What is pain?

Pain is defined as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”(IASP, 2010), which is an interesting concept in itself as the definition clearly states that pain can be tangible, or that simply the potential for damage is there.

The amount of pain you experience does not relate to the severity of the injury you have sustained- think how painful a paper cut can be even though it is a relatively minor injury! Similarly, we can continue to experience pain long after the original cause has resolved, simply because the body perceives that we are still in danger; this is due to resultant changes in the body tissue.

One common misconception is that pain is produced by injured structures- but we now know that pain, no matter where or how it is felt, is produced by the brain. Before our brain will tell us something hurts, it will first process a vast amount of information before deciding if we need to experience pain. Have you ever cut yourself and not realised until you looked down and saw blood? This is because your brain processed the injury and did not perceive it as a threat to warrant pain signals. Pain relies heavily on context and the brain’s perception of further threat- if you bump into a lamppost, it will hurt, but will it still be painful if you’re about to be run over by a train? Unlikely, because your brain will realise the incoming train is life threatening!

Pain can be both a help, and a hindrance- for example, if we put our hand on a hot stove, the acute pain we experience tells us that we are burning ourselves. However, persistent pain can be very unhelpful as often it does not indicate ongoing damage. This persistent pain can block out other sensations and become hugely disruptive to our lives.

When we are left with persistent pain, it can be hard to believe that there is no ongoing damage- this is because persistent pain is more to do with our nervous system’s interpretation of the information it is receiving. If you were asked to do the same task all day every day, it wouldn’t take long for you to become very good at it, performing the task quicker and more efficiently each time- the body can do exactly the same. It can become very good at sending pain signals, and can actually adapt so that it sends these signals more frequently. The body can then become so sensitive that it misinterprets normal messages and responds to them as if they were dangerous. We call this process “sensitization”.

So what happens when our nervous system becomes sensitized?

When we perform recurrence activities they become second nature to us, now try to imagine if these activities were painful to perform. If we perform these painful movements for long enough, the brain will associate the connection between those movements and pain, to the point that even preparing, or thinking about a movement can cause pain. This can be very confusing and worrying if we do not understand why this is happening.

Deep, unexplained pain can often cause more worry and anxiety simply because we cannot see what is happening, nor can we sometimes understand why it is happening. As the definition of pain says, it is both a physical AND an emotional experience- the two go hand in hand.

Have you ever noticed your back pain gets worse when you are stressed at work, or not sleeping well? Have you ever noticed your back pain gets better when you’re on holiday, relaxing in the sunshine? There is a vicious cycle that exists between pain and anxiety, which can be hard to break.

What we focus on as practitioners is addressing the factors that have led to us feeling pain. These factors can be our overall physical wellbeing, social environment, health beliefs, mental health, and social environment. We aim to progressively increase your activity and work to restore your confidence in movement as these will all help to reduce your pain levels, and help break that vicious pain cycle and turn it into a positive experience whereby more movement and confidence means less pain.

So how do I help myself?
If we learn to view pain as a motivator to encouraging us to help our bodies, we can start to work with it to get ourselves better.

1. Exercise. Implementing strategies to encourage more physical activity will help your body release feel-good chemicals (endorphins) which will make us feel better, blood flow to the brain increases and so our ability to function and concentrate improves, muscle strength and endurance will improve. Remember, as you start to become more physically active, you are likely to continue to experience some pain- however, hurt does not equal harm. With practice, and focus, normal movement will return and your pain levels will decrease.

2. Set yourself realistic goals. As humans we often set ourselves up for failure by setting unattainable targets (New Year’s Resolutions being a prime example), and so when we do fail, we lose the motivation to try again. Set yourself an attainable target, such as being able to walk the children to school and back within three months, or being able to hoover the lounge without sitting down. Competing in your very first triathlon in a months’ time is NOT an achievable target for everyone.

3. Take charge of your pain. Learn more about it, read around the subject, understand your condition. By increasing your understanding and addressing your thoughts and feelings about pain, you can actually affect your own pain levels by giving yourself more control over your pain. No health professional can take your pain away from you, you must take control.

4. What is your coping strategy? You might think that the sympathy offered to you by friends and family is helpful, but we actually know that those with a more attentive, concerned spouse/partner will report higher levels of pain.

5. If you have been prescribed help, this must make sense to you and increase your understanding of your problem. If something does not make sense to you, ask, we are here to help. A good clinician will help you master your situation but you must feed back to them if you do not understand what they say.

Remember- A good health professional should be able to answer all of the following questions:

• What is happening in my body?
• What is the scientific backing to your diagnosis?
• How long will it take to get better?
• What are my short and long term goals?
• What are the options for management?
• From science, what is most likely to help? What might help? What won’t help?
• What can I do for it, because I want to do as much as I can? What can you do to help?
• Is there anything nasty which needs special attention?
• What do my physical findings, x-rays and scans (if you have had any) really mean?

The way you think about pain is very important. Research shows that if you understand your pain, you can feel in control, make better decisions and experience less pain. The good news is that by having just read and understood this blog post you have already made a positive step in the right direction!

Find your nearest clinic online and speak to a professional about your health concerns.

P McKernan 2014