Ep 3. Pain is a Sound System
Complex pain is, well, complicated. Explaining it effectively can be even more so. In this episode, Dr. Dan shares his metaphor to think about and better explain pain called, ‘Pain is a Sound System.’
We’ll talk about how the amplification process occurs, (Justine will interrupt us with some “wiggle time”), and we’ll introduce the different types of pain - nociceptive, neuropathic and nociplastic pain.
With central sensitization in particular, we’ll define the different buckets in a way you haven't heard before, and pull it all together so you can actually make sense of various symptoms and better explain chronic, complex pain. Because it's not in your head. Pain, is a puzzle. Let’s begin to put it together.
Introduction
Dr. Dan Bates and Justine Feitelson present a unique analogy to explain chronic pain using the concept of a sound system. This approach aims to help both patients and clinicians better understand the complexities of pain without implying it's "all in your head."
Components of the Pain Sound System
Singer: Body parts
Microphones and leads: Nerves
Amplifier: Spinal cord, brainstem, and brain
Speakers: Pain output
Band: Context (past experiences, medical advice, beliefs)
Audience: Patient and their social circle
Amplification Process in Chronic Pain
In acute pain, like rolling an ankle, the process follows a normal pattern:
Nerve signals are sent to the spinal cord
Pain is perceived ("ouch")
Protective responses occur (increased heart rate, cautiousness, limping)
In chronic pain, amplification occurs:
Multiple nerve endings become involved
The amplifier (spinal cord/brain) is turned up
The speakers (pain output) are also turned up
Normal responses become amplified (anxiety, fear, deconditioning, depression)
Types of Pain
Nociceptive Pain (Body Part Pain):
Focal, intermittent, proportional
Specific triggers and relieving factors
Can involve inflammation, muscle, bone, or blood vessels
Neuropathic Pain (Nerve Pain):
Follows nerve distribution patterns
Described as burning, pins and needles, electric shocks
Can involve allodynia, hyperesthesia, and summation
Nociplastic Pain (Central Sensitization):
Widespread, disproportionate, and unpredictable
Associated with sensory hypersensitivity, sleep disturbance, fatigue, and cognitive dysfunction
Features of Central Sensitization
Sensory hypersensitivity (light, sound, smell, touch, temperature)
Sleep disturbance (insomnia, unrestful sleep)
Fatigue (physical and cognitive)
Cognitive dysfunction (brain fog, memory issues)
Mood disturbance (anxiety, depression, catastrophizing)
Dysautonomia (orthostatic intolerance, gastrointestinal symptoms, abnormal sweating)
Treatment Approaches
Interventions and surgery: Address body parts or nerves
Medications: Target nervous system and sensitization
Exercise: Acts at a central level
Psychology and education: Work on the "speakers" (pain perception)
Diet: Potentially affects multiple components