Everyone has some concept of what pain is, but beneath the surface-level experience lies a complex process that we still don’t fully understand. Under normal conditions in healthy individuals, pain serves an important purpose. Sometimes, however, this system can go awry, leading to the development of long-term debilitating pain that is challenging to overcome.
Whether you suffer from ongoing pain or not, developing a deeper understanding of the science behind pain will help you better understand your body and its senses. Discussing pain science can quickly become extremely complicated as it involves intricate interrelationships within our nervous system. I will do my best to give a high-level overview that offers some interesting information without turning this into a neuroscience lecture.
What are The Types of Pain?
There are two main classifications for pain, acute and chronic. For our purposes, you can think of acute pain as the pain you feel when you stub your toe or get a cut. It comes on quickly and its cause is typically traceable. We will use chronic pain here to refer to a medical condition characterized by unrelenting pain with no clear physical source or that is massively exaggerated beyond the severity of the injury. In clinical cases of chronic pain, the pain itself becomes the focus of treatment.
What Purpose Does Pain Normally Serve?
When functioning healthily, pain essentially exists as a warning signal. It alerts you about potential damage to the integrity of your body’s systems. While we often think of pain is inherently bad, we should really be thankful that it exists. Without pain, you could severely injure yourself without even realizing. This is a common complication of certain medical conditions that impact the nervous system.
For example, some people with diabetes develop a condition called diabetic neuropathy. This happens when high blood sugar damages nerves in the body, most often affecting the legs and feet. If this nerve damage impairs sensory function, one of the common problems is that people will sustain a cut or injury without feeling anything. Dangerous infections may develop if these injuries pass unnoticed for too long. (Source)
So, pain is not inherently bad. In fact, pain is an essential component of a properly functioning, healthy body. Without it, you would have no way of knowing when something has gone wrong that requires your attention.
Where Does Pain Come From?
Some of you may be thinking that it’s obvious that pain comes from whatever area of the body has been injured, but that’s not exactly true. Under normal conditions, pain is generated based on signals from the body. However, the actual sensation of pain – just like all other sensations – is generated in your brain.
Now, let me just take a step back and say that this is not the same as saying that “it’s all in your head”. Pain is an intensely real felt-sensation and is specifically adapted to be nearly impossible to ignore. If you think back to the previous section, this makes a lot of sense. If pain were easy to ignore, it wouldn’t serve its function as an alert system particularly well.
So, pain is a sensation created in your brain typically as an interpretation of signals coming from some part of the body. When functioning smoothly, pain is only created in response to signals that are associated with risk of true tissue damage. Your brain receives these signals from specific neural receptors called nociceptors and processes them into the complex experience we call pain.
What Happens When Something Goes Wrong?
Sometimes, it is possible to experience pain without a physical threat to the body’s tissues. When pain persists in this way, it can develop into the medical condition of chronic pain that I mentioned earlier. Chronic pain is incredibly challenging to treat and can be debilitating. If not adequately addressed, it frequently leads to long-term disability.
There are innumerable factors that can contribute to chronic pain and effective treatment relies on taking a truly holistic view of the situation. Medical professionals must take into account the individual’s present and past biological, physical, psychological, social, and environmental factors. Unfortunately, many medical professionals still practice on an outdated understanding of pain that fails to capture its full complexity.
There are a few specific mechanisms that contribute to chronic pain that I would like to briefly discuss.
Central sensitization refers to a condition in the central nervous system in which the threshold for pain becomes abnormally low. In this situation, the brain may start to interpret all sensations from a particular part of the body as pain even if they are coming from receptors that normally sense light touch or temperature. Central sensitization most often develops after a true physical injury of some kind. The brain develops a painful association with the injured area that is strong enough to persist after the physical injury has healed.
The other two mechanisms I’ll discuss feed into the development and persistence of central sensitization.
