relieve pain, but it would definitely help manage low pain if we can control our minds enough. Who knows? You might be able to conquer your mind enough to eradicate your pain and maybe even unlock the secrets to the placebo effect (which I will talk about in a later post).

Lutz et. al; Slagter, HA; Dunne, JD; Davidson, RJ (2008). "Attention regulation and monitoring in meditation". Trends in Cognitive Sciences 12 (4): 163–9.

NSAIDs and Possible Alternatives

What should I be using NSAIDs for?

NSAIDs are often used for low grade acute pain like headaches, small injuries, or lower back pain (LBP). NSAID medications are well researched and proven; they are most effective for short-term use once in a while. Some doctors feel that drugs like NSAIDs are never necessary or advised because they feel there are better ways to treat the pain with no possibilities of harmful side effects. Most doctors have no problem with suggesting NSAIDs, but almost all doctors are against long-term use of NSAIDs. So, in short, you might want to consider NSAIDs if you have a day-long headache, or a week long injury. You should never consider NSAIDs as a pain management option for chronic conditions like back pain that you need to find a relief from every day for the next ten years. NSAIDs could have harmful side effects for you, but the chances of having severe harmful side effects is drastically increased after taking the drug 30 days or longer.

Harmful side effects of NSAIDs

Common side effects include high blood pressure, fluid retention, and kidney problems, but maybe the most notable side effects are upset stomachs, ulcers, or stomach bleeding. As the COX enzymes are blocked, stomach lining is often striped and causes these stomach issues. If you get any of these side effects, stop taking NSAIDs, the side effects are harmful and might cause long-term damage. Over the last few weeks I have met many people who took NSAIDs long-term for chronic conditions like arthritis. Now, many of them are living with the consequences and can never take NSAIDs again. Most described to me that toward the end of their time chronically taking the drug that they no longer felt relief because their body became so used to and resistant toward the drug. They had to decide to either take more pills, poison their bodies more and feel pain relief, or, stop taking NSAIDs altogether and find an alternative. When they stopped taking NSAIDs regularly, but attempted to take it on occasion, they were usually doubled over in pain with ulcers throwing up blood from their stomach. Their stomachs were stripped from any protective layer by the years of taking the drug, and they became over-sensitized to NSAIDs. These people were forced to look for alternatives to NSAIDs and have done so with success. One of my main goals of this project is to highlight some of the alternatives so that it is never necessary to take NSAIDs.

Some possible alternatives

The effectiveness of herbal medicines that relieve pain have been debated for decades. Some say they can be equivalent pain relievers to NSAIDs. Homeopathic treatments such as Arnica Montana, Devil’s Claw, and Willow Bark are all said to reduce swelling and relieve pain but are not as significantly proven as NSAIDs. It is very possible that Devil’s claw (Harpagophytum procumbens) and willow bark (Salix alba) could help reduce pain. The Devil’s Claw roots contain harpagoside, a substance that is believed to be an anti-inflammatory compound. Devil’s Claw’s effectiveness is much debated. Willow Bark contains the chemical salicin. Scientists believe that the chemical salicin is an anti-inflammatory ingredient, but it is not well proven. There is less evidence that either could help reduce inflammation. Both homeopathic remedies need to have further research done to have sufficient evidence to fully suggest that they are effective pain remedies. After there is sufficient evidence that they relieve pain, there would need to be studies on the ideal dosages, ideal forms of the plant for consumption, and adverse effects.

In Chrubasik et al., (1996), the lack of research toward herbal medicine was explained in a way that made sense. “Some herbal remedies that predated the need for randomized clinical trial have become established pillars of contemporary therapeutics, while others of more recent popularity are regarded with condescension by the medical establishment because they have not yet been put to the conventionally approved test.” Some believe in the herbal remedies because they have been used since ancient times, while others need to see recent and approved evidence that supports the claims. Presently, there needs to be more research to definitively show that devil’s claw and willow bark relive pain, but there is a good start in that direction.

