Rather than sitting passively, we need to take back some control

Source: Inews.co.uk.

UK – I didn’t intend to write a book about chronic pain. For most of my life, I’ve been a medical ostrich despite being in constant, daily pain from inflammatory arthritis. I simply wanted somebody or something to make it go away. And for more than 20 years, that something has been drugs – specifically, opioids – in escalating doses.

See larger photo on: Inews.co.uk.

But after a chance remark, and a little research, I became fascinated by pain science, and the idea that I might be able to control my pain myself. Because pain isn’t simply the binary, on/off alarm system most people (and many medics) assume. Many amputees feel pain in limbs they haven’t got; soldiers often report feeling little or no pain despite horrific battlefield injuries; and there are those (22 per cent of men and 12 per cent of women, according to the Kinsey Institute) who actually claim to enjoy it!

That chance remark was made by award-winning BDSM (bondage, dominance, submissive, masochist) model and author Ariel Anderssen. She’s one of those people who enjoys pain. Tall, slim and blond, Anderssen looks every inch the ballet dancer and actress she was before she began earning a living doing something she loves – which is being tied up and spanked.

As one of the approximately 28 million adults in the UK (1.5 billion worldwide) with chronic, or persistent, pain – pain that never goes away – this was troubling. Pain is meant to hurt; it protects us from harm. Without it we’d be unsuccessful as a species and unhealthy as individuals. But plenty of people embrace pain, from athletes training their bodies to ascetics training their minds. And spanking has a long history as a risquĂ© bedroom activity. There’s clearly a lot more to pain than meets the eye.

For a start, all pain sensations start in the brain. Signals sent from the site of an injury (called nociception) aren’t “painful” as such until your brain decides they are. And a lot of extras – like whether you’re happy or sad, angry, frightened (
or desperate to be spanked?) – determine how those signals are processed. That’s why things that maybe should hurt sometimes don’t, and why things that shouldn’t sometimes hurt like hell.

Chronic pain persists due to what scientists call a “learned neural pathway”: we unwittingly train ourselves to become hypersensitive to pain – to feel much more, for much longer. But this hypersensitivity is reversible; you can rewire your brain and nervous system so it doesn’t react to every twinge or ache as if it were a serious threat. And one of the keys to doing that successfully is having a sense of agency. Which is where BDSM comes in.

On the face of it, BDSM seems (to the “vanilla” outsider) difficult to fathom. Maybe that’s why we try to fathom it with pop psychology or feminist theory: it’s a sign of abuse; a lack of self-esteem; a cry for help. But perhaps the best explanation is the simplest. Some people, like Anderssen, just like it. And despite signs to the contrary (and there are plenty: ropes, whips, canes) Anderssen insists she has agency. “It’s the safe-word,” she assures me. She wants what she gets and controls precisely how much she receives. Her safe-word sees to that.

The effect of this is easier to understand when you consider the most up-to-date theories of perception. Our brains rely on mental predictions of what’s going on every bit as much, if not more, than direct perception of what we see, hear, feel around us.

However, significantly, this predictive model is always a fraction of a second ahead of our perceptions; that way our brains can prepare our bodies for what is about to happen. Psychologists call this “perceptual inference” and it’s the key to constructing our sense of agency. But when our predictions are wrong, when they don’t match reality, we lose that sense of agency, and don’t feel in control. And when we’re helpless, we hurt more. It really is that simple.

All of which means knowing a little, doing a little, can make a big difference to chronic pain. Rather than sitting passively waiting for prescriptions or operations, we need to take back some control. Movement, for example, opens up the body’s built-in drugs cabinet. Walking, swimming (even knitting!) and other regular, rhythmic motion releases serotonin – a “feel-better” chemical that helps relieve pain. Yoga, mindfulness and meditation can all be effective alternatives to opioids, because our brains manufacture endogenous morphine (endorphins) all the time.

The real problem isn’t necessarily the drugs themselves, their harmful effects, or tolerance or addiction. It’s the passive attitude of being a patient and expecting someone else to take control of the situation.

And understanding that can be life-changing.

Tim Atkinson’s book Where Does it Hurt? A Memoir of Life With Chronic Pain – is out now