As part of our “Pain And…” series, Dr. Windsor discusses the relationship between pain and dysfunction within the autonomic nervous system.
Much is made of the autonomic nervous system these days, and with good reason. Autonomics is a core and incredibly adaptive system that is primarily responsible for maintaining homeostasis. This means that it adapts the body’s functions to meet external and internal demands to maintain balance. During times of danger, the body will adapt by mounting a response to mobilize the functions involved in protecting oneself from danger.
This effect is wide-ranging. It can include increased heart rate and blood pressure, slowing digestion, and nutrition absorption. The amount of light allowed into the eyes increases, sweating increases, and the bowel and bladder slow down. The body spends its resources fighting or running. It isn’t time to eat or use the toilet.
Internal threats like starvation (or skipping meals) and dehydration (or not drinking water) elicit similar responses. Blood sugar will be freed from storage, muscles will work hard but not repair as well, and the core body temperature will increase as blood flow decreases to the hands and feet.
So why are pain and autonomics so closely related? They are both part of the danger response system. Pain is the damage and injury part of the protection system, while autonomics is part of the sensing and maintaining body functions during danger. Sometimes, mobilizing resources is painful. For example, trying to eat during a period when the body is not focused on digestion can result in uncomfortable sensations like nausea or pain.
It is very rare in young people that these nerve functions are damaged or “broken.” They are often over-functioning or dysregulated. In some ways, it makes a sick kind of sense—if someone is in a state of acute danger, for example, amid a war with danger all around, feeling full quickly and on little food is a mercy. If, however, daily life feels like a war and it’s been 12 months of problems, then the body is not prepared to eat regularly, which can lead to problems. Just like with pain—when the body employs its short-term survival strategies in the long term, it’s not healthy.
One final, crucial element of the autonomic nervous system. In its quest for balance, the nervous system predicts the response based on past experiences and what is expected to happen. For instance, if reaching out to touch something on a cold day, the brain will slow down blood flow to the hand before touching it. Isn’t that amazing?! If, however, the object is hot when it is expected to be cold, the disconnect between expectation and reality is jarring. It causes a whiplash to the nervous system, making it feel more intense and with a stronger autonomic reaction than normal. It’s one of the features of the nervous system that underlie the self-fulfilling prophecy (what is expected is more likely to happen) and how the brain exerts control over the body.
The underlying causes of dysautonomia differ for everyone and require individualized evaluation and treatment. In many ways, for most children and adolescents, dysautonomia is a disorder of maladaptation. It’s a disorder wherein maintaining homeostasis causes problems instead of fixing them. It’s treatable but can sometimes require creative solutions to find healing.