There might be huge advantages to homeopathic pain relievers. Standard drugs like NSAIDs can have harmful side effects, especially on the gut, but other more natural options might have fewer. “The plant extract does, however seem to be free of side effects,” (Chrubasik et al., 1996). This is great news. But, again, this too needs to be researched more thoroughly. Some articles addressed above suggested that there could be adverse effects to the gut as well. “It is recommended that the use of Salix (salicin medication) preparations be avoided in patients who are sensitive to salicylates,” (Chrubasik et al., 2000). Some patients in that study were reported with gut problems. But in the same study, willow bark was suggested to those who can’t handle NSAIDs. “These drugs [PAIDs (Phyto-anti-inflammatory drugs)] produce potent analgesia with a significantly lower risk of gastrointestinal toxicity,” (Chrubasik et al., 2001). Through the studies I’ve read and analyzed, both plant-based relievers, Devil’s Claw and willow bark, showed positive tendencies. Clearly more research is necessary to have more concrete evidence and answers, but overall, I would suggest Devil’s Claw and willow bark as alternatives to NSAIDs for pain relief.

As a side note: if you are interested in reading my literature review on Devil’s Claw and willow bark, feel free to contact me via email.

Chrubasik, S., et al. "Effectiveness of Harpagophytum procumbens in treatment of acute low back pain." Phytomedicine 3.1 (1996): 1-10.

Chrubasik, Sigrun, et al. "Treatment of low back pain exacerbations with willow bark extract: a randomized double-blind study." The American journal of medicine 109.1 (2000): 9-14.

Chrubasik, S., et al. "Treatment of low back pain with a herbal or synthetic anti‐rheumatic: a randomized controlled study. Willow bark extract for low back pain." Rheumatology 40.12 (2001): 1388-1393.

What is pain?

To begin my project on pain management, we first have to understand what pain is. The most basic understanding of pain is that there is some kind of injury or harm to the body that triggers a feedback loop from the inflicted area, to the brain, and then back to the inflicted area. For example, if you pinch your shoulder, nerve signals starting from your shoulder will travel up to your brain, where the nerve signals are analyzed as pain. The brain then sends a new set of signals to the shoulder to react, maybe to jerk away out of harm.  This is a basic and simplistic way to think of one type of pain, but it is not always this strait forward or simple. Pain is quite a monster to try to understand. Someone who’s had chronic back pain for the last thirty years probably has a much deeper problem than a temporary pinch. That being said, we can see that there are different kinds of pain. The pain is either chronic or acute.

Acute Pain

The example of the shoulder being pinched is a perfect example of acute pain. Acute pain is often classified as temporary pain. If the pain lasts less than six months, it is acute pain. Also acute pain usually has a known explanation to its cause, most likely an injury that will heal. Acute pain is generally easier to treat. NSAIDs will often suffice for a while. Chronic pain on the other hand, is very different.

Chronic Pain

To begin, chronic pain lasts longer than six months. Chronic pain often stems from deeper rooted problems in which pain is only a symptom to the underlying problem. A good example of chronic pain stemming from a bigger problem is Rheumatoid arthritis, when the immune system attacks the joins causing inflammation, swelling, and pain. Other causes of chronic pain include nerve damage, injuries that did not heal right, or sometimes pain for no clear reason. Chronic pain is generally much harder to treat. NSAIDs are potentially damaging to the body if you are using them for very long. These definitions between chronic and acute pain are not hard and fast, but rather basic ideas.

Recently I sat with Jay McCallum over coffee, and learned a little about pain. Jay McCallum is the co-owner of a physical therapy practice, Corebalance Therapy, here in Flagstaff. His practice is largely based around back pain, though he treats many other ailments. I found one idea he thought regarding chronic pain particularly interesting. He explained that what once could have been an acute injury could have turned into full blown chronic pain, even if the injury had healed. When the tissue was injured, the pain signals through the nerves were constant. For whatever reason, even as the ailment was healing, the brain continued pain signals just as prominently as before. This can turn into a serious problem. The nerves that are used to the pain signals become over sensitized, and the brain could learn that sending an overwhelming amount of pain signals is the normal thing to do. Meanwhile, the patient suffers. So now, in these types of cases, the goal is to retrain the brain that it does not have to send pain signals because the body is not being harmed.  Later on in my project I will explore a little more of Jay McCallum’s work and also how there is a mind-body connection with pain.