What do a 17th century French philosopher and most chronic pain doctors have in common?
They both have an outdated notion of how pain works.
Among his many writings, René Descartes (1596–1650) delved into the mind-body connection that’s undergirded medical thinking for centuries: that pain always comes from a physical stimulus.
"We have two decades of research basically reinforcing that not all pain is the same, and that pain is really different from the way we thought it was."
Now, Descartes may have been at the forefront of a lot of thinking in the 1600s, including his brain-pain connection. At the time, the idea that our bodies had sensors that captured stimuli and sent messages to our brains to protect us? Well, it was revolutionary. Before that, much of the world believed that pain – especially chronic pain – was a divine punishment or test. Because of that opinion, pain often went untreated so as to not interfere with a deity’s will. A person in pain somehow deserved their pain.
Sound familiar? We may have come lightyears in our scientific theories and treatments, but much of the negative thinking about people living with chronic pain exists to this day.
But back to Descartes. His initial observations of what we now know as nerves and the neural pathways that connect them to the brain led to our modern beliefs of pain signals traveling from damaged tissues to the brain to say that something hurts and is therefore bad for our bodies.
He didn’t have it completely wrong, though. He did see the connection between the brain and pain. But it would take centuries for scientists to discover that there are more causes of pain than external stimuli or internal disease or damage.
Pain is Reframed in the Post-War Era
In the 1950s to 1970s, medical researchers began formulating the biopsychosocial model to understand pain. In short, this model proposes that “pain is the result of complex interactions between biological, psychological, and sociological factors and any theory which fails to include all of these three constructs of pain, fails to provide an accurate explanation for why an individual is experiencing pain.” So physical injury alone, in the biopsychosocial model, is not enough to explain why someone experiences pain.
"Pain itself is the “subjective experience that occurs after the brain has processed the nociceptive input.”
We’ve discussed nociceptive pain before: It’s our bodies’ reactions to physical injuries and inflammation, like bruises, cuts, sprains, and diseases like cancer. Any time something hurts, our brains translate signals from our nerves and catalogs those translations for future reference. Sprain an ankle chasing the ice cream truck, and you probably won’t associate ice cream with pain forever going forward. Sprain an ankle running from a big, scary dog, then your brain might make that association every time. That’s the biological (sprain) and psychological (fear) of biopsychosocial being combined.
Graphic from Washington University School of Medicine.
What about the social factor? The social part of biopsychosocial can overlap with the psychological factor,and it refers to social or communal interactions and pressures.
Social factors can also include pain behaviors. Ever seen a toddler fall down? If her dad’s facial reaction is fear, she’ll probably start crying. If her dad’s facial expression says to her, “I know you’re tough enough to pick yourself up,” she probably will.
So pain can come from our brains interpreting inflammatory signals, emotions, and what the painful incident means to us.
Pain can even occur when there’s no physical injury at all.
“Today we understand that there's some really different processes that start to happen, especially around primary pain, which is the vast majority of chronic pain.”
The Best News About Our New Understanding of Pain
The fact that the science around chronic and acute pain now takes so many more factors into account is great news for treatments. Because better treatments mean we there’s a lot of hope for recovery.
Taking the biopsychosocial approach to chronic pain management requires tailoring regimens to the individuals in pain (treating the person) rather than a one-size-fits-all solution (that just treats their symptoms). Some people might need physical therapy and a prescription medication. Someone might respond better to acupuncture and coaching to learn coping skills and calming meditations. Someone else might need surgery to correct an old injury and therapy to process the trauma of that injury and the effect it had on their life for years.
“One of the pieces I really like when I look at this is the feeling of hope that comes with it, the knowledge that there actually is a system to help you get the learning you need, and the practice, and be with you day in and day out to reverse that cycle.”
Lin was founded to give you tailored, holistic treatments to manage chronic pain. Lin’s program will provide you with a live discovery telehealth visit with a Lin provider, a pain recovery plan, a personal Lin Health Coach fuled by an integrative care team who will work with you every step of the way to a better life with less pain.
What are you waiting for? Answer a few questions now, and you could be on the road to more movement, better sleep, less pain, more hope, and more good days.