Why Doesn't Pain Just Go Away?

There's a lot of advice out there to get out of pain - rest, take a pill, stretch, strengthen - they all sound so simple don't they?

And yet, pain can linger or flare up repeatedly even after the original injury must have healed with time.

So why does pain persist, and why isn't it as easy to get out of pain as you're led to believe.

Pain is actually a complex phenomenon, meaning there are several factors that can contribute. These different factors can be grouped into 5x layers:

• Environment - Family, community, socioeconomic status
• Person - Thoughts, beliefs, goals, emotions
• Systems - Nervous, endocrine, immune
• Tissue - Muscle, tendons
• Cells - Nerve, muscle

Many interventions are only aimed at 1 layer, leaving the other 4 unattended and continuing to feed the pain.

How do each of these factors contribute to persistent or recurring pain?

1) Environment

Your environment has a huge influence on how much stress you're being exposed to. 

For example, imagine dealing with a toxic work environment + a strained relationship with a family member + 2 hormonal teenagers week in, week out!

The human nervous system has evolved to seek safety and reassurance in the company of other humans. We're a social species.

We use our senses (eyes, ears, nose etc) to scan our environment for potential dangers, and our facial expressions to ascertain whether other humans are friendly or hostile.

Autistic folk who lack the ability to read and use facial expressions appropriately, and who often also have sensory processing differences (SPD), commonly report feeling more stressed. Their SPD can make everyday levels of noise, sounds, light, temperature etc. seem uncomfortable or even painful.

Stress feeds inflammation and strong emotions like anger and fear. You respond by initiating one of the 3 stress reflexes (Green Light, Red Light, Side Trauma reflex), which contributes to chronic muscle tension and pain. 

2) Person

I love this quote by Curable "Pain is your brain's opinion of how much danger you're in."

Catastrophising is the elephant in the room when discussing recovery from injury. Thinking and saying things like....

• "My back is really weak"
• "If I bend over I'll put my back out"
• "I can't do anything about my body, it's just a part of getting older".

Consider where these beliefs come from - were they true at one time? Are they actually true now? Are these things that you've experienced or been told?

Strong emotions, like fear or anxiety, will cause your muscles to tense to guard and protect you from injury. The resulting pain deters you from doing that movement, and the belief is confirmed. 

The less you move, the more deconditioned your body becomes and the less active you are. Any movement can then feel like an effort and painful.

Remember that your brain acts like the flight control centre of your entire body. Subconscious programmes, often embedded during early childhood, constantly run in the background on your mind governing your thoughts, choices and behaviour. 

3) Systems

The human body is made up of various systems, such as the nervous system, endocrine system and immune system.

The first 2x systems acts as messengers, carrying the brain's instructions to the rest of the body.

The nervous system carries electrical signals via the nerves and nerve cells. This carries instructions quickly so that the body acts rapidly. For example, the neurotransmitters adrenaline and noradrenaline initiate the 'fight or flight' response in a matter of milliseconds. 

The endocrine system takes longer to deliver the brain's instructions but lasts longer than nerve signals. An example is the hormone cortisol which keeps the body in a state of alert vigilance after the initial fight or flight' response. 

The immune system is the body's defence against foreign invaders like viruses, bacteria, fungi etc. Inflammation is a natural part of the immune response. 

If these 3x systems don't work appropriately they can perpetuate stress and pain. 

It might seem logical to take anti-inflammatories to calm down inflammation, but there's a strange situation where using non-steroidal anti-inflammatories (NSAIDs) like Ibuprofen can both block and also fuel inflammation. I wrote about this in a previous blog article - link at the bottom.

4) Tissue

Pain can come from the tissue level - muscles and tendons. 

It's important to rule out pathology here when you have unresolved pain, whilst also bearing in mind that X-rays and MRI scans are very bad at predicting pain. 

In other words, pathology on a scan image indicates tissue change, but not whether that will cause you pain.

There's evidence that sometimes having a scan or X-ray can increase catastrophising and make pain chronic. If you believe it to be so, then so shall it be!

Muscles can and do misbehave, but there's always a reason! Perhaps they're trying to stabilise an unsupported structure or compensate for another part of the body. 

An example would be a feeling of tight hamstrings and achy lower back. You might assume that the muscles need to be stretched and released t find relief, or that the glutes and core need to be strengthened.

But consider these points first:

• What's pulling the hamstrings tight?
• Are the hamstrings tight because they're trying to stabilise you?
• Why are the lower back muscles aching - are they working harder than they should and why?

And finally, remember that muscles are the slave of the nervous system. They don't just act by themselves, they have to be told what to do by signals from the nervous system and endocrine system. 

5) Cells

Cells are the building blocks of the body. Millions of cells grouped together make a tissue. 

Therefore a muscle is composed of many, many muscle cells.

Each cell has an internal environment containing cytoplasm (fluid), a nucleus (the brain) and organelles (the working components), contained by a fatty cell membrane.

