Happy Thanksgiving!

Giving thanks!....

With the holidays coming up, especially Thanksgiving, everyone is talking about gratitude these days.  We all know what gratitude is – by definition “the quality of being grateful (or thankful)” – but gratitude has far reaching health effects beyond just giving you a warm, fuzzy feeling inside.  Gratitude has been shown in numerous research studies to decrease pain, reduce anxiety and depression, improve sleep, and lower blood pressure – just to name a few of its many beneficial effects.  And the wonderful part about it is, gratitude is 100% something that YOU can control.  No matter how bad your lot in life is, the very fact that you are alive and breathing gives you AT LEAST one thing to be grateful for.  If you are reading this blog post, then you obviously have access to the internet and some sort of device with which to be able to access it, so chances are that you have many, many things to be grateful for.  It’s all in how you choose to look at the world (glass half-full vs. half-empty kind of thing).  In reality though, living in a first world country (I assume most of my readers are reading this from the United States), most of us have our glass WAY more than half full.  Our cup overflows with abundance, and when we choose to focus on the negatives in our life, it’s kind of like crying about the few drops that spill over the top of the glass rather than recognizing the full glass underneath the endless tap with which to refill it.  So lets take a look at just a few of the health benefits of gratitude and be grateful for our ability to literally improve our health with our frame of mind.

Effects of Gratitude on Pain

To understand how something like gratitude can affect pain, it is first helpful to understand a little more about pain itself:

The International Society for the Study of Pain (IASP) defines pain as “an unpleasant sensory and emotional experience related to actual or potential tissue damage, or defined in terms of such damage”.  An important thing to note is that EVERY pain experience – has both sensory AND emotional components, and those cannot be separated from each other.  From the acute injury that happens when a football player tears ligaments in his knee to chronic pain from arthritis, fibromyalgia, or just general back pain - ALL of these pain experiences have both a sensory component (the messages your body is sending to your brain) and an emotional component (your brain’s interpretation of these messages).  The science of pain has greatly expanded over the past 30 years, and we now understand that “pain” is not the signal that your body sends to your brain (in fact, we do not even have “pain receptors”), but rather it is the message that your brain sends back to your body when it interprets that there is potential danger.  Yes, neuroscience now confirms that ALL pain is 100% produced by the brain – it is a MESSAGE TO TAKE ACTION – to get out of whatever potentially dangerous situation you may be in.  And when the brain is satisfied that you have taken the appropriate action to get out of that situation, it stops yelling at you – and the pain stops.  (Click here for more information on chronic pain management).

Now for many reading this post who may deal with chronic pain, as most of my patients do, you may be asking – “So are you saying that my pain is all in my head?” This is the typical first response people have when they hear this type of message.  Well – no more so than ANY person’s pain is in their head – but what goes on inside your brain is ABSOLUTELY influenced by what is going on in your body. In fact there are many things that influence how much danger your brain perceives in a given situation.  Some of those factors include:

1. The messages coming from the body tissues:
   • Stretch or pressure – such as from an injury OR from the atmosphere. This is a common reason why people with arthritis have more pain when weather fronts come through – because of the change in atmospheric pressure.
   • Heat or cold – Ever wonder why your joints ache when it gets cold out? A drastic drop in temperature used to be a threat to our survival before we lived in nice heated and insulated houses (something to be grateful for by the way).  Your body produces pain in such situations to alert you to such potential dangers.  Using a heat pack, putting on an extra layer of clothing, or taking a hot bath or shower satisfies your brain that you have gotten out of that potentially dangerous situation (freezing to death), and the pain often gets better.
   • Chemicals – Certain chemicals in your body can trigger a danger signal. That can range anywhere from the chemicals that get released from your tissues when they are injured (such as histamine), lactic acid after a hard workout, chemicals in and on the foods you eat, natural hormones produced by your body (such as cortisol), or man-made versions of those same things (such cortisone/prednisone).
2. Emotions – Such as anxiety, depression, anger or fear. All of these activate parts of the brain (especially the amygdala) involved in the danger response system.  They can put your body in “fight or flight” mode and make the signals from the body appear more dangerous than they actually are.
3. Sleep – When you don’t get enough sleep, your cortisol levels rise. This has negative effects on both cognitive function (impaired memory, longer processing time for complex tasks) as well as increasing your pain sensitivity – meaning that that it doesn’t take as high of a level of danger signal from the body to produce a pain response.
4. Role in Society – Largely most people can deal with signals coming from their tissues. Most patients who present for pain treatment say they have “high pain tolerance”…what they can’t tolerate is when those tissue signals start to prevent them from doing the things that they need and want to do to fulfill their social roles…earning an income, playing on a sports team, taking care of children, spending time with family and friends, etc.  This fear of loss of role in society increases the “danger value” of the situation, and makes the PAIN response worse than if the SAME amount of signal from the tissues did not affect societal roles.
5. Expectations and past experiences – If someone has previously had pain in a bodypart, or they know someone who has, that past memory can alter their pain experience. For example, if a relative was disabled by back pain, then an episode of back pain may trigger that past experience and make the person fearful that the same thing will end up happening to them.

