It is commonly believed that there is a direct relationship between pain and damage within the body. However, this could not be more incorrect. Modern pain science has demonstrated that your thoughts, beliefs, perceptions, emotions, past experiences, context, and input from your body all affect your experience of pain (Edwards et al, 2016).
The UK Construction worker
In 1995, the British Medical Journal published an infamous case of a construction worker who jumped onto a plank at his worksite and landed on a 15cm nail. The nail pierced right through his boot, leaving the worker in excruciating pain. The smallest movement of the nail was painful. As a result, he was taken to the hospital and given opioids. However, when the ER doctors removed the boot, they discovered something incredible - the nail had passed between the toes and the worker was not injured at all.
The US construction worker
In 2007, the Psychosomatic Medicine Journal (Dimsdale & Dantzer, 2007) published a case of a construction worker who visited his dentist with a mild toothache. Much to his surprise, an x-ray revealed a 10cm nail embedded in his head (piercing up into his cerebral cortex!). The tradesman believed that the injury must have occurred 6 days earlier! He remembered using a nail gun when it unexpectedly discharged, hitting him in the face - but, at the time, he thought he saw the nail go into the wall and he felt minimal pain.
What does this tell us about pain?
Pain is not an accurate indicator of damage within the body. You can experience terrible pain without any bodily harm whatsoever (e.g., the UK construction worker above) or you can experience almost no pain in the presence of significant bodily harm (e.g., the US construction worker).
So, what is pain?
Pain is your body's warning system. Pain is activated by the brain when it perceives that you are in danger, and when it perceives that you need to take action to protect yourself.
In our first example, the construction worker’s brain took in the situation (the site of the nail through his boot, knowledge of his work environment being dangerous, reactions from others etc.) and deduced that he must be injured and in danger. The brain subsequently created a painful sensation to get him to protect his 'injured' foot and to seek safety.
In our second example, the construction worker's brain was convinced that the nail had fired into the wall and the only injury the body had received was a knock to the face. The brain deduced that the situation was safe, that there was no injury and, therefore, that there was no action required. Thus, the brain failed to signal any major pain.
The brain always decides whether you feel pain or not, regardless of whether you have a broken arm or a migraine headache. This decision is made rapidly and unconsciously based on whether the brain believes that you are in danger and whether the brain believes that you need to take some form of action to protect yourself. The brain can make mistakes, as it is unable to process every piece of sensory input in every moment (it takes a lot of shortcuts).
Often the danger your brain is sensing isn't physical
The development of chronic pain after an injury is more closely related to psychological factors (PTSD symptoms, stress, depression, anxiety etc.) than it is to the extent of injury (Jenewein et al., 2009). One's thoughts, beliefs, perceptions, emotions, past experiences and context can feel dangerous enough to the brain that it continues to think that you need to take action to protect yourself (thus keeping you in pain) even though your original injury has healed. The same is often true of chronic pain that exists without any preceding injury or illness. Indeed, emotional pain and physical pain exist in almost the same areas of the brain (Kross et al., 2011):
No, this doesn't mean your pain is 'in your head'
The pain of a broken foot is a real as pain that exists in the absence of tissue damage - they both come from the brain. However, it does mean that if your pain is continuing beyond the regular healing time, is poorly explained, or is not responding to treatment as expected then you should consider whether stress and perceived danger may be at play. In such instances, a bodymind healing approach (which targets mind and body) should be explored.
It is estimated that approximately one in six adults and one in three primary care patients could benefit from bodymind therapy.
Contact me if you'd like to explore this revolutionary approach to treatment.
Super fascinating! It's like we live our lives as if every part of ourselves is so separate. I heard a similar story from a helicopter Paramedic with an "impaled" foot that was never impaled. It just looked like it until they finally removed the boot and all realised it missed. No amount of morphine or fentynal made the pain go away until the truth was revealed.