Two pains at once

Can you feel two pains at once?
Instinctively the answer is, ‘yes!’ After all, haven’t we all filled in pain body charts over the years with pain #1, #2, #3, #4 and even more in the ‘pain everywhere’ presentations?

This is worth reflecting on. I don’t think you can feel two or more pains at once.  Pain is such a fast, even primitive, brain construction that is designed to make us take action and change the behaviour that the brain believes is related to the pain. Maybe the brain can only deal with one pain at a time?

There are many stories of people who have been badly injured in accidents, for example, with all the focus on a neck injury, and two days later their complaints of foot pain reveals a fracture in the foot. Pain is not such a good defender in this state.

The bite the lip experiment
Try this… bite your lip until it hurts – and at the same time pinch your tummy till it hurts – try to focus on both pain constructions and you will (probably/maybe!) note that the pain moves from one site to the other. But the key here is that the ‘threat value’ at both sites is the same. If you were biting your lip and I came along and pinched your tummy, there should be no doubt about where the pain will be.

If you really want to – try this… next time you are out in the middle of nowhere with nobody around and it’s all peaceful and quiet, pull both ears and you may feel a pain go from one to the other. Just don’t get caught!!

By the way, have you had the need to hit two biting mosquitoes at once?

Of course, I realise the error here – who am I to suggest what your personal pain constructions are like? Some of our readers may well be sufficiently evolutionary advanced to appreciate two pains at once.

Physical and emotional pain dualism
Reflect for a moment on the dualism of physical and emotional pain, still so prevalent in society (“he has got over the physical side, still needs time with the emotional” I often read in the local newspapers).

We know now of course, courtesy of the brain maps and cognitive psychology that it is impossible to have a pure ‘physical pain’ – there will always be brain areas related to emotional and cognitive events included. And pain states that are more emotional – the pain of bereavement, the pain of being told there is nothing wrong with you – will always have a physicality, evident for example in postural changes or cortisol levels.

Yet even here, the two pains at once issue arises. You can bite your lip at a really sad time and arrest tears for a time (shifting from more emotional to more physical perhaps).

So what could all this mean?
I think there is a lot in this, much related to the conceptual changes we seek in clinicians and patients. The obvious thoughts relate to the mechanisms of distraction and the importance of the threat value that the brain places on a body part. 

The notions of physical and emotional dualisms suggest that both domains need integrating and managing early on in patients. Education is the glue. I believe that the more pain sites a patient has, then the higher the likelihood that there is one major pain generator existing in the brain.

It’s a little graphic but this hollywood clip is a good example.

Your turn
Send us your best two pains at once story and the winner will receive our ‘two pains at once’ which we like to call the Pain Pack.

Last month’s Wall Street pain
Thanks Nick, Anne and Geir for your thoughts on Wall Street Pain and Anne especially with the details of your little experiment. You will be sent an Explain Pain audio for your contributions which read…

…You mean my $410 000 becoming a $41 000 – while my electricity was out from Hurricane Ike?

Ah… you mean my Financial Planner patient!

His neck ‘discs’ go out every time he reaches down to turn on his computer in the morning! It is so bad, that he has missed the opening quotes on Wall Street several times. It causes severe headaches and right arm paraesthesia, sometimes nausea and dizziness. Before being sent to me he had a full work-up. He’s had brain MRI, neck MRI – guess what – ALL the lower discs are ‘shot!’ But he hasn’t had a stroke and doesn’t have a brain tumour.

HE said it was as if he were allergic to Wall Street!

Management
I am new to this Explain Pain stuff – sort of. After 34 years as a PT some has become intuitive. We talked about this and the article on Mirror Neurones was insightful. He was intrigued by there being a mind connection to this, but not in his case. I really need to fix his discs before he wants to deal with pain. He can handle the pain – but just fix the discs so he doesn’t have to have surgery (threatened by the neurosurgeon who sent him to me).

I’ve only seen him twice. I was miraculous in getting rid of arm pain with joint gapping and nerve gliding. For 1 day, it didn’t happen (do you know, that was the day after the market went up). So, he is going to chart morning pain and previous day’s stock price for me! I have no idea where this will go. He denies any relationship between pain and the stock market, but is willing to chart for me. Just so long as I fix his discs.

This should be interesting. 

Anne, TX United States

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