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Pain and Brain

Rene Descartes, a French philosopher, theorised there to be a complete separation between the body and mind, the biomedical model of pain. He likened the human body to a machine or clock. This “separation” theory was that pain was a disturbance that travelled along nerve fibres to the brain. He hypothesised therefore all injury and disease resulted from a breakdown within the body. This biomedical model still largely dominates in most healthcare professions.

However, in 1970’s an American psychiatrist, George Engel, adopted a Biopsychosocial model. This incorporated the different factors that could play a part in an individual’s presentation of pain and injury; an interplay between the biological, psychological and social factors. In recent years it has become more prevalent in the theory of pain.

Biological (physical) factors may contribute to sports injuries and can be internal or external to the individual. Internal factors, directly relate to the individual and can predispose to injury and recovery times.

Some of these internal factors include:

  • Body composition such as weight, body fat percentage, bone mineral density.
  • Physical fitness, for example muscle strength, flexibility, joint range and imbalance
  • Cardiovascular fitness
  • Individual anatomy for example alignment of joints, ligament laxity, and soft tissue viability.
  • Physical health for example previous injuries, co-morbidities, systemic illness
  • Skill level i.e. the better the skill level for specific activities the less likely to experience pain and injury.
  • External factors include:
  • Excessive training loads, an increase in training loads too quickly, chronic training and overload.
  • Environment that one is exercising on and the temperature of the surround.
  • Any equipment that is being used for example in sports helmets or guards play a role in determining injury risk.

Psychological factors have been shown to contribute to pain, recovery and return to function or sport. These factors include:

  • Life stress, which is a natural part of life but when combined with excessive psychological stress it can contribute to injury and pain. Stress can be work or family situations, physical health and financial considerations. When stress occurs, it triggers a response in the autonomic nervous system which releases hormones such as adrenaline, noradrenaline and cortisol. These hormones affect, amongst other things, the heart, muscles, blood vessels and the immune system. Therefore, there may be a possible link between the psychological state of an individual and how it may have a negative effect on their physiology and leave them vulnerable to injury and prolonged pain.
  • Negative beliefs, where an individual’s beliefs about their injury and body in general can influence pain and injury recovery. Negative beliefs and catastrophising can increase pain and prolong recovery.
  • Low mood, anxiety and depression can be related to high levels of injury.
  • Fear avoidance where individuals avoid certain movements / activities as fearful of pain.
  • Social factors for example level of support and communication in team sports, relationship with the coach where a negative relationship is associated with a greater risk of injury and individuals playing through pain so as not to let the team down.
  • There are implications that practitioners should consider when treating and interacting with people in pain. These include:
  • A good patient-clinician relationship
  • Listening to what the patient is saying and trying to understand them.
  • Remembering that each patient is individual, and the healing time may vary from one to another.
  • Communicating with every individual in such a way to provide positive expectations as these clients tend to have better outcomes.

 

So, it is important to remember that pain is not necessarily only a physical state but may incorporate a psychological and social issues.

 

Source: Sports Injury Bulletin, Issue 176, July/August 2018 P8-10

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