Pain is a really complex topic and can leave a lot of us feeling perplexed. Being in pain creates an uncomfortable sensation. It can also be draining and have a huge impact on our lives. In this post I touch on the basics of what it is and how we can understand it better. As a physiotherapist, I deal with pain on a daily basis. Therefore I have done a lot of reading and listening to others to build up my knowledge in this areas. I am now sharing some of this with you.
The Role of Pain
Essentially, the main role of pain is to protect bodies. The brain is alerted to protect an area that may be in danger. For example if you touch a hot stove the brain will receive pain signals. This will trigger the action of removing the hand. The brain perceives messages from the tissue, makes a decision whether to interpret these as painful or not and if an action is required.
The amount of pain we experience does not necessarily equate to actual tissue damage. An example of this is stubbing your toe. It can be incredibly painful, but with next to no actual tissue damage. there are athletes who may continue running despite stress fractures because they experience very little discomfort, but there is in fact significant tissue damage.
We refer to pain as persistent when it has lingered beyond the expected healing time of tissue. At this point the pain no longer serves a purpose of protection. There is a lot of research on this topic and there are a few different things that can play a role an impact whether pain develops to become persistent or not.
As we have already discussed, when we are initially in pain due to e.g. an injury, the brain receives signals to protect the body. These signals transmit via nerves to the brain. These nerves can become hypersensitive with time. Therefore signals for light tough in the area can be perceived as painful despite a lack of threat to the tissue itself.
An analogy to help explain this, is to think of a car alarm becoming more sensitive the more it goes off. At the start there is an actual thereat of someone to break in and the alarm goes off. We can all agree that this serves a purpose. The next time it goes off it is because someone has bumped into the card door quite roughly. Although there is no threat, there could potentially have been as there was significant contact. However, then the alarm starts to go off for someone brushing by it lightly or a small bird landing on the car, it is no longer helpful. Our pain system can become oversensitive in the same way, where non-painful stimulus sets off the alarm.
In a similar way the brain can remember pain and in anticipation fo pain send out signals to the brain, although there is no painful stimulus. For example, say you have recovered from a shoulder injury and it used to be painful every time you raised your arm. Then the brain would potentially be expecting this to happen even when the injury has healed. Therefore the brain would send out pain signals predicting a painful response.
The brain has a map representing our bodies in the motor and sensory cortex. The areas we use the most and feel the most with e.g. hands and lips, appear larger on the map. Therefore, the brain pays more attention to these areas. When we are in discomfort, we tend to focus a lot on the areas that are painful. As a result of the plasticity of our brains, the painful areas becomes larger on this cortical mapping.
Is It In My Head?
I frequently get asked if pain ‘is in the head’. My answer to this is yes and no. Yes in the sense that the brain is the boss and makes the decision whether something is painful or not. No in the sense that the pain is very much real for the person experiencing it, regardless whether there is a presence of tissue damage or not.
What Can Be Done?
Being in discomfort can have a significant impact on somebody’s quality of life. Pain can stop you from doing things that you enjoy. This can be associated with low mood, decreased activity, stress and frustration. All of which, can lead to increases in pain. We can reverse the changes in the brain. We need to re-train our body and pain system in order to do this.
Over the next few weeks I will be posting a blog series on pain management in the hope that it can help you get on top of your pain and manage it in the best way you ever have. So make sure to subscribe to get notified when the next article is up. If there is something specific you want me to cover, please leave a comment below. However, please remember that I cannot give individual advise over social media.