Amplified Pain: Turn Down the Volume!

If you have inexplicable pain anywhere in your body, it may be stemming from your brain. Here’s what to do when standard remedies, such as aspirin or ibuprofen, don’t work.

with Daniel Clauw, MD

Ever wonder why two people may have the same or similar medical conditions, but one person seems to suffer more pain than the other? Have you ever experienced pain for which there was no medical explanation? Some individuals are much more sensitive to pain than others, and doctors and medical researchers are now beginning to understand why—and what can be done.

While it has been known for some time that there are different types of pain, it now seems clear that there is also more than one way to experience pain. For example, when you feel pain from a knee injury, a signal is sent from activated pain receptors in your knee up through your spinal cord and brain stem, and into the part of your brain known as the cerebrum, where the pain is processed. That’s the way pain has traditionally been understood. But pain management experts know that pain can encompass a wide spectrum of causes, including nervous system damage, cancer, multiple sclerosis, and metabolic conditions such as diabetes.

“Pain can occur for many different reasons, including for no obvious reasons at all,” says Daniel Clauw, MD, director of the Chronic Pain and Fatigue Research Center at the University of Michigan. “You may have what is called ‘centralized pain’ that you experience at different times throughout your life, in different areas of your body, but that actually originates in your brain and spinal cord.”

Can the Brain Feel Pain?

The brain itself does not have pain receptors, but it can create sensations of pain in your head and throughout your body, and even in locations where pain receptors are inactive. Typically, when pain receptors are inactive, there is no reason to feel pain. The brain’s ability to create pain in the absence of active pain receptors—or any pain receptors at all—helps to explain headaches. This connection also sheds light on why someone might feel pain in their jaw or in arm when they are having a heart attack, or how the sensation of pain can sometimes be delayed until you have time to pay attention to it.

Other examples of how the brain can promote sensations of pain include phantom-limb pain—that is, when a person feels pain or other sensations where an amputated limb once was, as well as how a person may suffer from a level of pain that is not reflected in x-rays, lab reports, or physical examinations.

As a result, finding a clear understanding and diagnosis of a pain condition can be difficult. If you have a life-long history of chronic pain conditions, starting with, say, severe menstrual symptoms or headaches in your teenage years, followed by gastrointestinal disorders in your 20s or 30s, followed by fibromyalgia or arthritis in later years, this may be because you have a higher sensitivity to pain. In a sense, your brain may be overreacting to, or misinterpreting, the legitimate pain signals that it’s receiving from your body. Thus, the type of pain one person might consider minimal becomes unbearable for you. It’s as if their pain is on low-volume and yours is on high. The remaining question is: How do you turn down the volume?

“Drugs that work well to treat acute pain, such as non-steroidal anti-inflammatory drugs (NSAIDs) or even opioids, are not likely to help with this type of pain” which stems from the brain, says Dr. Clauw. “The best treatments are classes of drugs that work in the brain, such as serotonin norepinephrine reuptake inhibitors (SNRIs), tricyclic drugs, and gabapentinoids, as well as non-drug therapies, such as yoga, tai chi, more active exercise, improved sleep, acupuncture, and pain-based cognitive-behavioral psychotherapy programs.”

Dr. Clauw also points out that alternative therapies can sometimes be as effective, or even more effective than, medicinal treatments. Although complementary therapies like acupuncture and yoga have not been rigorously studied, they are generally safe and may help reduce pain in some people. It is important to approach any type of new exercise regimen slowly and gradually at first and, in some cases, to simply increase daily activity before engaging in formal exercise, in order to avoid worsening of symptoms.

Related practitioner article: Neural Pathway Pain

Updated on: 12/20/17
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