Pain: Body-self neuromatrix

What happens in our body to elicit pain when we slip on the ice, take a fall while skiing or get diagnosed with a chronic disease like fibromyalgia? Pain is described as a physical discomfort or some type of suffering caused by illness or injury. We may have always thought of pain as purely subjective, meaning each of us might describe the pain differently, from a fall down the stairs or a crash on our sled. Some might describe the pain as a stiffness with a dull or achy feeling. Others might say it is sharp, shooting or incapacitating in nature.

However, according to Melzack and Katz, pain is not purely subjective in nature. A physiological event occurs that “triggers” a feedback loop in the brain to interpret the action through a complex, “body-self neuromatrix” that has a sophisticated genetic code. “The body-self is a large, widespread network of neurons that consists of loops between the thalamus and cortex, as well as between the cortex and the limbus system.” “These links are genetically determined and then later fabricated by sensory inputs.” This is the neuromatrix.

Here we see that our genetic patterns from our family systems come into play as a key component, when experiencing pain. Our central nervous system is responsible for recognizing, describing and interpreting our crash on our fat tire bike. We experience the pain in our leg during the crash, but a chemical reaction, that occurs in the leg, travels to the brain and elicits the central nervous system to interpret the pain. The input we feel is merely the “trigger,” that starts the sophisticated “neuromatrix” in the brain. All the physical changes that happen to the leg after the break are generated by structures in the brain. Pressure, swelling, warmth and the pain pattern that is hard-wired in our genetic code.

How is it that our amputee patients still feel their leg after it is gone or our paraplegic individuals still feel fatigue in their limbs that no longer function? It is due to the intricate body-self system where the brain senses the body as a whole and not as parts alone. There is no input from the legs in either of these people but the “brain does more than detect and analyze inputs; it generates perceptual experience even when no external inputs occur.” “The brain generates the experience of the body.”

Melzack and Katz theory of the body-self neuromatrix fascinates me, because as a physical therapist I care for people who are in pain everyday. Whether acute in nature or chronic, which is thought of to be pain that lasts over 6 months long, I often find myself discussing their pain patterns with them. Pain is important as it teaches us when to stop, rest, avoid or escape, but for many their pain has become their disease. “Chronic pains, clearly are not a warning... they are the result of neural mechanisms gone awry.”

This does not mean that chronic pain is unchangeable. In our physical therapy world we treat patients that live with chronic pain and their is hope for them. The body ultimately strives for balance in its systems. We call it homeostasis. Any insult to the body self whether physical or psychological or a combination of both will activate the

system for homeostasis. An example of this is when an injury occurs with high stress inputs around it, such as a man falls and breaks his back after being fired from his job earlier in the day. The brains imprint of this due to the high levels of physical and phycological load are great. He may never recover from his back pain, even though his physical back pain is resolved. Now add on the fact that his father had chronic back pain due to a farming accident that occurred at the age of 19, and now you may have a genetic code or a pattern that is set-up in the neuromatrix that is deeply imbedded. His pain is real, we are not questioning that, we just need to know how to unlock the system to assist him in having a better quality of life.

As you can see once again the brain is a powerful thing and we are still learning and discovering how this delicate system works during injury or disease. Pain is an out cropping of injury and disease but our goal in the physical therapy arena is that it does not become the disease. The body-self neuromatrix does not intend for pain to be the disease, it is merely a way to lead us to homeostasis, in order to have optimal health.

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Sheree DiBiase, PT, is the owner of Lake City Physical Therapy and she and her staff believe that the mind body connection is a powerful thing and that healing can occur when we address our health for wellness. Please contact us for your health, in our three offices: Coeur d’Alene (208) 667-1988, Spokane Valley (509) 891-2623, Hayden (208) 762-2100.