Many patients wonder if their pain is all imagined and in their head. Pain is a very complex problem. Often the source is hard to determine and treatment is not totally effective. The definition of pain also gives us a clue of the complexity. The IASP, an international medical group that studies pain, defines pain as:
“An unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”
Emotions are from the brain – therefore pain can be “all in your head” at times.
The Brain & Pain
The brain is the master of all sensory signals. The role of the brain is to receive, interpret, and then provide a response to signals received. Some sensory signals are from pain fibers in the periphery of the body, they travel to the brain, and the signals are then decoded in several different regions of the brain. Acute pain sensory signals are often interpreted correctly and the body and brain can handle an appropriate response. The body handles chronic pain signals differently.
There are multiple areas in the brain that respond to pain sensory signals. When pain is chronic, there is an actual increase in pain sensory signals going to the brain and an increase in brain sensitivity to these signals. Furthermore, areas of the brain that are near pain responders become stimulated, including emotional areas of the brain responsible for depression. A short circuit occurs and emotions are often perceived as pain. Treatment of pain that is it stimulated by emotions (such as depression) centers on successful treatment of the depression.
A Short Circuit in the Brain
There are also a few central pain syndrome triggered by damage to the spine or brain causing the brain to perceive pain, sometimes whole body pain, when there is no other injury. The pain is very real, but the source is basically a short circuit in the wiring to the brain or within the brain. Treatment of these problems is extremely difficult. Minimal pain medications help and central neuropathic medications like drugs for seizures are often the most helpful.
When pain is all “in the head,” there is likely an emotional component to the pain signals. Chronic pain often stimulates this problem. Treatments of the emotional components of pain are often as important or more important than medications for the pain itself. Pain is complex, and treating all components is necessary, and since pain entails emotions, these must be treated equally.
Thomas Cohn, MD
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