Pain and Self-regulation
Pain has been variably defined by WHO and other learned bodies by consensus. While all these definitions are valid, they have added little to classic time-respected definitions across the centuries. One of the most elegant of all is attributed to the Chinese sage Lao Tse, the founder of Taoism: “Pain is the penalty for infringing on the principle of nature.” Infringing on homeostasis may result in pain among, other consequences. Pain is a signal of suffering until one redresses the homeostatic disturbance that created it. Like ripples in a lake when a stone is thrown, the vital organs respond, each one in its way, to the presence of pain.
Autonomic Response to Pain
The responses are quite predictable: muscles will tighten, breathing will become rapid and shallow, the heart rate quickens, the blood pressure usually rises, a cold sweat may occur, the skin temperature may drop, the pupil enlarges (midriasis) and, in some extremes, there may be incontinence. In addition, the endocrine and exocrine glands respond in predictable fashion.
This massive response is quite similar in states of pain as it is in the states of ‘fight or flight.’1 The body seems to want to withdraw from the noxious factor that generated the pain. Furthermore, it will remember the event and reproduce the responses very quickly any time there is a recurrence of similar experiences.
A simple example involves pain in association with muscular injury of a limb. The initial response to the injury and consequent pain is the instinctive behavior of ‘splinting’—the generalized spasm of the affected area and not moving the limb. This behavior results in reduction of the pain or avoidance of worse pain. The secondary response is that of ‘protective guarding.’ Just as instinctive and predictable, the contra-lateral limb takes over, as much as possible, the function of the injured limb. These are examples of instinctive human behavior, probably related to an archaic neuro-motor engram—itself related to the survival instinct.2 Is the muscular activity the only expression of pain and its perception? The SNS and PNS—at times in tandem and most of the time in opposition—contribute almost instantly with multi-organ behavior related to the presence of the injury and of the pain.3
The splinting and associated pain are the starting points of reactions such as increase in the heart rate; blood pressure; respiratory rate; and change from abdominal to thoracic breathing in association with exertion of the accessory muscles of respiration; ‘cold sweat’; vaso-constriction of the lesioned area; and reduction in the peripheral circulation of ‘non-essential’ organs; etc. Given the acute presence of pain, the body gets ready for ‘flight’ and survival. There is practically no part of the brain that is not involved in the response. If one takes the presence of acute pain away—such as with anesthesia—most, if not all, of the ‘flight’ responses return to the baseline state in a very short period of time.
Whereas pain is usually the result of injury or lesions of varying etiology, in the post acute phase, it can take on a life of its own. The lesion or injury may resolve and yet the pain may become chronic and unrelenting. It has the potential to augment its ascending and descending neuro-sensory pathways in intensity and anatomic extension. The phenomena of hyperalgesia and allodynia are well known to the clinicians who deal with chronic pain. These phenomena are probably related to changes in the pain pathway CNS engram, whereby the pain intensity perception is greatly exaggerated and other sensory modalities such as touch, pressure, vibration or temperature sensation are replaced by hyperalgesic pain perception.4
There is some evidence that fibromyalgia may be a condition where there is dis-inhibition of neuro-motor pathways resulting in widespread pain and co-activation of inferior muscle girdles supposedly at rest while muscles of the superior girdle are in motion.5,6,7
Where do the perception of pain and the ability of self-regulation come together? To begin with, we have to expand our understanding of the concept of self-regulation. The Earth was flat for a long time until it was found to be round—and, even then, the courageous people who officially announced the concept suffered or died in the hands of dogmatic and self-serving officialdom.
A functional definition of ‘self-regulation’ is that of the innate ability to modulate and control body and mental functions.1 Self-regulation is an essential homeostatic process. It is a vital component of the autonomic homeostatic functions of survival and reproduction.2 A number of vital organs depend on autonomic function and are regulated by autonomic controls primarily responsive to the ‘instructions’ of the sympathetic (SNS) and parasympathetic (PNS) systems and only secondarily to the central nervous system (CNS). Vital functions such as respiration, heart rate, blood pressure, sweating, excretory functions and temp-erature control may be found to be intact in conditions such as coma where the higher brain functions may not survive.
The body has the innate ability to self-regulate, when it is taught and trained to do so. Infants and young children are incontinent until they are toilet-trained, most of them very successfully early in life (usually by 12-16 months in Europe and 24-plus months in America). Of interest is that the training is done by parents or other ancillary persons who have no medical training, nor do they need double-blind control repeated studies (published in peer-reviewed journals) to proceed with the control of the urinary and fecal incontinence. The small minority of children with pathologies not enabling them to be toilet trained in a reasonable amount of time, of course, need medical attention.
If infants and small children can very rapidly learn to ‘self-regulate’ complex body systems involved in bowel and bladder control, people of any age may be able to self-regulate other systems, if taught properly to do it. Children who are taught yoga or other meditation systems of self-regulation, e.g. heart rate, breathing, mental focusing, etc, matter-of-factly learn the procedures and furthermore the training is not forgotten (assuming continued health).
In our culture, we have yet to learn to do such training, however, most people learn how to swim or bicycle and never forget to execute those activities. Needless to say, bicycling depends on our innate sense of equilibrium and swimming is a vey complex activity that involves the breathing cycle and neuromotor control involved in avoidance of sinking and drowning. These examples serve to demonstrate that we have ample abilities of self-control, should we (a) be taught to use them, (b) be motivated, and (c) be encouraged to use them.