Therefore when assessing muscle behaviour it's useful to also consider cell health.

External stress from your environment increases oxidative stress within the cell, which is a signal to the nucleus to manufacture pro-inflammatory protein molecules and pushing the gas pedal on inflammation. 

Inflammation leads to heat, swelling and pain.

Some people experience muscle pain from drugs like statins. Some types of statins adversely affect mitochondria - the batteries of the cell. When mitochondria stop working the muscle cell doesn't have enough energy to function properly and fatigues faster than usual. You may feel this as a heavy, achy feeling in your arms and legs when you try to exercise.

There are many other things that have an impact on how well cells function, including gut health and the immune system.

How do all these layers combine to feed pain and make it chronic?

Say that you've got a lot on at work, a strained relationship with a family member and you're running around after your children. You feel constantly rushed, busy and on edge. You find it hard to switch off and rest, let alone sleep! There's always something happening and a long to-do list every day.

You don't feel supported at home, and you find it hard to talk to friends or accept help. No one wants to be a burden, right?!

In trying to stay on top of everything your nervous system gets stuck in 'fight or flight', keeping you in action "go-go-go" mode and your cortisol levels never get the opportunity to return back to baseline levels. Coupled with a lack of good quality sleep you're battling a low level of inflammation in your body - you wake up feeling groggy, hay fever, a minor cold that never goes away fully and digestive issues (heartburn, bloating).

Your hamstrings always feel tight and you've got an achy, stiff lower back, even though you're stretching, strengthening your core and glutes and having weekly massages.

You tell yourself that the aches and stiffness are a sign of you getting older, and that once you get a bad back you just have to live with it or take painkillers.

This is a super common scenario - do you know anyone going through this right now, or maybe you recognise yourself in this story?

Can you see how all 5 layers  are involved in delaying recovery and prolonging pain?

• Environment - busy job, strained relationship with family, looking after children, not feeling supported
• Person - feel edgy, rushed, busy, unable to ask for help, believe that pain is part of ageing and can't be changed
• System - nervous system and endocrine system stuck in 'fight or flight', immune system not working properly
• Tissue - body stuck in Green Light stress reflex, muscles constantly tense
• Cell - oxidative stress fuelling inflammation 

A Framework to Get Out of Pain

Many interventions work on 1 layer, leaving the others unattended and continuing to feed pain.

For example, CBT (Cognitive Behaviour Therapy) focuses on the person and their beliefs, whereas physiotherapy works at the tissue level.

Trying to work on each layer separately becomes time consuming and expensive, plus you're still in pain throughout.

That's why I devised a system that works on all 5x layers to find freedom from pain once and for all.

My system is called The Befriend Your Body (BYB) Method. It has 4x pillars:

1. Body
2. Breath
3. Be (Mind)
4. Bond (Community)

Here's how these 4x pillars of The BYB Method connect with the 5x layers of pain:

My Stretch and Pilates classes give you a chance to experience the Body pillar. The most common comment I hear from class participants is "that was so informative". Slow, gentle movement explorations allow you to become aware of what's happening in your body that may have previously gone unnoticed.

My Yoga and Yin Yoga (Yoga Meditation) classes allow you to explore the Breath and Be pillars. You'll also get a sense of the Body pillar, but in a different way to my Stretch and Pilates classes.

I think it's important to say that the breath technique I use in The BYB Method ISN'T the same as Yoga pranayama breathwork. It's a very simple breathing exercise that promotes heart coherence and Heart Rate Variability (HRV), which is a measure of nervous system resilience and balance.

You can experience all 4x pillars of The BYB Method in the new 6 week course I'm running from Sunday 24th September. 

The course includes 6x in-person small group sessions with extra time for Q&A, recordings of all classes and supplementary resources to assist learning. 

The in-person sessions will be highly interactive and personal . You'll learn how to use The BYB Method to create a roadmap of tension in your body, release that tension to find relief from pain and move with freedom and confidence again.

Find out more HERE.

NEXT STEPS

• Book into a Stretch, Yoga or Pilates class with me - these are a good introduction to The BYB Method
•  "The BYB Method: A roadmap to reducing pain and moving with ease" A 6 week small group course - learn more HERE
• Attend a mind-body retreat - these are deeply relaxing, fun, social small group experiences typically held in various locations within easy reach of Worthing, West Sussex. The next retreats are "Rest & Reflect" half-day winter retreat on Sunday 3rd December and "Sun & Moon" mini retreat on Sunday 17th December. Click HERE to read more about them,
• Subscribe HERE to receive "The Movement Chronicle", a weekly e-newsletter delivering mobility and pain reduction tips directly into your inbox every Monday morning,

To find out more about my classes and retreats, or to join my email list you can contact me via any of these channels:

• Email at norma.pearson1@ntlworld.com
• DM me on Facebook Messenger 
• WhatsApp message to 07801 867361.