Saturday, 5 September 2015

Your Brain is Trying to Protect You: Part One

Did you ever touch a hot stove as a kid? It hurt, right? Hopefully you were leery about touching a hot stove after that, and learned that touching the stove when it's on leads to pain and should be avoided. 

The fact that you learned to avoid a hot stove is your brain at work protecting you. Likely you got the message after only one time, and didn't have to repeat that lesson over and over to learn not to touch that hot stove. Rick Hanson, a psychologist, talks about how we are wired to register negative experiences more quickly than pleasurable ones. He explains that for our survival it is more important for us to register that a certain insect bite can be fatal to a person than that the flowers beside us smell nice (Hanson, 2013).

So when your brain learns (very quickly) that a certain movement or situation causes pain, it becomes cautious. Avoiding things that are painful helps us survive and helps us know what parts need rest so they can heal. 

This is great.....until it becomes a problem.

The problem comes in when this "what is harmful" map becomes outdated or overgeneralized and begins to steal activities from us. Sometimes injuries can heal, but when you move that part of your body, your brain still says "Bad news, Bad news! What are you doing?" Your brain can become hypersensitive to that part of your body, so any message from that area becomes an alarm.

Your brain can also begin to generalize and gradually become sensitive to more and more movements and situations over time. That insect that was dangerous, so maybe all insects that look similar are dangerous too, and your brain learns to avoid those. If your brain takes this even further, then maybe the field you were in when you encountered that insect is dangerous. Maybe all fields are dangerous. Maybe simply going outside is dangerous. 

We're not saying the pain isn't real or the fear isn't justified. However, sometimes this protective mechanism can began to limit activities. An example of this process could be a person with chronic back pain that began after an injury from helping a friend move. The injury began by lifting very large objects in a way that caused tissue damage. Later it turned into chronic pain. The person could become reluctant to help anyone move after that. This probably won’t have a huge impact on the person’s day to day functioning, because this situation doesn’t occur frequently, and there are usually other options. The disruption to daily life comes if the same emotional reaction gets applied to similar situations that do occur frequently. For example, maybe the person notices that even lifting smaller objects like groceries now increases his pain. Or lifting his children or grandchildren. Or maybe he has a job that involves lifting and carrying, and he is now afraid of how his work will impact his pain (and vice versa). 

There are other valid reasons he may feel afraid to move. He may have been told by a well-meaning health care provider to avoid certain movements. He may have heard the idea that bed rest is the best thing for a back injury (an old way of thinking, but still believed by many people) (National Institute of Neurological Disorders and Stroke, 2014). He may have been told over and over that pain always equals harm, so he may be afraid of doing more damage to his body. 

As his brain tries to protect him, this can translate into an emotional reaction. Where at first he was cautious, he may become anxious or fearful. Frustration occurs when pain and the fear of pain limits movements. If it is limiting activities that aren’t important to him, it’s not a problem. The problem comes when it affects movements that ARE important.  

In healthcare talk it’s about the pain related fear and avoidance model. At its root this is where the fear of creating or worsening pain causes a person to avoid certain activities or situations. Pain avoidance has received a bit of a negative reputation, but if you look a little deeper it is just one of your body’s ways of trying to keep you safe; it has its roots in protective behaviour. It’s a totally normal and logical process.  It is not a character flaw or a weakness. So instead of feeling like pain avoidance is a “negative” give yourself (or your client) a pat on the back, your brain is just doing its job.

If the way your brain does that job is becoming problematic for your life, then it’s time to make a decision about whether you want to change it.  As a physiotherapist we know would love to say “acknowledgement is 50% of the solution”. In order to reclaim parts of your life, it can be helpful to examine the reasons and thoughts behind avoiding certain movements and activities. As you examine those, you can learn the difference between avoidance that is helpful to healing and fear that is disruptive for your life. If you are a health care provider, it’s essential to talk with your clients and find out their perspective on how avoidance is affecting them. Then you can empower them by tailoring your approach and utilizing individualized strategies that will help them live the life they want to live. If you can learn about [avoidance], and acknowledge it when it occurs, then you can begin to challenge it and change it. It’s not an exaggeration to say that overcoming fear-avoidance is essential if you want to self-manage pain successfully. It’s really that important” (McAllister, 2103).

Please join us next time as we look at some of the ways we can begin to challenge and change these behaviours.

Acknowledgment:

Diagram by Ashley and Colleen at Reclaiming Life. Graphics used are from Freepik.com (background, man lifting boxes, hurt and anxious man, thief, superhero, light bulb and shield).  

References:

Hanson, Rick. [The Rush on Shaw TV].  (2013). Interview with Neuropsychologist - Dr Rick Hanson.
[Video file]. Retrieved from https://www.youtube.com/watch?v=9gK9DyvWuGA&feature=youtu.be on September 5, 2015.

McCallister, M.J. (2013). Institute for Chronic Pain Blog: Fear-Avoidance of Pain. Retrieved from http://www.instituteforchronicpain.org/blog/fear-avoidance-pain/ on August 31, 2015.

National Institute of Neurological Disorders and Stroke. (2014). Low Back Pain [Brochure]. Bethesda, Maryland: National Institutes of Health Department of Health and Human Services. Retrieved from http://www.ninds.nih.gov/disorders/backpain/low-back-pain-brochure.pdf on September 5, 2105. 

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