This amazing study involved evaluating various physiological responses of subjects who received electric shocks. Seriously, who volunteers for these studies?? It is of course expected that some degree of physiologically stress would be present during the painful shocks, but what this study clearly demonstrated was that when the shocks were not predictable and uncontrollable, the stress responses were significantly amplified.
“…unpredictability and uncontrollability are central features of stressful experiences.” – Berker et al 2016
So what does have to do with pain? Well everything. Pain is stressful, but when it is sensed it is unpredictable and uncontrollable, the associated stress response and the perceived severity of the pain will be amplified. Our primarily goal as PTs must be give some sense of empowerment to patient that THEY can control their symptoms.
Here is the conclusion of another study that also used electric shocks on innocent subjects…
“When the person gains control of situations through their own actions, anxiety diminishes.” –Boeke et al 2017
There are 2 basic types of pains, chosen and un-chosen pains. Chosen pains are expected, such as eating spicy foods or playing sports. Most in fact thrive on the pain of running, lifting weights or a hot curry dish. With chosen pain, the brain understands it is temporary and releases endorphins, the body’s own painkillers to help reduce the pain intensity.
Chosen pain and suffering are in fact promoted in religions through fasting, sacrifices or even self-mutilations. When pain is voluntarily experienced, there’s no suffering and the pain is often even enjoyed.
On the other hand, there is no joy in un-chosen pain because it’s unwelcomed. Un-chosen pain is everything from accidentally stubbing your toe, banging your thumb with a hammer, car accidents, back pain or cancer. If pain is un-chosen, it is feared and endorphins are not released. With un-chosen pain, the brain wants the pain to be fully experienced so attention can be paid to its cause.
I have a crazy theory. Perhaps the more we experience chosen pains, we can reduce the suffering of experiencing un-chosen pains. Understandably the last thing people with chronic pain want is another type of pain. They just need to realize that deliberately and consciously experiencing a non-harmful self-chosen pain, such as physical movements, may release endorphins and in fact help with chronic pain. There is no easy way out!
“If you don’t choose your OWN pain, then pain will choose you!”
– Bahram Jam, PT