Over the next two issues, we will be sharing with you the fundamentals of pain. In this months article, we will discuss what pain is and how it can show up in our bodies. Next month, we will explore further how to deal with pain.
This is intended to give you some clarity on the topic of pain, which you may find empowering when dealing with pain, whether it be acute or chronic pain, which can have a huge impact on your daily life.
The International Association for the study of pain (IASP) defines pain as “an unpleasant and uncomfortable sensory and emotional experience, associated with actual or potential tissue damage”.
This uncomfortable and unpleasant sensation we call pain is an output elicited by the brain. It is something your brain decides that you should experience when it believes that there is something wrong or compromised.
Specifically it is signifying that there is a threat, problem or that something is hurt or about to get hurt.
This experience of pain occurs when the brain initially receives danger signals or information of potential damage or threat to the body. The body has specialised nerves that detect potentially dangerous changes or abnormalities in chemical balance, temperature or pressure. These specialised nerves are called nociceptors. They monitor what's going on in the body and act as the eyes of the brain.
These receptors (nociceptors) can be stimulated by a rapid change in temperature, any chemical related changes (e.g. inflammation or lactic acid build up), lack of blood flow, soft tissues being pinched, pulled, punctured, torn, or squeezed.
When these receptors are stimulated, they produce signals that go up the spinal cord to the brain.
The brain then analyses and evaluates what those signals mean in order to determine whether the threat is real/significant or not, and it does this by looking at the pain in context.
By analysing other information as well, such as your emotions, cognitions (beliefs about pain), past experiences and especially the situation in which the ‘pain’ occurs, it can work out the context.
Then the brain simply asks, "how dangerous is this really?"
If the brain is of the opinion, after analysing all this information, that the body is under potential threat, is vulnerable or is progressively getting hurt or damaged, the brain will provide you with the message or output of pain.
This is a signal that you will perceive, a warning as it may, acting as a basic request for change (which may be withdrawing from a threatening mechanism, insult or behaviour, seeking treatment or allowing time to heal)
It is ultimately a highly sophisticated signalling mechanism or alarm system that also functions as a protective mechanism.
What we have described so far relates to acute pain.
Acute pain is the type of pain that is of sudden onset and rather short lived, lasting up to 4 weeks. It is the informative and protective variant of pain. It usually originates from an injury or trauma.
Unfortunately for some people, pain can persist even after an injury has healed. For those people, this type of pain is no longer helpful, informative nor protective at all and if left untreated and/or after a period of time, it can eventuate into the other subtype or variant of pain which is chronic pain.
At this point the brain readily elicits a pain response i.e has become sensitised. This means it becomes ‘good’ at producing pain, regardless of the input from the nociceptors.
Chronic pain is long-term pain or pain that is ongoing lasting more than 3 months, and it is considered relatively difficult to treat. This is due to the fact that the pain is being compounded and negatively reinforced by psychological and behavioural influences. Acute pain that is not treated effectively or is continuously re-aggravated by poor physical and psychological behaviours can become chronic pain.
When this occurs, the brain and spinal cord becomes sensitised or hyper-sensitive, where signals of pain aren't regulated well enough by the brain’s naturally occurring painkillers.
This can eventually lead to pain that persists even without the presence of tissue damage or potential threat or problem. In other words at the point of chronic pain, the relationship between damage/potential damage and pain becomes very tenuous or weak.
When pain becomes chronic, it is ideal for the person to have assistance in addressing not only a particular incident that has led to their pain experience, but also to observe and address the thoughts and emotions (psychological barriers), as well as poor behaviours which may be attached to or related to their pain experience.
Simply put, chronic pain is heavily influenced by emotions and thoughts. Some of these could be negative connotations/beliefs, fears, anxiety, stress associated with pain and lack of physical activity or even social withdrawal.
Therefore chronic pain is more about or heavily influenced by thoughts and emotions, rather than tissue input/tissue damage .
(As shown in the picture below)
The Pain Paradox
We have broken down the mechanisms of pain in a simplistic way, however, as simple as pain may have sounded so far, it is certainly a complex mechanism which is still not yet fully understood.
The reason for this is due to underlying contradictions and inconsistencies in our knowledge so far.
Hence, we welcome you to the paradox of pain!
Contrary to popular belief, pain and damage are not one and the same. The degree of pain does not necessarily correlate with the degree of damage.
In other words pain can occur without any particular damage (chronic pain), but it can also occur when there is much damage, but no pain- this is the parody.
People often visit us at Spinal Symmetry in a certain degree pain for a supposable muscle-joint issue, but have little or no tissue damage.
On the other hand, we also have people who seek treatment from us with muscle, tendon and ligament issues (e.g. rotator cuff in the shoulder), muscle tears, biomechanical joint dysfunctions, disc bulges or moderate to severe degrees of osteoarthritis, yet they have show minimal symptoms or no pain at all!
This aspect of pain can be based on how well the pain regulation chemicals are working in your brain, and how sensitive your body is to pain-potential messages or threats to optimal functioning.
Your brain has it’s own pain suppressing chemicals known as endogenous opioids, which are basically naturally occurring painkillers in the brain.
The function of these painkillers are determined by the history you have, the state you are in, the location you are in, as well as the context in which you experience pain.
So ultimately, we know that if pain exists, it is generally good at telling us that there is a potential problem but unfortunately it is poor at telling us how severe the problem is.
To add further, pain does not necessarily tell us where the location of the problem is either. In many situations, the source of the pain is elsewhere, usually far removed from the location of the pain.
This holds true in regards to referred pain from another location, but ultimately this refers to an underlying problem or cause.
The Pain Parody and Spinal Symmetry
Looking at this from a bio-mechanical point of view, often the primary cause can be below, above and or on the opposite side to where the pain is located. This is because the body is completely connected and inter-linked.
When we talk about musculo-skeletal dysfunction, this can occur over time in a particular area of the body, causing the body to compensate and create a build-up of strain. When this happens, the pain is usually expressed somewhere else as a superficial point of breakdown.
Ultimately, to summarise this distinction, the underlying issue is not necessarily in the painful tissue- this being that the pain in the muscle, ligament or tendon you are experiencing may not be where the primary issue lies.
When we utilise the Spinal Symmetry method in treatment for our patients, this paradox of pain is a distinction that we come across regularly. This is due to the nature of the method we use, which analyses our musculoskeletal biomechanics to find the PRIMARY CAUSE of any dysfunction.
In next month’s issue, we will discuss further the management of pain.