Pain is a funny old thing as there are so many different types. I find that when I talk to people about pain it can be a controversial and sensitive subject. Even today, when people know more about pain than they did before, there is still a stigma around it. Pain is subjective and is there to protect us. Everyone experiences pain, whether it be once or twice with an injury or all day every day.
Pain for me is an everyday occurrence. Every day I wake up in pain and every night I go to sleep with some pain. When I first started to experience daily pain, it was scary, I wondered what was wrong with me. However, when I started researching about it I knew that there was no damage to my body. I had just learned how to keep producing pain.
Coming to university and doing a physiotherapy degree has helped me to understand my pain even more. I have learnt how I can help myself to carry on with my daily activities. There is an overlap with physical and mental wellbeing. When my physical wellbeing was at its worst, my mental wellbeing started to dip. I’m sure it’s the same for many others. When we are in pain and feeling low, the last thing we want to do is get out of bed and do something. So learning the reasoning behind pain really helped me to start being again.
It is well known for acute pain you should rest and recover. For example, if you hurt your ankle running you go home and ice it, elevate it, then rest until it feels better. With chronic pain, things are a little less known by people. We’re advised by health care professionals to exercise because there is no tissue damage and exercise is good for pain. Plus if we don’t exercise, we will decondition. However, when I was first diagnosed with fibromyalgia, I honestly couldn’t think of anything worse than leaving the sofa to go for a walk. Now that I know more about pain I am able to live well with it rather than fighting against it.
So, what is pain? And what do we think about it?
The IASP defines pain as: “An unpleasant sensory and emotional experience associated with, or resembling that association with, actual or potential tissue damage.” Pain doesn’t necessarily mean that there is damage, it is influenced by a lot more than just body tissue. Pain is always a very personal experience. No two people will feel the same and it is influenced by biological, psychological and social factors. Pain is affected by and influences many areas of life. Emotions, sensations, cognitions (beliefs about pain) and social aspects of life are all influenced by and can influence pain. Pain is multidimensional and as it persists it becomes more about other triggers than just damage. We become more sensitive. Activities, environments and movement that we could previously do without a second thought become triggers for pain.
To many people, pain feels like we need to stop doing everything. That if we keep doing something then it’s going to cause harm to us. However, rest and avoidance are usually the last thing that we need.
The science stuff.
Pain firstly is about the brain and the spinal cord. Let me give an example that I saw when watching a Lormier Mosely talk. He was walking in the bush in Australia and felt something uncomfortable on the outside of his leg. Lorimer had walked this way for many years so just brushed it off as a twig touching him. He went for his swim, walked back to camp and then two days later woke up in the hospital. Turns out he had been bitten by a venomous snake and was lucky to be alive. So, later on in the year he went for a walk with some friends and again felt something on his leg. This time he was screaming in agony. He had only been poked by a branch. Due to his previous experience, his brain told him he was in danger.
Your brain considers all the information from your body and produces pain in response to its evaluation of the danger. So in the first example above, the message from the leg, up the spinal cord and to the brain. The brain decided there was no danger and so no pain response was produced. The next time he was touched on the leg, the brain remembered the previous danger and a pain response was produced.
In our peripheral nervous system (everything that isn’t our brain and spinal cord) we have these things called nociceptors. They are the nerve endings that initiate the feeling of pain. These nociceptors pick up on something that could cause damage to the body. They then send potential danger signals from the body to the spinal cord via the nerves. This signal means that there is potential for tissue damage.
When/if the signal reaches the brain, you make a subconscious decision of how important that information is. If you think there is a threat then pain will occur. The nociceptors respond to physical, chemical or temperature stressors. For example, when you sit down sometimes the nociceptors send a message for you to move to get more comfortable. You move around a little and the nociceptors are now happy. There was no damage but the nociceptors got a little irritated. Nociception is a good thing and does not necessarily lead to pain, it just needs to be interpreted.
With regards to acute pain, nociception and pain are well related. You get tissue damage, nociception is translated to pain. Pain makes you rest and avoid aggravating the injury, so you stop walking on that broken leg. However, as pain continues, the relationship between it and the nociceptors is not as strong. You can start to have more pain with less nociception. Or more pain with the same amount of nociception; you can even have pain with no nociception at all. Sometimes wires can get crossed in the brain and we can confuse nociception with something less important like pressure. When this happens, the spinal cord sends nociception signals to the brain by mistake so that we feel pain instead of pressure. When this keeps happening, we get better at thinking that we need protection and essentially get better at having pain.
Pain is not always just about nociception. It is based on our past experiences. Where we are can trigger pain if something bad happened to us the last time we were there. Our beliefs and attitudes towards pain can cause something to be more painful than it could be. Our emotions also contribute to pain, if we are in a heightened emotional state, that can make our pain worse.
So, there you have it. Pain is extremely complicated and there is no one person who will feel the same way.
In my next blogs I will be talking about central sensitisation and chronic pain. Plus how we can learn to live with pain and how we might be able to reduce the intensity of pain experiences.
About the Author
Hi, I’m Zandra. I’m a second year Physiotherapy student currently studying at the University of Brighton. My interest in Physiotherapy grew during lockdown while I was looking after my Mum. I saw what a difference I was making to her wellbeing. I have lived experience of chronic pain and fatigue as I have been diagnosed with CFS, fibromyalgia and haemochromatosis. Through finding my own ways to cope I feel like I have a lot to offer to people who find themselves in similar situations.
I live in Kent with my Dad and my brother. In my spare time I love to walk, read, watch cricket and trampoline!
So let me know what you think and feel free to get in touch via firstname.lastname@example.org. I Also have an Instagram account that I am working on @zandraphysio. Hope to hear from you soon 😊
References & Further reading
Lehman G. Recovery Strategies – Pain Guide Book. Found at: https://static1.squarespace.com/static/57260f1fd51cd4d1168668ab/t/590dca266b8f5b01a7f97ceb/1494075961206/recovery+strategies+pain+guidebook+2017.pdf Accessed on 18/03/23