When pain is present, there are often also high levels of fear. After an injury, movement may be painful enough that the individual develops a powerful fear of it. That fear causes them to avoid movement, strengthening the association between movement and pain. Over time, the brain starts to “believe” that moving that part of the body is dangerous, so it creates sensations of pain as a protective mechanism.
This is problematic for multiple reasons. First, it directly contributes to the development of central sensitization by convincing the nervous system that movement is dangerous. Second, movement and loading are essential parts of healing after an injury. Immobilizing the injured area for too long can delay or severely impair recovery. This leads to weakness, stiffness, and possible physical disability on top of debilitating persistent pain.
Pain catastrophization involves an exaggerated assessment of the severity of threat represented by current or anticipated sensations of pain. When processing pain in this way, individuals often become trapped in cycles of rumination and intense feelings of hopelessness. The individual deeply believes that their pain represents something “broken” or “fragile” that must be protected. With this constant focus on the pain and the thought that it is representative of some severe underlying injury, the pain response becomes amplified.
This feeds into central sensitization as the nervous system increases its output of pain to even small stimuli because it now overestimates the level of threat that is present. It also contributes to fear avoidance behavior by framing pain as a sign of something severe and dangerous.
How Can You Change your Thinking?
You’ve already taken the first step. Congratulations! Simply educating yourself can significantly ease fears and begin the process of developing a healthier relationship with pain. Here are some other steps that you can take:
- Choose medical professionals carefully – If you meet with a medical professional, make sure that they talk about your injury or pain in a constructive, healthy way. There are too many medical professionals that still speak to people in ways that make them feel fragile, broken, and hopeless. Find a medical professional that is honest and open with you, but discusses your condition in a way that inspires you to feel hopeful that things will get better. Don’t listen to anyone who tries to use fear to convince you to do things their way.
- Remember that the human body is strong, adaptable, and resilient – As explained earlier, pain is a valuable communication tool. It allows your nervous system to bring potential problems into your conscious awareness. It is not, however, a sign that you are fragile or broken. Don’t ignore your pain, but don’t fear it either. Listen to it, assess it, and make a conscious decision on how to respond. There are times when pain is a signal to back off, other times it is okay to push through. It can be difficult to differentiate between the two, but any medical professional you choose to work with should be able to provide guidance.
- If you’re struggling with pain, get help! – You don’t have to go it alone. There are lots of resources available and many medical professionals who care and can help. If you’ve had bad experiences in the past, push past that and keep looking until you find someone whose approach works for you.
- Don’t forget that movement and loading are essential – Excess rest after an injury negatively impacts and delays recovery. Keep moving and work with a physical therapist to learn how to load things safely and effectively.
- Remember that pain is not purely physical – Pain is a complex physical, psycho-emotional, environmental, and social process. Don’t neglect the influence of the non-physical factors.
In closing, pain is not a simple physical phenomenon. It involves the interaction of physical, psychological, social, and environmental variables. Based on all these contributing factors, your brain creates a sensation of pain that is then consciously processed – again with input from each domain. This is why someone else’s experience of pain may be so drastically different from your own. It also highlights why treating pain is so difficult. With many potential influences, there are countless opportunities for things to go wrong. A key takeaway is that being in pain does not mean you are fragile, your body is strong and highly adaptable! Just thinking positively about your situation and allowing yourself to feel hopeful can make a world of difference.
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Health Advice Disclaimer
This article provides examples that are applicable to many, but not all people. They are based on typical presentations seen in my personal clinical practice. This information represents common findings in the population discussed, but can in no way take the place of professional evaluation and treatment by a licensed medical practitioner. It is impossible to provide 100% accurate diagnosis or prognosis without a thorough physical examination and likewise the advice given for management or prevention of any injury cannot be deemed fully accurate in the absence of this examination.
If you are currently experiencing any pain or injury, seek professional evaluation before undertaking this or any exercise program. Ensure that you are medically cleared for exercise before undertaking any exercise program. Significant injury risk may occur if you do not seek proper evaluation. No guarantees of specific outcome are expressly made or implied in this article.