Last updated: 19-Jul-18
Every six months or so, a new headline pops up about ultra marathoners, their brains and pain. As more people take up the sport, more research is being done and although it is still at a relatively early stage, there have been some interesting results. Here, I take a look at the theory of pain catastrophizing and how that might be translated into pain management when you are 40 miles in and everything feels bad.
Types of pain
There are two basic types of pain: direct damage – ie twisting your ankle and the more complex pain that comes from damage to the nervous system that reports and interprets damage.
To quote www.painscience.com, “It’s the difference between engine trouble and trouble with that light on your dashboard that says there’s engine trouble.”
Nociceptive pain (engine trouble) arises from damage to the tissues/bones/joints which is then reported to the brain by the nervous system. Nociceptors are the nerves which sense and respond to parts of the body which suffer from damage. They signal tissue irritation, impending injury, or actual injury. When activated, they transmit pain signals (via the peripheral nerves as well as the spinal cord) to the brain. Nociceptive pain typically changes with movement, position, and load.
Neuropathic pain (light on the dashboard) arises from damage to the actual nervous system from disease, injury, or pinching. It is nerve pain like sciatica but is a very broad church covering anything that damages neurons. It’s often stabbing, electrical, or burning. This is also the type of pain that often goes on to be chronic pain.
There is also Mixed Category Pain which is a combination of both.
For runners, the most likely type of pain is generally nociceptive pain, which is caused by injury or impending damage and which should disappear once the injury is resolved.
So far, so physical but what makes this even more complex is the role played in pain and its management by the brain.
“The physical response where the pain goes down the nerves to the brain is only one component. How we think and feel about it are also really important,” says Tanya Woolf, Consultant Counselling Psychologist.
“The idea is that if we think something catastrophic about the pain like, “Oh my God, I’ve broken a leg or torn a ligament”, then that is likely to make us feel anxious. The physical effect of that is that we are likely to tense up so the pain will feel worse. The way we think about it and feel about it will put a psychological overlay on our experience. It will feel worse because we feel emotionally bad about it,” she continues.
What this shows is that there are two elements to how the brain processes the pain. The first, the tensing up, creates a further physical reaction and the second is how we emotionally react to it.
It seems that it is this last point, where ultra runners are able to manage pain more effectively.
The Pain Catastrophising Scale
Researchers at Monash University tested a group of ultra runners and found they scored differently to a control group of non ultra runners on a number of pain measures, including the Pain Catastrophising Scale.
The researchers gave the two groups a Cold Pressor Task, which meant they immersed the participants arm in icy water for a period of up to three minutes. On average, the ultra runners kept their arm in the water for longer than the control group, and reported less pain when asked to rate themselves on an 11-point scale every 10 seconds.
Lead researcher Dr Bernadette Fitzgibbon, from the Monash Alfred Psychiatry Research Centre, said: “What we found in this preliminary study is that ultra-runners had reduced pain ‘attention’ and may think about pain in a distinct way from the rest of the population.”
The science is backing up what we know anecdotally and what many runners talk about and experience during an ultra. If you reframe your pain emotionally, or manage to compartmentalize it, it has a positive effect.
My own experience of this is not a running but a hiking tale. I was on a hiking trip in Patagonia and fell on a descent and cracked my fibula. It hurt like crazy but this was the trip of a lifetime and I still had four days to go – including the iconic ascent of Los Quernos. I strapped myself up, took a shedload of painkillers, used my sticks heavily and kept going. I made a very positive mental decision to ignore the pain and concentrate on other things like the scenery, my hiking companions, the fact that I was doing something really difficult and exciting and so on.
Crucially, I didn’t know I had actually fractured my bone, I thought I had just had a bad fall and ripped some stuff. If I had known, I think that would have tempted me to stop. I didn’t do any permanent damage and I achieved my goal and had an incredible experience.
I’m sure that every runner will have a similar tale.
What can we take away?
All runners know that there are times when you have to listen to the pain or do yourself permanent damage – it is there for a reason. However, the takeaway from the science is that for non-critical pain, if you can reframe your emotional response to the pain, and refrain from catastrophizing it, that pain will feel “less”.
This is something to take into consideration when training and preparing for the race as it is something that you CAN train for. Learning to accept extreme discomfort and doing sessions that get you into that zone can be a very useful tool for race day.