Back in my twenties, I returned from a journalistic foray into the Soviet-Afghan war with raging reactive arthritis sparked by contracting severe dysentery. The inflammation attacked my hips, knees and hands, and each morning became a trial of agony and fear as I forced my burning body to mobilise for the day.
What is inflammation?
Hobbling to the GP surgery brought no relief. The doctors just hoped that the arthritis would resolve itself somehow and prescribed maximum doses of the anti-inflammatory drug ibuprofen. They shrugged when I suggested this might erode my stomach walls and add ulcers to my woes.
That was 30 years ago. Mercifully nowadays I’m pain-free – and painkiller free – most of the time. This is thanks to the fact that, as a young medical reporter, I was able to seek advice from some of Britain’s leading pain experts.
Among them, a new idea was beginning to emerge: that our minds held far more influence over basic bodily mechanisms such as pain than the medicate-everything culture of contemporary medicine believed. In the 1980s this sounded frankly hippy-dippy, but I listened. I learned to meditate as a way to break the vicious cycle where pain caused stress and fear, which in turn stoked my pain still higher. I also learned to replace my anger and grumbling rumination with calmer thoughts. Along with eating a fresh, junk-food-free diet and taking up yoga and exercise, these methods have kept me largely painkiller free.
Since then, three decades of clinical research have confirmed the fundamental role that mental attitude plays in determining how we experience pain, yet doctors persist in prescribing ever more painkillers. Sales of over-the-counter drugs such as paracetamol, aspirin and ibuprofen hit a record £567 million in 2018. And nearly 24 million powerfully addictive opioids, such as morphine and fentanyl, were prescribed in the UK last year; 10 million more than in 2007. It’s not only America sleepwalking towards addiction.
Our age group is a prime customer. Around half of Britain’s over-50s suffer chronic pain, double the rate among under-35s, according to Imperial College London researchers in BMJ Open, the British Medical Journal’s online resource. Chronic pain is defined as pain that exists every day for at least six months. The most common causes are osteoarthritis in the lower back and neck, musculoskeletal pain, and chronic joint pain.
The evidence shows that drugs usually cannot offer lasting answers. The Royal College of Anaesthetists says clinical evidence shows even strong opioids ‘may only reduce pain for some patients in the short and medium term (usually less than 12 weeks)’. A study of 1,600 people in The Lancet has concluded that paracetamol is no better than dummy sugar pills for acute lower back pain, even though doctors routinely prescribe it as a first-line therapy.
We clearly need sustainable alternatives, which is where the power of the mind comes in. ‘Our beliefs play a fundamental role in pain perception,’ says Professor Irene Tracey, a leading pain expert who runs the University of Oxford’s Nuffield Department of Clinical Neurosciences. Using its MRI brain scanner, she has demonstrated how mood, attitude and beliefs determine how we experience pain.
‘They can override the most powerful painkillers known to science,’ she says. ‘In one test we told patients we had stopped giving them a strong opioid, when in fact we were still giving it. They complained of rising pain, because they thought the analgesic had stopped.’
But this wasn’t just ‘all in the mind’. The professor’s MRI scans show that in patients with chronic pain, their brain fibres have effectively become rewired to become hypersensitive. Just thinking about pain can cause them real agony. ‘In chronic pain, the area of your brain that processes your anxieties, fears and worries plays havoc,’ Professor Tracey explains. ‘Everyday touch can piggyback onto the pain system and fire off widespread brain regions, so that even putting on clothes can cause burning sensations.’
This ‘rewiring’ may explain how negative beliefs about pain can create a devastating spiral. The more anxious, stressed and depressed we become about pain, the more we may physically rewire our brain’s architecture to become hypersensitive.
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The good news is that we may, with practice, reverse-engineer this process. Positive beliefs, attitude and mood may be our best long-term analgesics.
Drug companies already benefit from this confidence trick. A Keele University study of 800 women found that those given sugar placebo painkillers in boxes carrying trusted brand names felt 30% more pain relief than women given placebos in plain boxes.
That’s not just the power of advertising. Brain scan studies at the University of Michigan have shown that when people take placebo treatments they trust, it triggers their brains to release natural painkillers called endorphins. Patients given placebo drugs can also show reduced activity in brain regions that process pain.
The question is, how can we harness this? Talking therapies can clearly play a role. Warwick University investigators who studied 700 British back-pain sufferers reported in The Lancet that those who had received cognitive behavioural therapy (CBT) were almost twice as likely to recover as those who had just used painkillers.
CBT involves helping patients to break habitual ways of seeing things and to think positively instead of negatively. Zara Hansen, one of the researchers, says: ‘We are not saying back pain is all in the mind. It is very much a physical problem but the way you understand it affects how you manage it.’
Back pain specialist Dr Lynn Dunwoody, a lecturer in health psychology at the University of Ulster, says negative and fearful thoughts exacerbate discomfort. ‘When people are anxious or stressed, they tend to stress up their back muscles,’ she explains. ‘If you do this when you are walking or sitting, that in itself can cause back pain.’
Conversely, good posture can be an effective painkiller, thanks to its positive psychological influence. Chronic pain can make us slouched and round-shouldered, but scientists at the University of Southern California have discovered that such ‘submissive’ poses tell our brains that we are vulnerable – making us more pain-aware.
Doing the opposite – adopting ‘dominant’ postures such as sitting or standing up straight, pushing the chest out and expanding the body – can help create a sense of power and in turn make us feel confidently in control of our physical sensations, says the report in the Journal of Experimental Social Psychology.
We can even bamboozle our brains into lowering pain, according to scientists at Jerusalem’s Hadassah Medical Centre, who are pioneering the use of virtual-reality goggles.
The goggles give patients the impression that their pain-affected body parts are moving freely and easily. Shimon Shiri, a rehabilitation psychologist, believes that the brains of patients with chronic pain can get ‘imprinted’ with the belief that parts of their body are in agony.
When the brain ‘sees’ through virtual reality that this is not the case, it may be tricked into rewiring itself. Shiri says that in tests this year on 30 patients, all the volunteers reported feeling less pain – and all of them wanted to repeat the therapy.
While we can’t all play with virtual-reality gadgets, we can all try another effective perception-altering trick, by changing the language we habitually use.
Psychologists at Jena University in central Germany have discovered that words such as ‘tormenting’, ‘gruelling’ or ‘plaguing’ are actually capable of firing up our brains’ pain-processing areas and amplifying discomfort. Changing one’s self-talk to feature more confidently soothing words may do the opposite – telling our brains to relax, as everything’s OK.
At the base of all these strategies lies a powerful realisation: our minds are incredibly powerful things. They can cause us physical agony. But by learning to harness our thoughts, we can turn our brains into strong natural painkillers.