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It's not all in your head (but some of it is)
Today we're finishing up our pain science series by looking at centralized pain, or what I like to call "mind pain."
I'll explain that shortly but first let's review our first two pain types:
Nociceptive pain signals direct tissue damage to muscles, tendons, bones, etc. This feels first like sharp, acute pain when you injure things and dull throbbing pain after when the inflammatory response creates excess pressure in the tissues near the injury. Nociceptive pain hurts the worst but typically fades quickly provided you don't reinjure the same area before the body has completed the initial recovery process.
Neuropathic pain signals neurofascial (nerve and fascia) damage/dysfunction. This can feel like shooting, tingling or even stabbing sensations when a nerve gets trapped or pinched between bones, muscles, or tendons but is most often the result of the various kinks, knots, and scarring that occurs in the fascia as we compensate around acute injuries and gradually succumb to sedentary modern living. This pain tends to persist and become chronic and widespread if it's not dealt with on a regular basis via training and movement habits.
Neuropathic pain often gets confused for nociceptive pain and becomes a reason for people to avoid training themselves back to full function. They believe (incorrectly) that they will just hurt themselves worse.
What they're actually doing is allowing their neuropathic pain to spread, which guarantees additional loss of function.
And then there's centralized pain.
Pain science doesn't have a universal definition of centralized pain yet. In fact, various terms - "psychosocial", "nociplastic, et. al. - are still competing for the title with centralized.
What most researchers are willing to say, whatever we end up calling it, is that the cnretral nervous system can amplify or dull both nociceptive and neuropathic pain, and that this ability is connected to how we react to it in our thoughts and emotions.
Said differently, the way we psychologically interpret our pain influences how it feels and thus what we're willing to do about it.
"Interpreting pain" means to convert our reactions into language, which is why we teach clients to regulate centralized pain by "watching their words."
The vocabulary people use to describe their pain, especially as they attempt to train through it, is a dead giveaway as to how successful they'll be.
People who say things like "I can't it hurts too bad" or "My leg/hip/knee doesn't want to do that" or "I did XYZ before and that's why I'm afraid to do this now" will never, ever heal their pain. Period.
Through their words, they've decided (unconsciously, but still) that their pain is an overwhelming force that can't be overcome.
When they frame their situation this way they become identified with it, causing their centralized pain response to amplify the felt experience of bodily pain until they're "proven" right.
Congratulations, you've talked yourself into never healing.
By contrast, people who say things like "Ok my shoulder/neck/back/knee hurts when I do X, but if I back off to Y intensity, then I can work with it" tend to pull off great recoveries.
The difference? Agency.
Using words that give you the power to do something about your pain, instead of framing you as helpless before it, sets the table for long-term joint repair by reducing the centralized pain convincing you it can't be done.
Your mind is just that - yours. Make it work for you.
Watch your words.
-Coach Seanobi, BS, CSCS, CEP, CPT
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