Is the change in air pressure or the humidity causing my joint pains to flare up, or is this just an “old wives’ tale”?
As we age, it's more common to have aches and pains. But is your pain real or is your brain playing a trick on you?
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Welcome back to Get-Fit Guy, I’m Kevin Don. Recently, the weather here in the United Kingdom has been pretty wet and thundery and my hip and lower back have been causing me significant discomfort. So, what’s the deal? Is the change in air pressure or the humidity causing my joint pains to flare up, or is this just an “old wives’ tale”?
We will dig into that and more pain myths in a moment, but first of all, how about we define what pain is? According to the National Institute of Health, pain is an unpleasant signal that something hurts. It is a complex experience that differs greatly from person to person, even between those with similar injuries or illnesses. It can be mild and almost unnoticeable or it can be explosive.
Typically it comes in one of two forms. Acute pain usually comes on suddenly and is related to a specific injury. It is a protective response to damage. It is also, usually, time limited. If not, it can become the second pain type, chronic pain. This is persisting pain and involves environmental and psychological factors more than it does protective ones.
Pain occurs when nociceptors, which are specialized sensory cells, send an electrical impulse, or signal to the brain. This is usually in response to a stimulus, such as heat in the case of a burn or localized tissue damage in the case of an injury. Pain also has an overlap with emotions such as fear, anxiety, and anger, which can amplify the experience of pain.
There are also a bunch of chemicals called neurotransmitters that have a role to play in your pain experience. Glutamate heightens sensitization and makes pain persist. There is ongoing pain research into how to block glutamate receptors. GABA, a neurotransmitter I take sometimes at night to aid sleep, decreases signals between neurons and therefore reduces pain signals. Serotonin dampens the stimuli from the nociceptors and in fact, antidepressants are often prescribed for chronic pain. Triptans, a class of drugs prescribed for migraines, work on the serotonin receptors as well.
Ok, so that’s the biological part (mostly) covered, but pain is often referred to as being under a bio-psycho-social model. How could it be that my pain is affected by my psychology?
One of the most common pain complaints in aging adults is low back pain. In fact, when I went to the doctor with low back pain last year, without doing ANY diagnostic imagery at all, she said it's likely I had a disc herniation which was pressing on nerves. She then filled a prescription for an incredibly addictive nerve-blocking medication and sent me on my way. Must be great having x-ray eyes. That being said, MRI findings (1) do back up that disc degeneration causes more low back pain in populations over 50 than asymptomatic controls. However, this reinforces that we do need to have some imaging for diagnosis. Sadly for occupational therapists and osteopaths though, there is also no sound relationship between posture and low back pain.
So what gives? Well, pain serves to alert us to a potential threat, not always to an injury. A great demonstration I saw of this was where a doctor placed a man’s left hand on the table in front of him and placed a fake right hand alongside it. From the man’s visual point of view, it looked like both his hands were on the table. The doctor then smashed the fake hand with a hammer, resulting in screaming and nausea. This was in spite of the fact that the man KNEW it was a fake hand. His eyes sent a signal to his brain that he was in danger. This is called neuroplastic pain.
It’s a bit like your brain has learned what pain is in certain situations and creates the pain response, irrespective of what is going on. Pain that is not caused by injury is neuroplastic pain. There are two main ways for clinicians to determine if your pain is neuroplastic or not. The first is to rule out fractures, infections, tumors and so on with diagnostic criteria. The second is to look at hallmarks of neuroplasticity: pain without injury, pain that originated and gets worse during stress, pain that is inconsistent (your back hurts when standing but not when running), pain which moves around your body, history of a wide range of pain complaints and tendencies towards anxiety, hyper-vigilance, and perfectionism.
One or two of these doesn't indicate neuroplastic pain, but the more criteria you meet, the more likely that it could be. So, if it is our mind fooling us, what can we do about it?
Well, just like thoughts and actions trained the brain that these signals were dangerous and not safe, you can train it of the opposite. That the sensations are just that: sensations, and you are in no danger and are safe. It's called PRT, which stands for Pain Reprocessing Therapy. Typically, when we have some pain, we respond with fear. We wonder if it will get worse, how long it will last, and what's causing it. With PRT, you reverse these thoughts and look at pain without fear or judgment. Appraisal of the situation that nothing untoward has occurred and there wasn’t any acute bodily injury, that this is a false alarm. The goal is not to say the pain doesn't exist, because it does, on a spectrum. Instead, the goal is to start to view pain as a signal and appraise the situation as nondangerous because the biggest driver of neuroplastic pain is fear.
It's critically important to use PRT during feared activities. For example, if you happened to have hurt your back deadlifting at some point, you may have learned to associate deadlifting with pain and this fear results in the onset of activity-related pain. Which brings me also to the idea that weather causes pain. In studies done on exactly this, there was NO correlation found. (2) But of course, if we grow up hearing about these things from older family members, it is quite likely that we have experienced a learned outcome. We expect there to be pain when the rain is coming.
Another of the biggest myths around pain and its management is that rest is good for pain. Whilst your doctor may prescribe short rest after an acute injury, we shouldn’t be thinking the same about a chronic pain experience. If, in response to ongoing pain sensations, we cease to move, we will find that we make things worse. The saying is that “motion is lotion” and certainly, improving or even maintaining mobility, range of motion and strength will most definitely help not just with retraining the brain that the positions you are in are safe, but with mitigating other negative health outcomes. I see so many older people at the gym on that hand bike thing because they have had a fear response that impact is bad in older populations, when we know, from a bone density perspective, that this isn't true. What do you think happens when you stop using the joints of the lower body? When you cease to work the knees, hips, and ankles through their natural ranges? Of course, you have some pain and discomfort when you do use them again. Get off the handbike!
My own experiences with the doctor showed me that psychological treatments are not used widely for pain and that non-diagnosed prescription filling was the go-to. I would urge any listeners who experience chronic pain issues to look into neuroplasticity and Pain Reprocessing Therapy before reaching for the opioids, because we know that pain is much more complex than purely biological.