Gina is a busy mother and a single parent who works at night to support her son. Unfortunately, she has been riddled by severe pain enveloping her entire body for the last 11 years. Gina has seen several specialists for her pain and they performed diagnostic testing which included MRI’s of her brain and all areas of her spinal cord. No abnormalities were found, and she was told that she was normal.
Words cannot describe the level of frustration Gina experienced. Her pain was severe and she knew it was real, yet her doctors repeatedly implied otherwise. Doubting herself, Gina wondered if the pain was truly “all in her head”.
The simple answer to Gina’s question is yes, the pain is in her head. However this is not meant to imply that Gina is crazy, histrionic, or embellishing her suffering. To fully comprehend what is meant by this statement, the reader needs to understand how the master computer of the body, the brain, along with its communication system- the spinal cord- process pain. For the fibromyalgia sufferer and all of the 120 million chronic pain sufferers in this country, it is important to understand how pain signals arrive at our central nervous system (brain and spinal cord), the purpose of this pain (to let us know something is wrong) and what other factors (stress and biochemical) which can influence it.
To better understand these concepts lets further explore the issue by using a 15 year old soccer player’s injury as an example-
When the shin of a soccer player is kicked violently, “pain” receptors in the shin will send signals in nerves that transmit the message to the spinal cord. The nerves that carry these signals to the spinal cord and the brain are not called pain nerves or pain neurons (neurons being the term for nerve cells), but are instead referred to as nocioceptive fibers and nocioceptive neurons. The emphasis on the difference in these terms is intentional and important to the fibromyalgia and chronic pain sufferer. “Nocioception” is a process. The nocioceptor is a cell that “senses” and can respond to potentially damaging stimuli (burns, inflammation, infection, trauma, etc.) to those cells. If one of the stimuli stimulates these cells, nerve signals are then sent to the spinal cord and brain. The process described here is called nocioception and usually- but not always- causes the perception of pain- in the brain.
As many as 70-75% of these signals from the kicked shin will not enter the conscious (awareness) area of the brain but instead terminates in the “subconscious” midbrain. This is the “older area of the brain” – the non-thinking part of the brain.
But because our soccer player’s shin was kicked so hard, the remaining 25% of the pain signals will reach the conscience area of the brain, so that the brain can interpret that the shin was kicked and enable the brain to perceive and understand this as a painful event. Thus the 70-75% of the nerve signals first go to the area of the conscious brain called the parietal lobe and because in our example the nocioceptive signals are “overwhelming” the 25% will go to the “subconscious” area called the cingulated gyrus.
For all of the fibromyalgia and chronic pain suffers this is where the proverbial rubber meets the road. Because the cingulated gyrus is where we experience pain and suffering. In order for a person to feel “chronic” pain the anterior cingulate gyrus must be activated and perpetually stimulated.
The brain, in its attempt to prevent pain automatically sends signals down the spinal cord to shut off the pain process of nocioception. It does so by using chemical molecules such as serotonin, morphine, and endorphins. These chemicals proposed aim is to shut off the nocioception process coming into the spinal cord before it travels up the spinal cord to be experienced as pain. This is what drugs and other “alternative” interventions (5HTP, melatonin, serotonin etc) do.
Endorphins shut off pain- as in the endorphins in the long distance runner’s experience of “getting their second wind. Or as they call it, “the runner’s high”. And many of you are familiar with morphine and its pain inhibiting properties. But how many of you knew that our brains naturally make morphine (if it’s not under stress) to shut off the nocioceptive pain mechanism, so that the nocioception never reaches the brain to be realizes as pain. SO now the saying “it is not pain until it reaches the brain” should make sense. For the fibromyalgia and other chronic pain sufferers this saying also summarizes why they have chronic pain. The pain can be in the brain- and usually is. Causes of the destruction of this mechanism and the perpetuation of chronic pain conditions are exhaustive. In part 2, we will discuss fibro, chronic pain conditions, stress, inflammation, and many more causes of pain experience “all over their body” until then- the pain is in your head-but you’re not crazy!!