SO, BACK TO GRATITUDE…

Your brain only has a limited ability to pay attention to so many things at one time.  If you intentionally focus your brain on positive emotions, then it doesn’t have as much attention left to devote to the less positive stimuli that may potentially trigger a pain response. MRI studies (Zahn 2008; Fox 2015) found an increase amount of the “feel-good chemicals” dopamine, serotonin and oxytocin in regions of the brain that help control pain (anterior cingulate cortex, prefrontal cortex, and hypothalamus, for those that care).  The release of these chemicals counteracts the danger response (“fight or flight”) that produces fear, anxiety, and depression….all of which ultimately contribute to pain.   Gratitude improves depression, anxiety, self-esteem, and sleep (Lin 2015; Ng 2013).  Another study by Jackowska et al in 2016 showed that a gratitude program improved overall well-being, optimism, and sleep quality and decreased diastolic blood pressure.  Further benefits of gratitude include improved social relationships (Algoe 2008; Lambert 2010) which as noted above, also has an effect on pain.

Ok, I get it…gratitude is great!  But why do I still hurt?

Gratitude, in psychological terms is more than just saying “I’m thankful for…”.  It’s more of a deep appreciation for what you have or things you have received, whether tangible or intangible.  In other words, YOU CAN’T FAKE IT.  Just saying, “I’m happy for this and I’m happy for that, but I still have this, that, and the other problems…” is not true gratitude.  Alternatively, it is more an attitude of, “Although I have this that, and the other problems, my life is still happy and full of wonderful blessings.”  Are you still going to feel aches from your knee or back…yes, of course…they just won’t be as bothersome.  This is basically what opioid drugs do: you still feel the signals from your body, you just don’t care as much…which actually makes the PAIN less. (As an aside, gratitude releases endogenous opioids, natural opioids produced by your body that have been shown to be better pain relievers than morphine.)

So how can you incorporate TRUE gratitude into your life?

There are numerous ways you can incorporate gratitude.  Some of them are listed below.  The key point though is that no matter what method you use, you can’t just go through the motions.  Doing the steps just to do the steps and say, “I’m grateful for…” or “I tried gratitude…it didn’t work”.  Take a serious inventory of your life…appreciate the things you like… and to quote the great Maya Angelou…”if you don’t like something change it…if you can’t change it, change your attitude”.

4 gratitude strategies:

1. Give someone you care about a heart-felt “thank you”  – Written, verbal…the  medium is not important, but tell them that you are grateful to have them in your life AND what you appreciate them (“positive affirmations”).
2. Keep a gratitude journal – Taking time to write down 3 things each day that are are grateful for forces you to systematically look at the positive things in your life.
3. Pray – If you hold religious beliefs, giving thanks to a higher power is a wonderful way to be grateful.
4. Mindfulness – Mindfulness is non-judgemental awareness of the present moment. Just appreciating each moment for what it is, without placing a value label on is a form of gratitude.  Click here for more information on mindfulness.

That’s all for now folks!  I’m grateful that you’ve taken the time to read this. Have a happy and safe Thanksgiving!