Pain has come a long way over the last 40 years. Initially, pain would be treated and seen as a cause-and-effect response in the body. An alarm system our body transmits that is associated with potential or associated tissue damage. This is not entirely false, however our body is a little more complex than that.
Have you ever finished a day at work, jumped into the shower and seen a massive bruise on your thigh unsure of where or when this occurred? Or have you ever cut yourself on something innocuous like a paper cut, and not realise until you have seen the blood on your hand. Where was the pain in those scenarios? Was your alarm switched off at that time?
Now think the opposite end of the spectrum, have you heard the story of the builder who jumped onto a 15cm nail that pierced his steel toe boot. The 29-year-old male was in agony requiring emergency crew to take him to hospital due to the pain. When doctors removed his boot, there was no evidence of cuts, blood, scratch or any contusion, but instead the nail passed between his toes never touching his foot. Why was this painful? Was it even real?
If pain was identified to be a measure of damage, these situations and these responses would not make sense. The new definition of pain according to the International Association for the Study of Pain (IASP) is;
‘an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage’
This new definition of pain now allows the flexibility for the link between pain and damage not to be so linear. There could be pain with damage, zero pain with lots of damage and lots of pain with minimal damage.
So how does this happen?
We need to understand where pain comes from. In our body, we have millions of neural connections that communicate to each other. At the hub of all these communications is the brain. This is our control centre for pain. If we were to twist our ankle, the nerves in our leg identify ‘something has happened here’ but it is then the brain that receives this information to send down another signal to the ankle saying ‘yeah, that really hurt’. Our PAIN comes from our BRAIN – and it’s very smart too.
Pain is often dictated by lots of things that we may not even think about. Your surrounds, the emotional state you’re in, the history that you’ve had with this pain or injury before. We call this the biopsychosocial model of pain. This is a good thing as many things can influence your pain, so that means that there are many options to help manage and treat your pain, not just the tissue damage itself!
Why is this important?
The majority of clients that come and visit a healthcare professional is often due to pain. As a population and society, we also want an answer to our symptoms and pain. Often it can be hard to understand pain when you cannot point it out on a x-ray or explain it using a grade X tear of this muscle. Understand that YOUR PAIN IS REAL – just like the nail in the boot pain was real, but it’s not always related to something that can be seen.
Think of it like a volume knob – go back to the twisted ankle…our brain has turned up the volume of pain to 11 after that incident. As our ankle and tissues heal over time, our volume knob usually drops as our body recognises it doesn’t need protecting because the ankle is getting stronger. However, in some cases long after our tissue has healed and strengthened, some volume knobs get stuck and take a lot longer to get down and pain can remain. In these cases, our pain is less related to our initial injury and more to do with our brain and nerves (central nervous system). This stuck feeling of pain after your injury has healed can lead to what is called persistent pain.
This can be a very complex time making simple task such as running, bending, twisting and even walking laborious and even painful. This sensitivity of your pain and movement is again REAL and not a pretend thing. Even though we know that pain comes from your brain… it is REAL… and it can IMPROVE. When we are looking at changing pain we need to understand that pain could be there for many different reasons. As health professionals, it’s important to ask the right questions to understand YOUR beliefs, YOUR story and YOUR history so we can find the best context at which to improve your pain.
Some helpful tips to keep you on the right track and avoid going down this pathway have been established by Derek Griffin – a physiotherapist researcher specialising in pain and pain science:
- DO know that your pain is real
- DO stay active
- DO more meaningful activities
- DO maintain social relationships
- DO face your fears
- DON’T rely on scans to tell you the whole story
- DON’T believe everything you have heard
- DON’T blame yourself or fight your pain
- DON’T’ assume pain always means damage
- DON’T rush or panic if you have a set back
If you or someone you know has a battling history of pain that has not resolved, seek help, see our physio or chiros to help start you on the path at helping reduce the noise and drop the volume knob down. Know that we can help and things can change, even if it means opening your eyes to different ideas and challenges.