Please enjoy an excerpt from my book, Winning the Injury Game, which will be available soon.
Neurosciences Professor Dr. Lorimer Moseley says, “Pain is a construct of the brain.”1 Now to be clear, I am not suggesting that the pain is all in your head or that you are making it up. However, I do understand that can happen. During my healing, a therapist implied this was what was holding me back in my recovery process. He suggested I read anything by Dr. John E. Sarno, a physician and pioneer in the field of mind-body medicine. I did find this helpful. If you are interested in learning more, I’d recommend starting with his New York Times bestseller, Healing Back Pain.2
Back to Moseley’s point: our soft tissues, by themselves, are unable to create the sensation of pain. It is not until the information about the damage reaches the brain that a determination is made about how to react. The brain interprets the situation and makes a judgment about the severity of the injury and the best way to respond. Depending on the circumstances and your previous experience with similar pain, the brain can choose to make the pain intense or barely noticeable.
In his TED (2011)1 talk and book, Painful Yarns,3 Moseley tells his popular story of being bitten by an eastern brown snake, one of the deadliest snakes in the world. I highly recommend watching his presentation as he is quite entertaining. In his talk, he describes walking in the Australian bush, something he had done many times before, and feeling discomfort on the outside of his calf, a sensation that usually meant he was scratched by a twig. On this particular day, however, it was a snake bite. What is interesting to notice in his story is how his brain responds to the snake bite—along with his reaction the next time he is out walking after he’d been bitten.
As he explains it, he was walking along in the bush and felt a sensation on the outside of his calf. Upon sensing this, his brain surveyed the situation and surmised that it was not dangerous, so he continued walking with little pain. His brain had determined that he had been in the area before, had felt the same feeling on the same area of his body during the same phase of the gait (walking) cycle, and so it was not a threat—a notable injury to the body. It was merely a scratch by a twig. The reality was, he had been bitten by the often-deadly eastern brown snake and was lucky to have survived. Hence, when he was walking in the bush the next time and felt the same sensation on his leg, his brain sounded the alarm bells and made his leg hurt so much that he could not continue walking. His brain had the memory of almost dying the last time this had happened and was not going to let him ignore this “very serious threat.” However, this time the injury turned out to be the familiar small scratch by a twig. Moseley’s recent experience of being bitten by a snake influenced how his brain reacted to the pain. It was not the body injury itself, the scratch or snake bite on his leg, that dictated his behavior, but rather the brain’s interpretation of the situation.
In his book Explain Pain, Moseley states that “the amount of pain you experience does not necessarily relate to the amount of tissue damage you have sustained,”4 as his snake bite story demonstrates. Interestingly, back pain research has found that the amount of damage and pain experienced do not always correlate. A study by Jensen, et al., found people with no back pain had disc bulges and protrusions on their magnetic resonance imaging (MRI) scans.5 Although damage was seen in the lumbar spines of these subjects, they did not feel any pain. Consequently, according to Moseley, this would mean that the brain did not perceive these body changes as a threat and did not register them as pain. How much you hurt, then, is influenced by other factors outside the amount of physical harm.
Pain is only one option the brain has as a response to a bodily injury. Moseley tells stories of people who don’t feel pain even though their body has sustained a great trauma—soldiers who have been shot and surfers who have had their legs bitten off.4 Due to the dangerous environment the people in these examples are in—war zones with enemy fire or the ocean waters—it is not in the brain’s best interest to send the response of severe pain and immobilize the person. In that moment, the brain is more concerned with keeping the person safe and out of harm’s way. Pain would jeopardize the victim’s ability to flee the scene and get to safety.
- TED. (2011, Nov. 21). Lorimer Moseley – Why Things Hurt [Video file]. Retrieved from https://www.youtube.com/watch?v=gwd-wLdIHjs
- Sarno, J. E. (1991). Healing Back Pain: The Mind-Body Connection. New York, NY: Grand Central Publishing.
- Moseley, G. L. (2012). Painful Yarns: Metaphors & stories to help understand the biology of pain. Minneapolis, MN: OPTP.
- Moseley, G. L. (2013). Explain Pain (2nd ed.). Adelaide City West, South Australia: Noigroup Publications.
- Jensen, M. C., Brant-Zawadzki, M. N., Obuchowski, N., Modic, M. T., Malkasian, D., and Ross, J. S. (1994). Magnetic Resonance Imaging of the Lumbar Spine in People without Back Pain. N Engl J Med, 331, 69-73.