By Chris Stoddard
“No-one really wants pain. Once you have it you want to rid yourself of it. This is understandable because pain is unpleasant. But the unpleasantness of pain is the very thing that makes it so effective and an essential part of life.
Pain protects you, it alerts you to danger, often before you are injured or at least injured badly. It makes you move differently, think differently and behave differently, which also makes it vital for healing.” (“Explain Pain”, Butler and Moseley, 2nd ed. 2013)
Pain is a universal human experience. As the quote above accurately points out it is both unpleasant and essential to human existence. It is the body's alarm system to potential or actual tissue damage.
As a physiotherapist I deal with it every day, and the more I see of pain the more I realise it is the tip of the iceberg. What manifests as pain on the surface may not accurately reflect what’s going on underneath the surface.
The brain is central to this whole process. Even if problems do exist in your joints/muscles/ligaments/nerves etc. if your brain does not think you are in danger it won’t hurt.
Take the example of the soldier injured during battle and hiding from his enemy. The brain will decide that experiencing pain is not the best thing for survival and hence pain will not be experienced in its fullest despite the tissue damage.
On the flip side of the coin even if no problems whatsoever exist, pain can still be present if your brain perceives you are in danger.
Most people, including health professionals, don’t have a good grip on understanding pain. This is despite it being well documented that the physiology of pain can be understood easily by anyone and that understanding this physiology changes the way people think about their pain, reduces the threat value of it and improves their management of it.
The explanation of pain physiology is beyond the scope of this blog post but what I wanted to do is expel 2 misunderstandings or myths about pain and start to get you revolutionising the way you think about pain.
Myth 1: “Pain is relative to tissue damage.” Many of us have heard stories where people have been severely injured and felt little or no pain. The shark attack victim or the war veteran who has a routine chest x-ray 60 years after the war and finds a bullet has been lodged in his neck the whole time. And then all of us have a paper-cut that barely breaches the surface but stings like crazy and annoys you to no end. Severe injury creates lots of loud alarm signals that pour into the brain but does not necessarily result in pain. Small injuries are no different. The point is that it is the brain that decides whether something hurts or not and how much it hurts 100% of the time, no exceptions!
Myth 2: “All the test and imaging are negative… so it’s all in my head?” This is the most commonly asked question I get asked about persistent pain. I’d be lying if I said no. As I just said, all pain is produced by the brain.
However, anyone who tells you it’s all in your head, implying that therefore ‘it’ is not real, does not understand pain biology.
We know down to the hours and minutes what most tissue healing times are. Even after these times elapse we know pain often persist, as the brain perceives that a threat still remains.
The simple explanation for why this occurs is that there are now changes in the way the alarm system works (i.e. the spinal cord and the brain). This is influenced by many different things including stress, previous experiences, how the tissue is being used, other disease processes (e.g. depression) and stigma of certain conditions (i.e. lower back pain and ‘discs’).
So when pain persists longer than anticipated it is vital to consider the enhanced sensitivity of the alarm system.
Pain is a very personal event. No one knows what you are experiencing or the exact biological processes that are in play but we (as health professionals) should be able to make sensible predictions.
We aim to be able to tell you a) what is happening in your body ; b) how long it should take to get better ; c) what your options for management are ; d) what your imaging and physical findings show and (probably most importantly) ; e) what you can do for it, so you can do as much as you can.
Remember, there is incredible empowerment in understanding and overcoming pain.
(If you want to know more about why you are in pain and what you can do about it, give us a call on (02) 4983-1765, shoot us an email at firstname.lastname@example.org or come see us in the clinic.)