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A physiotherapy colleague of mine was doing some cross-country running in a local forest. He was running alone but had his new dog with him. He tripped on a branch and fell badly. Immediately, he felt pain in his ankle and knew he had injured himself, but fortunately, the pain was not too bad. He was far away from his car; his mobile phone had no signal, and his dog had run away. He was immediately consumed with thoughts of finding his dog and returning to his car. He managed to walk slowly back to his car and thankfully he found his dog on the way. As he approached his car, his pain went through the roof! It turned out that he had fractured his ankle and he needed surgery to fix it. Why did he not feel intense pain at the time of the accident? His brain had turned the volume down on his pain because his priority was getting back to the safety of his car and finding his dog. When his brain was sure he was safe (he could see his car), it turned up the volume of his pain as his survival was no longer a priority.
Another colleague told me a story that illustrates just how powerful our brain is in turning down the volume of our pain.
My colleague’s sister-in-law was at a fancy, black-tie work event. She was strutting her stuff on the dance floor when she slipped and fell. People gathered around to assist her. Very quickly, she realised that she had lost a front tooth and rushed to the toilet. She was distraught! A colleague’s wife, who happened to be a dentist, assisted her and ultimately managed to save her tooth. When the dental drama was settling down, her friend told her that she would call an ambulance. She couldn’t understand why an ambulance was needed – didn’t dentists deal with teeth? It was only then that she realised that she had broken both of her wrists in the fall. She had not been aware of any pain in her wrist. What had happened? Her brain had carried out its assessment, prioritised her tooth, and turned down the volume on her wrist pain.
The role that the brain plays in the pain experience can also explain how the rugby player, Joe Westerman, could continue to play an important rugby game despite sustaining a dislocated knee in the match.
In June 2019, Joe Westerman was playing for Hull FC in the British Super League (Rugby League). Playing against Hull Kingston Rovers, Westerman’s knee was dislocated when his studs caught in the ground as he was tackled After carrying out ‘an assessment’ – his brain decided that the rugby match was more important than the pain in his knee, and as a result, the volume was turned down on his knee pain and Westerman smacked his dislocated knee back into place allowing him to play on despite his injury!
What all of these stories demonstrate is the fact that the brain seems able to turn down the volume of pain signals when it is distracted, or if it decides that other issues are more important.