Understanding your pain is one of the most important components to getting rid of it.  So first of all, what is pain? The most commonly accepted definition of pain is an unpleasant sensory and emotional experience that is associated with actual or potential tissue damage.  That seems like a pretty straight forward definition, but there is actually a lot packed into that sentence.  The following is a short list of important keys to grasping the difficult and complex topic of pain:

 

  1. Pain is all in your head. That’s right, your pain is all in your brain.  I’m not saying your pain isn’t real, it certainly is, but you only suffer pain if your brain determines you should.  Remember the definition above, which stated that pain is an experience.  The brain receives signals from your body 24/7.  Some of the signals it receives come from damage sensors called nociceptors.  When there is damage, or even potential damage to some part of your body, these nociceptors send alarm signals to the brain.  If the alarm signal is “loud enough”, your brain may tell you something hurts.  The point is to get you to act.  You may be injured or in danger and you need to do something to protect yourself.
     
  2. Your pain is unique to you and relies on context. Your pain experience is not based solely on the “alarm signals” received by your brain.  There are other factors in play such as past experience, the level of perceived threat/damage, and how important is it for you to feel pain at that very moment.  Here is an illustration that might help.  If you are running through the jungle and twist your ankle, it might really hurt.  However, if a tiger jumps out of the bushes, your brain is likely to determine that not being eaten is a pretty big priority at this point.  Suddenly, the alarm signals from your damaged ankle are of very little importance to your brain and you don’t perceive pain.  Keep in mind, there are still alarm signals being sent to your brain, but your brain is choosing to ignore them.  The context surrounding your pain has changed and therefore, your pain experience has also changed. 

  3. Pain is subjective. This means it belongs to the thinking of the person in pain and is therefore influenced by thoughts and opinions.  For this reason, pain can be very difficult to measure.  It also means that two people who experience the same injury, say a paper cut, may rate and describe their pain very differently.  One may be in agonizing pain over a little paper cut and the other may continue on as if no injury occurred.  In the same vein, the degree of injury does not necessarily match the intensity of pain experienced.  Some minor injuries can be excruciating while other major injuries might involve very little pain. 

  4. Diagnostic imaging may not accurately indicate what is causing your pain. In fact, it may actually cause your pain to be worse.  Wait, what?!  If you refer back to a previous blog post on diagnostic imaging, you will recall that many people have positive findings on diagnostic imaging such as x-ray or MRI, but have no pain at all.  In fact, a study performed on individuals aged 60 and over who had no symptoms of low back pain found that 21% had spinal stenosis (narrowing of the open spaces within your spine that can place pressure on your spinal cord or spinal nerves), 36% had at least one disc herniation and 90% had a degenerated or bulging disc.  Therefore, if somebody develops low back pain for any one of a multitude of reasons and we take images, it is possible to falsely assume that the finding on the picture is the patient’s “pain generator”.  In addition, showing a patient positive imaging findings may now increase their pain and/or the time it takes to get rid of pain. The reason is because things like arthritis, degeneration, disc herniations, they can look pretty mean and therefore, the patient’s perceived threat is now greater.  Now, I need to be very clear on one thing, any exam findings should be discussed with a patient, but there needs to be quality patient education in order to insure the patient has a good understanding of exactly what these findings mean.

  5. Psychological factors can modulate your pain. Things like depression or anxiety can influence how you experience pain.  Literature has shown that after surgery, people with a prior history of depression tend to rate their pain higher and take longer to recover on average. 

  6. Social factors can modulate your pain. Statistics show that people who are more socially engaged through life tend to report less pain.  In addition, people also report increases in pain while they are at work or wrapped up in stressful situations.  Our suggestion is that if you have been suffering from pain, try with all your might to get out of the house and join friends for some fun activities.  It may be fun, but also therapeutic. 

  7. It is possible to decrease pain by increasing body awareness. Knowing where your body is in space (proprioception) and therefore the ability to determine your left from right may be hampered when you experience pain. Each side of your brain has a “map” of the opposite side of your body (left brain has a map of your right side).  This map allows you to know where your body is in space at all times.  Have you ever woken up in the middle of the night and your entire arm is completely “asleep” because you were laying on it and then it takes you a minute to figure out whether your arm is underneath you, beside you or worse, no longer attached to your body?  Well, while you were laying on your arm, decreasing blood circulation to various structures such as the nerves, you were in turn decreasing the signals sent to your brain from your arm.  Overtime, your brain lost track of where your arm was in space.  When you injure a part of your body, it may cause a “smudge” in the brains map due to decreased feedback from the injured area.  So now, the part of your brain that had a nice clean map of your hand, might look more like a glove.  If you are able to “clean up” the image of your hand through various exercises and activities, research has found you may also decrease the pain you’re experiencing in that hand.

  8. Education and understanding of pain may reduce your need for care. In the book, “Explain Pain” by David Butler and Lorimer Mosely, they suggest that the perceived threat value of pain directly contributes to the pain experience and by informing people about what is happening when they are in pain, you change the way they think about pain, reduce its threat value and in turn, improve the management of it.    

Ok, so we’ve officially scratched the surface of what is going on when we experience pain.  In future posts, we will dive a little deeper and address how we apply these concepts in patient care.  For now, I have attached a fun little video that can help tie this all together for you.  You can find the video at the bottom of this post.  

If you have any questions, please do not hesitate to contact our office directly.  We would love to help you understand your pain as best as we can.

 

-Dr. Derek