Safety and Pain
How does the concept of safety relate to pain?
We are all familiar with the sensation of pain, but where does the concept of safety come from? For an explanation we can take a look at our evolutionary development. Animals have three basic modes of interaction with the environment. Moving towards, moving away and neutral.
These three dynamic states can be seen even in the most primitive single celled organisms – the motivation to move towards optimal conditions (i.e. food, warmth) and away from unhelpful conditions (i.e. no food, cold). Following on from this, the concepts of threat and safety are attached to the same ‘directional’ motivation – towards things which support life (safety), and away from things which endanger life (threat). We can also see that the concepts of positive and negative are born out of the same basic motivational ideas.
The neutral state can be seen as a dynamic equilibrium, a notional place of ‘safety’ where needs are met, the organism is not motivated to tip the directional dynamic either way, but remains responsive to each.
Pain is not an accurate measure of damage
The relationship to all this with pain, is the idea that the sensation of pain is strongly related to the perception of threat. The more threatened an organism feels, the more likely it is that the sensation of pain is perceived. In fact, it is now known that pain is not an accurate measure of actual damage to the body but more of a measure of the level of threat that a person feels as a result of injury or potential injury. Indeed it’s quite possible to feel pain without any actual damage to the body at all, just a perception of threat. The threat is related to the context of the situation. The whole point of pain actually is to motivate a behaviour that will increase chances of survival, for example to rest, withdraw, and to learn about actions that are likely to be damaging.
It’s the autonomic nervous system (ANS) that is responsible for the control of the body’s response to threat, adjusting homeostatic systems, taking the decision to mobilise resources to deal with threat or to conserve, rest and repair in the context of perceived safety. The ANS is also responsible for instigating the behaviours associated with each. Think of how someone under threat behaves compared to someone feeling safe and secure.
We can think of the autonomic state at any given moment as providing a neural platform from which the organism organises itself within the perceived context of safety or threat. The ANS has three basic strategies for defensive action. These strategies correspond to the three developmental stages in the evolution of the ANS. The most primitive system, that is shared with most vertebrates is mediated by the dorsal parasympathetic branch of the ANS and activates the freeze/shut-down response, whereby breathing and heart rate is drastically reduced – feigning death. The next stem to evolve is the sympathetic branch which mediates the classic fight or flight response associated with increased metabolism, heart rate and breathing to support evasive action. The most recently evolved system mediated by an additional branch of the parasympathetic system is a highly sophisticated social engagement function which seeks to promote safety by developing close relationships and maintaining communication with others of the same species to establish mutual support networks and safety in numbers.
Humans generate psychogenic stress
The big problem with this system – for us humans, is our tendency to repeatedly if not consistently live with the sympathetic ‘fight/flight’ system activated. The reason that this is a bad idea, is because it’s original purpose was, and is, to prepare the body for some kind of evasive action. This means the body adopts the theme of breaking down stored resources to power muscles for action, the emphasis of blood flow changes to a muscular bias, blood pressure and heart rate increase and sub diaphragmatic visceral function is inhibited. Predictably, behaviour changes too and is dominated by hyper vigilance, hyper reactivity and social communication becomes difficult. All well and good when we can turn it all off at the end of a life threatening episode. But often we don’t, because of our unique human capacity to generate ‘psychogenic stress’. In other words we tend to precondition ourselves to respond to the many stresses of our complex culture with the threat response, and those stresses are constant.
So the net outcome of a body constantly on the brink of psychogenically induced evasive action, is a body unable to properly rest, repair and settle into that dynamically balanced metabolic state called health. And as mentioned before a body under a perceived threat is much more likely to feel pain.
The Parasympathetic division of the ANS, in the context of perceived safety, mediates the opposite actions, namely to promote rest and repair, to optimise function of visceral organs, reduce blood pressure and heart rate, and induce behaviours concerned with pro-social communication, relaxation and positive affect.
The perception of safety is key
The key in all this complex nervous system action and reaction, is in the perception of the context of safety, or of threat. How the nervous perceives it’s environment (external AND internal) - affects it’s own function. For example the dorsal branch of the parasympathetic Vagal nerve promotes visceral function and health in a context of perceived safety, but in a context of extreme life threat, it functions to promote the freeze/ shut-down response. The activating properties of the sympathetic nervous system in a context of safety and not threat, promote behaviours of play and sexuality.
Most people with persistent pain problems, have a nervous system tuned to respond to perceived threat much more readily than others, and the cause is often some kind of history involving trauma, whereby the nervous system has learned to become hypersensitive to perceived cues of danger.
Threat is a primary motivating factor in human behaviour, and it’s only natural to move away or fight. But sometimes we can become so habituated in avoiding, blocking, and running we don’t realise that finding ways and practices that make us feel safe again can start to reorganise the way we respond – because practicing things that make us feel safe, can actually help to tune down the sensitivity of the threat response and allow the parasympathetic neural circuits that promote the context of safety to allow rest, repair and healing.