In the last blog post, I suggested that musicians should not perform or practice while in pain. In his blog, “Better Movement: Seven Things you Should Know About Pain” (posted on Posted on June 24, 2010), Todd Hargrove listed seven basic ideas from the latest pain research. All of the items are interesting but I will only touch on numbers five and six, because they are the most relevant for us.
5. Pain Breeds Pain
One unfortunate aspect of pain physiology is that the longer pain goes on, the easier it becomes to feel the pain. This is a consequence of a very basic neural process called long term potentiation, which basically means that the more times the brain uses a certain neural pathway, the easier it becomes to activate that pathway again. It’s like carving a groove through the snow while skiing down a mountain – the more times the same path is traveled the easier it is to fall into that same groove. This is the same process by which we learn habits or develop skills. In the context of pain, it means that the more times we feel a certain pain, the less stimulus is required to trigger the pain.
This idea is important because musicians who practice several hours day, if in pain, will reinforce the potentiation. Basically practicing in pain is “practicing pain.”
6. Pain Can Be Triggered By Factors Unrelated to Physical Harm
You may have heard the phrase that neurons that fire together wire together. The most famous example of this principle is Pavlov’s experiment where he rung a bell each time his dogs ate dinner, then later found that he could cause the dogs to salivate at the mere sound of the bell. What happened at the neural level is that the neurons for hearing the bell became wired to the neurons for salivating, because they fired together consistently for some time. The same thing can happen with pain. Let’s say that every time you go to work you engage in some stressful activity such as working on a computer or lifting boxes in a way that causes back pain. After a while your brain will start to relate the work environment to the pain, to the point where you can start feeling the pain just by showing up, or maybe even just thinking about work. It is no surprise that job dissatisfaction is a huge predictor of back pain.
Further, it has also been shown that emotional states such as anger, depression, and anxiety will reduce tolerance to pain. Although it is hard to believe, research provides strong evidence that a significant portion of chronic back pain is caused more by emotional and social factors than actual physical damage to tissues. You may have noticed that when you return to a place you haven’t been for many years, you quickly fall back into old patterns of speech, posture or behavior that you thought you had left behind permanently. Pain can be the same way, getting triggered or recalled by certain social contexts, feelings or thoughts that are associated with the pain. Ever notice that your pain went away went you went on vacation and came back when you returned?
Once again, this shows how repetition strengthens the habit of pain. Stress is often a faithful stand partner in a musician’s life and that can aggravate the pain. The above two factors can also help explain why it can be so difficult to alleviate the pain after it has been around for so long. For those of you who are struggling with chronic pain, I think realizing how complex the issues are can lead to better understanding and perhaps more compassion.
In the next post, I’ll talk about some ways to work with getting better and dealing with pain. In the meantime, take care of yourselves and be well.