What is pain?

What is pain?

Pain can be described as an unpleasant sensation deriving from actual or potential tissue damage, which has both physical and emotional components. This is an interesting description that requires a bit of exploring. Before I understood pain, I believed all pain was damaging but we know now that this is not the case.

Pain is produced in the brain. Not in the back or the neck or the knee or foot. If you stub your toe, for example. Before you’ve had a chance to call for help, messages are being sent from your foot to your brain informing them of the crisis. This pain is as a result of acute tissue damage. Rubbing your toe is a way in which we can try to reduce our pain. This sends more messages to the brain via our inhibitory nerves to lessen our pain experience. Think about that for a second. We stub our toe. We all rub our toe on impulse; but rubbing our toe can’t change the damage right? The damage has already been done. So why do we do it? Its because the rubbing is a stimulus input to our brain to try to affect our pain output. Simply put, it’s a distraction. And it does work to reduce the pain we feel. For this type of injury, you probably won’t need to see a physio even though you’ve experienced pain because it is most likely acute and you should recover quickly.

Now take someone who has had low back pain for 10 years. Initially they may have tweaked a muscle in their back. They were busy in work, doing long hours and very stressed. They were lifting something at the weekend and suddenly ‘aaagggh’. Sharp pain in their low back. Most likely acute tissue damage as a result of a build up of tension from the last few busy months. They try and rest but the pain doesn’t go away. They try to go back to work but by the end of the day they are in agony. However, they still have work to do so they keep ploughing on. Eventually they go to their GP who prescribed some pain relief which helps. They cautiously return to full activity but are conscious of not doing further damage. A few months later the back goes again. They repeat the process. They may see a physio and get some relief. After frequent episodes a year, multiple medications, MRI scans, numerous different physios, they are convinced they have a ‘bad back’. Do they? Or have they just been unable to fully restore movement and confidence?

Remember, pain is both physical and emotional. And its processed in the brain. The patient above’s brain most likely went into protective mode, trying to reduce further damage. And now the pain is lingering long after the tissue damage has healed. What they needed to do was to restore movement and confidence.

This can often be hard for patients to hear. Any mention of emotional pain or psychological pain can lead some patients to feel that they aren’t being listened to. You are, I promise. Take our two patients above. The patient who stubbed their toe won’t have experienced much emotional pain; but what if their pain lingered for 5 months? Now their pain experience has exceeded their pain expectations. It would be normal for this patient to think: “why is my toe still sore?”; “I thought it would be gone by now”; “It’s really getting me down at this stage”; “I better go easy on it as I don’t want to make it worse”. Now there are psychological factors associated with their pain. They are not ‘making it up’ or it’s not ‘all in their head’. The pain, however, has moved past just acute tissue damage and is now more about the persistent nature of the pain and how it is affecting their central nervous system.

I understand that this may be a different view of pain from what most people are used to but it is the most widely accepted scientific view of pain we have. If you are experiencing pain, just remember. You are not damaged. Or broken. Or out of alignment. Or doomed with pain forever. Pain is a symptom. The underlying issue could be tissue damage. Or if you have persistent pain, it could be the effect this is having on your central nervous system. And to rid ourselves of this type of pain takes a more holistic approach that looks at physical and emotional components.