CarlNeal

Pain is one of the few things that all of us will experience in our lives.  It can be great for us, protecting ourselves from seriously hurting ourselves but more commonly it can become the bane of our lives and prevent us doing the things we enjoy or need to do . Apologies for the length of this post but I cannot emphasise enough how important it is to understand your pain.

Although we will all get pain to some degree in our lives no-one can truly compare their pain to  somebody else's, we all experience it differently. There are often no words that accurately describe it and equally there are no ways to measure it.

Pain is weird.  We can get lots of pain with minor injuries (think paper cuts, stubbed toes e.t.c.), we can even get pain with no injury (think psychological pain, phantom limb pain) equally we sometimes get minimal pain with big injuries (think wounded soldiers, rugby players (well some) and cultural sacrifices).  Isn’t it strange that if you break a bone it is agony, once it goes in a cast the pain goes.  The fracture is still there but it doesn’t hurt as much.  Pain is a complex beast.

For these reasons people have become more interested in studying pain and with technological advancements our learning has come a long way in recent times.  We now know more than we ever did and our thoughts on it have flipped on its head. This is important for you, the people in pain.  Understanding your pain can have a huge impact on how you manage your pain, how you participate in rehab and ultimately your success in improving your quality of life.  It provides the foundation for recovery. Understanding it can be crucial to get a good outcome.

This article aims to introduce the science and theory behind pain (all pain: chronic pain, acute pain, deep pain, sharp pain).  Hopefully I can do this in simple terms.  Although I've said pain is complex it Is only as complex as how the describer describes it. It may be having read this you still won't understand it however it will hopefully give you a start.  If this you there are links at the bottom of the page to further your knowledge,  alternatively  book in for an appointment.  This will help in putting everything into perspective and open your eyes to how this can help you.

A word of warning before we go on.  A lot of what I am going to write may challenge your thoughts.  It is often in direct opposition of what you may have been told about your injuries previously, it goes against how society as a whole view pain.  Many therapists have also been challenged and whilst some (including me) have accepted this new knowledge and used it to positively to affect patient outcomes, many others have been reluctant to accept it as it challenges their approaches to treating pain.  Remember though that this is knowledge newly found and proven by science.  Importantly the same science has also proved that learning about pain can improve it.

Since integrating this knowledge into my practice I have seen patients outcomes improve considerably.  This is particularly true for patients who have had pain for a long time or who are highly anxious about their pain.  Therefore, try to bear with it and approach it with an open mind.  It could be the key to unlocking your potential.

What is pain

Pain is a threat response and pain is 100% of the time created by the nervous system. These are the two key principles to understanding your pain.

When we get pain, what happens is that sensors in our tissues (muscles, bones, skin, ligaments) send messages to our spinal cord.  Historically we always thought these messages were pain messages however we now know these messages are mechanical (force, movement, pressure), chemical or temperature in nature. Our spinal cords then have to decide whether the information is important.  Sometimes it can stop the messages at source (why we can ignore things in our periphery) but other times it will relay the information to the brain.  The brain pieces this information together and  couples this with information already stored. This information is based on previous experiences, the environment, the implications of damage, our emotions, thoughts and beliefs and many other things.  The brain then has to decide is this dangerous?  If based on all the information it deems there is risk it will be send pain or make the body part in question stiff to protect the area.  It is as simple as that.

This is what happens every time we get pain regardless of what type of pain it is.  When we sprain an ankle the mechanical and chemical sensors will go into overdrive and send messages which make it to the brain which decides there is risk of damage and will then give pain to stop us from injuring it further.  It really is a great system.

Over time the ligament heals, we restore normal movement and strength and more often than not the pain goes.  However sometimes the pain persists.  Our body will have still healed the ligament as our bodies are great healers. The damage has gone but we still have pain.  What is happening here is that the nervous system has adapted.  More sensors may have developed and are more easily triggered.  Equally there may be more nerves in the area which means more messages are sent to the spinal cord.  For various reasons the spinal cord is now more likely to send this information to the brain and the brain also treats the information more cautiously as it doesn’t want it to risk further injury.

Pain is an alarm

The pain alarm system is therefore too sensitive and we get pain without damage or with movements that under normal situations are not dangerous / wouldn’t cause pain.  This is obviously not a great system, our pain system is not perfect.  This explains why pain often doesn’t match up with the amount of damage present. Pain does not equal harm and often is a poor reflection of what is going on in the tissues.  This does not just apply to the ankle here but to all injuries.

A big part of rehab is to desensitise the nervous system.  This requires careful choice of words, treatments and explanations from your therapist.  Poor choices here can actually harm you.  For example telling you that your back is unstable or realigned with manual therapy will make you consciously or subconsciously believe you need protection. In turn your brain will give you protection in the only way it knows how: pain and stiffness.  This is why I have concerns with some diagnoses and treatments that are frequently used by therapists as I will discuss in future blogs

Exercise and exercises also have potential to sensitise the alarm system so it is of great importance that they are tailored, both too much and too little can be problematic.  The great thing with pain science is we can use it explain the ups and down when rehab doesn’t go exactly to plan.  We can use it to explain everything in your pains history and future.

Pain is rarely made up or exagerrated

One of the biggest assumptions that people wrongly make here is that I am saying that the pain is all in your head, that it is made up, not real. This is far from what I mean. Pain is always 100% real.  It is in your head but only in the same way our vision and hearing is in our head.  Our brain is 85% subconscious and we cannot control this, these processes in the nervous system are happening without us thinking about it and we can see them on scans.  It is most definitely not made up

Summary

I hope at least some of you have found this information useful and / or enlightnening.  As I said early it often goes against our normal beliefs. Pain, particularly persistent pain is often less about the health of our bodily structures and often more about the sensitivity of our nervous system.  With careful guidance we can do things about this to get on top of your pain.   Book an appointment today.

I also know some of you will have read this and thought what utter tosh.  You will not be alone.  This is understandable given how society and therapists have always thought about pain.  You guys (and girls) have two options really: ignore all I have spoke about, carry on with the same beliefs and same treatment approaches and hopefully your symptoms will improve. Alternatively have a look at some of the links below and challenge some of your concepts and beliefs to help you progress.   Remember also that if other approaches don’t work you can always come back to this way of thinking.  Remember having read this blog, it may be valuable to you in the future.

Further learning resources (free)