Fear of pain, fear of needles, being anxious about what the dentist might find are the most common reasons people have for not going to the dentist, or even shying away from dental appointments altogether. Could it be that what we assume about pain is completely untrue?
We’ve certainly been wrong about complex mechanisms before. Sight, for instance doesn’t actually work the way we thought it did. In a split second, so much of the process of our brain creating a visual experience happens outside our awareness, that sometimes it’s mistaken.
If we saw only what was hitting our retina, we’d see only the facts and it would make no sense.
The idea that light hits our retina and takes an upside-down visual to the back of the brain where it’s flipped back around the other way by millions of cells isn’t simple, and it’s not even that close. It’s so much more than that. Why, for instance, will a two-dimensional image of alternate squares made only of the same grey be interpreted by our brain as consisting of two colours? It’s only when key information is removed that what’s actually presented is what’s actually seen.
Very complex lightning-fast reasoning goes on to fill in what’s not there but should be, in order for the image to be logical. Clearly related to what’s viewed, it’s tweaked and modified so it’s biologically advantageous; but not always correct.
It’s tempting to remain equally outdated in the realm of pain, when there is no obvious MRI, CT scan, X-ray or blood test finding to identify the cause. It’s easy then, to decide that it’s the patient who is mistaken.
Not true.
To biologically explain pain is no simple task; but let’s give it a go.
A noxious stimulus activates pacinian corpuscles and other receptors that sit on the end of wide, myelinated fast-acting nerve fibres. That message very quickly travels straight up the spinal chord into the primary sensory cortex of the brain, to effectively tell it the source of the sensation. It triggers ‘danger’ receptors: thin, slow conducting fibres that again, via the spinal cord, excite neuro-transmitters. These fire off other receptor types in the thalamus to alert the brain of a threat to the body.
It’s then up to the brain to decipher and evaluate all of the other extraneous information. Like where you are, what you’re doing, whether you’ve done that thing before, etc – to decide whether there really is any danger or not.
That’s how pain works as a protective mechanism. And the question to ask ourselves when it comes to pain sensations is not “how” something can hurt so much; but “why”? Because sometimes the simplest injury can carry a pain process that doesn’t logically equate. And vice-versa.
Sydney Rabbitohs captain John Sattler’s 1970 grand final performance is Aussie legend. He played 77 minutes in searing agony; his jaw bloody, torn, and broken in three places to bring the win. He registered the pain, knew the damage was great, and withstood it anyway. He wasn’t thinking about the following week’s dental appointments, just how to focus on winning that great game.
The experience of pain can only be subjective; all down to environmental, physical and psychological factors. It’s what makes everything from childbirth to dental fillings to stubbing a toe, different.
Anecdotally, as a eight-year-old a ruptured appendix had felt little more than a bad stitch. It didn’t render me unable to walk, or in floods of tears. Not even one. Had anyone asked what the pain felt like on a scale of 1-to-10, it’s likely I’d have said “4 or 5”. That it landed me in hospital for weeks with septicaemia is pretty telling of the severity, and I realise now that I’d always seen myself as a pretty tough kid. My mind had responded accordingly. As an adult, put me in a dentist’s chair and I’ll tell you the water syringe is a 10 – such is the psychology behind the perception of pain.
Having only one body, it’s impossible to know what that number scale really means. You can’t compare it others, and you can’t compare it with yourself either.
Fortunately self-reported pain it only one of many measures medical staff use in assessment.
This evolutionary self-protection response means that if, in that moment, feeling pain does not assist survival then it’s not processed that way. We have a tendency to presume the relationship between the degree of injury and the level of pain is fundamentally intertwined, and it isn’t.
It’s how we judge it. As any psychologist will tell you, it’s not what’s happened to us, it’s how we explain it to ourselves. If that convincing doesn’t include enormous damage or danger, we’re attuned to a less severe experience of the pain sensation.
It’s all in our head. Of course it is: all experience and sensation is in our head – it’s where our brain is; and that’s where everything happens. Is there truly any separation between physical, psychological and spiritual when it all comes from the same place?
According to University of South Australia’s Professor of Clinical Neurosciences and Foundation Chair in Physiotherapy, Lorimer Moseley, “It’s the same human that makes the pain, and that tolerates it.” So pain is a mystery, woven into the mythology of heroism and social virtue. We understand what’s going on with an injury and aspects of what’s happening in the brain, but we can never absolutely know what another person really feels.
In 2020, the International Association for the Study of Pain revised pain definition to relate to what is known as a bio-psychosocial model. It recognises not just the biological reason for it, but the psychological and social pardigms that create, amplify, or minimise it. Although it’s the contemporary model, clinical psychologist Professor Michael Nicholas of Sydney University claims that, “Most people don’t use it. Most clinicians, unfortunately, even.”
Being able to unplug your own pain is a highly useful tool to have.
The short-term stress of it is the motivator for adrenaline and natural endorphins to allow us to get through it. After that, coping techniques vary across contexts and people. Learning how to calm your own body with emotional regulation strategies is effective.
Unlike subconscious and chemical responses to the stimulus, shifting attention, and reframing beliefs about the pain remain under our control. When you can intentionally alter those, your reaction to the sensation is vastly improved.
Orientating toward the goal is the better option: don’t think about the discomfort of the dental visit, focus on the reward of having beautiful, healthy gums and teeth.
Let’s see to that during our next 6-monthly visits. It’ll be in the forefront of mind. Rather than the stick, it’ll be the carrot. The raw carrot we’ll happily be able to crunch.
