Don’t stand so close to me…

The Police song came to mind recently when I was thinking about how people protect themselves and their painful body parts, especially in cases of CRPS.

Pain is part of the the protective response initiated to promote survival and healing. We attend to the painful area and take action. This action can be conscious guarding by wearing a device (e.g. a boot or splint) and posturing to show that there is a problem and to avoid actual contact with other people.

We feel pain in our bodies although it is neuronal activity in the brain that underpins the experience of pain. In other words, we experience pain in our ‘physical self’ but it is the brain that constructs the feeling and gives it an anatomical location.

We have our bodies mapped in various cortical locations including the sensory and motor centres of the brain. These maps are very well defined under normal circumstances as far as we know. This accuracy changes in cases of persisting pain, thereby affecting our ability to know where we are being touched and controlling movement. Modern treatment of persisting pain states target these changes as well as promote tissue health and overall wellness.

More recently it has been discovered that we also have a virtual body that is mapped out in the brain, meaning that we can alter the physical experience and pain by positioning the limbs in the contralateral space. For some time we have known that there is extracorporeal awareness that changes when we have nasty pain. In other words, the space around us and in particular the painful area becomes protected as well. On approaching the affected limb in CRPS, often the individual will flinch and guard before the actual contact arrives. Sensible you may think. This can happen when they have their eyes closed as well.

So, as the song says, ‘Don’t stand, don’t stand, don’t stand so close to me’ is an important protective response driven by the salient network in the brain but needs to be addressed as part of a comprehensive desensitisation programme.

For further information about our treatment programmes for CRPS, please call 07932 689081 or visit our website here: Specialist Pain Physio Clinics, London.

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