The Many Layers of Pain
We’ve all heard by now that pain is complex, that it doesn’t always accurately reflect tissue damage. So what is it about pain that makes it so hard to treat? Some people will say diet alone healed their pain, while others will eat raw vegan with no shift in their pain symptoms. Some prayers are answered with pilates-based exercise, others with craniosacral therapy or visceral mobilization. So why is there such a variability in response to pain treatment?
There is this curious phenomenon in the body where the brain will “prioritize” different pain signals. Imagine you’ve been experiencing chronic low back pain, but then suddenly stub your toe really hard. In that moment, it’s likely that you won’t be feeling the low back pain. What I often see as a physical therapist is that as one body region heals, another will take over as being the most painful.
To add complexity to this understanding of pain, one must also consider the influence of the emotional state. A person who experiences depression or anxiety is much more likely to report higher pain numbers than an individual who is otherwise content with their life. We know that emotions have an influence on the release of certain hormones in the body, but there is a more mysterious relationship between pain and one’s emotional state. The regions of the brain that process emotional pain also process physical pain, which can result in a more intense perception of pain in the body.
From my experience working with pain, I’ve also found a very strong correlation between regions of pain and the associated chakra (or energy center). Individuals suffering from unprocessed grief will often report pain in regions of the body associated with the heart chakra, such as rib pain, shoulder pain, or chest pain. Hip pain can be represented by challenges of the 1st or 2nd chakras, which are associated with self-worth, authentic self-expression, or physical safety/history of physical trauma to provide a few examples.
Then, of course, we have pain as a result of inflammation. Inflammation is caused by any combination of the following three things: 1) pathogens, such as viruses or bacteria; 2) toxins/chemicals; and 3) physical injury. This inflammation can affect muscles, joints, nerves, fascia, organs, and even bone. Therefore, inflammation in a region of the body may be causing pain for a multitude of tissues, which all need to be accounted for in order to be effectively treated.
So with all these layers to consider, what does this mean for pain treatment? Taking the earlier example into consideration, pain may not actually improve until all the layers are effectively addressed. Many people will try one healing modality for a short period of time, then ditch it if they don’t experience any improvement in pain. But what one may not realize is that any single healing tool is likely only peeling back a single layer of the multi-layered pain experience.
This was perfectly highlighted by a patient I’ve been working with for about 2 years now. He reported unrelenting right hip pain, and had a history of multiple back surgeries, right hip replacement, and radiation therapy for prostate cancer. When I first evaluated him I was drawn immediately into his right lower abdomen. The first thing that presented itself in his body was inflammation of his pelvis, digestion, and liver. He made some changes in his diet and supplement routine, which helped reduce much of this inflammation. The next layer was what appeared to be functional lumbar instability, leading to irritation of the nerves going into his right hip. We improved his core stability and did some deep fascial release around the pelvic compartment, which helped for a few days at a time. Our following sessions focused on the next priority revealed by his body: his energetic relationship to his inner feminine, caused by a history of social trauma. These layers took time to clear, as integration of energy work unfolds slowly. These energy healing sessions would improve my patient’s pain for several days, but still no lasting results. His pain would vary in region or intensity to these various treatments, providing my with valuable information each session. But only recently did his body show me the final layer. This session, he could pinpoint his pain in the very back of the hip. Further assessment revealed the presence of scar tissue very deep in the hip from his joint replacement surgery, adhering to his sciatic nerve. And to his relief, finally, his pain improved long term.
The main takeaway from this experience as a practitioner who works with chronic pain is this: pain is not always an accurate indicator of the healing progress. The body will prioritize and reveal the layers in the order the body needs them healed, and pain does not always reflect this journey until the finish line. A more accurate marker of progress is the change in how the tissues feel, which will show a much more important result: the effectiveness of the treatments. People suffering from chronic pain don’t inheritely trust this process, and can easily become frustrated without much change in their superficial symptoms. Especially when fear is involved. But real healing takes time, a willingness to trust the process, and the ability to listen to the nuance of sensations in the body beyond just “pain”.
