🚨 Time to rethink the alarm analogy!? 🚨

The analogy of pain as an over sensitive alarm system is used pretty commonly! The question I am asking today is, how accurate is this analogy?

This is how it often goes……

“Pain is like an alarm system, its job is to alert you to a potential threat, not to measure tissue damage directly.  A sensitive alarm can go off when the threat is relatively small, like a smoke alarm triggered by burnt toast. Over time, the nervous system can become more protective or sensitive, meaning things that previously weren't painful can start to trigger pain”

So what’s the problem here…….

This concept positions pain as either a product of tissue damage or a dysfunction in the detection system (the alarm) but misses a crucial step, nociception is not just a product of damage! (A caveat would be purely mechanical nociception like bending the finger back, but this doesn’t explain longer term pain states)

But why is this important……

MSK pain is influenced by so many things from co-morbidities, to sleep, to smoking, stress, activity levels, this could be individually or in combination. So, what if the alarm system is just fine? Rather than focusing on the alarm system as being dysfunctional, why not focus on things that could be causing it to be quite normally activated?

It’s much more likely that these factors are playing a role through systemic inflammation and immune system function, which can cause a pro nociceptive environment, rather than the alarm system being dysfunctional through something like central sensitisation, which of course requires on going nociception to develop, and this falls back into the old find it/fit it model of treatment.

The perfect storm probably is nociplastic changes in the periphery, an unhelpful systemic environment and a lack of descending inhibition from the brain. These maybe kept in place by the specific behaviours that make up our lives currently, and also previously, rather than them being dysfunctional and require fixing or retraining.

 One issue is the rise of treatments focused on the alarm, not the factors that could be sensitising it. They often focus on ‘normal’ information coming from the body that is ‘turned up’ by the brain/nervous system. In fact, it could actually be a lack of inhibition of those signals rather than a facilitation.

This has given rise to approaches that attempt to “retrain the nervous system”. Can we train the nervous system to stop telling us about stuff it is designed to tell us such as systemic dysregulation? Should we attempt to do that? Why would we not see that as a clear and credible threat to the system?

Rather than thinking how do “we fix, or retrain the alarm”, let’s focus on helping people get better regulated across the BPS spectrum.  This requires great listening and connection alongside being interested in more than the just the tissue, and ultimately behaviour change!

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