Understanding Pain
Pain is one of the main reasons people seek medical care. Understanding pain - what it is and why it occurs, is a critical step in managing it effectively. Whether you're dealing with a new injury, or chronic pain for several years, it's important that we understand pain, and why it's there.
Why is it important that I understand pain?
Understanding your diagnosis, and why your pain exists should always be part of your management with your osteopath. Pain education can assist you in managing it more effectively, reduce fear, improve function, and put you in control of your situation.
This isn't suggesting that as soon as you understand your pain, that you no longer need any help or need to do anything else or need treatment/rehabilitation, but it is an important first step
How pain is explained to you can also impact recovery. Being told that your spine is weak, and fragile, compared with receiving a practical explanation with a structured plan can make a large difference with long-term outcomes
The Problem with Fear Avoidance
Fear avoidance is very normal to experience after an injury, where we avoid certain movements or activities due to worrying about making the pain/injury worse. In some cases, avoiding certain activities may be necessary depending on the injury. However, in other cases, avoidance may seem protective but it can actually make the pain worse. If the brain continues to associate certain actions with danger, pain persists, so It's important to remember that hurt doesn't always mean harm. While pain should always be acknowledged and respected, it should also be challenged. When it isn't, people can find themselves trapped in a cycle of avoidance and discomfort.
What is Pain
Pain refers to the body's internal alarm system, designed to alert us to potential threats. The International Association for the Study of Pain (IASP) describe pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage".
In other words, pain isn't always purely reflective of physical damage - it can be also influenced by emotions, beliefs and past experiences. This is why some individuals with the same injury may have an entirely different experience when it comes to pain and recovery.
Real Vs Potential Tissue Damage
Pain can occur due to actual tissue damage, such as torn ligaments, strained muscles, fractures, etc. But you can also feel pain when there isn't any physical injury. Our brain uses all of the information its given to detect any potential threats, so if your brain perceives something that may be harmful, it might elicit pain to protect you.
A simple example of this is when you feel discomfort when you hold your hand too close to a flame, even before there's any damage or burning to the skin, our brain registers this stimulus as a potential threat and uses a pain signal to protect you. Another example of this is when we begin to feel some pain in our body after working at your desk all day, whether it's your neck, lower back, shoulders, hips etc. This is usually not a sign of injury, but rather a signal from your body saying "I don't want to be in this position anymore, you need to move now". Staying still for too long can cause muscles and joints to stiffen, so our brain may send a pain signal encouraging you to move.
In some cases, pain responses occur automatically through reflex arcs, like quickly pulling your hand away from a hot stove before consciously registering the burn. The reflex arc is the body's way of responding instantly to potential threats without having to wait for the brain to process the danger.
The Brain and Body's Role With Pain
Our brain does play an integral role in the experience of pain, even though we feel pain in our body, it's the brain's interpretation of the signals it receives that leads to pain. When the perceived threat is high, the brain amplifies pain signals, and the more attention we give to pain, the stronger the response, as the brain is prioritising the threat. A good example showcasing the brains central role with pain perception is phantom limb pain, where individuals feel pain in a limb that they don't have, showing how pain isn't always reflective of the actual tissue damage.
Psychological factors such as stress, anxiety, depression, negative beliefs and fear avoidance behaviours can also cause the brain to amplify pain signals. In such situations, the complex nature of pain may require a multi-dimensional management plan that goes beyond manual therapy to address these factors.
The "Gate Control Theory" suggests that our central nervous system is able to modulate pain signals. Have you ever gone to rub your shoulder after hitting it on something like a door frame? Or shaken your hand after touching something hot? For this theory, think of your spinal cord as a freeway with toll gates. When a painful stimulus occurs, the "pain cars" flood the freeway, when an innocuous stimulus occurs to the same area (Such as rubbing the area, using heat packs, etc..) It sends "blocker cars" up and down the freeway which can reach the toll gates faster, these toll gates can then close off, letting less of the "pain cars" through. This way, the sensation of pain is reduced, because less of the pain signals are reaching the brain.
This is certainly not suggesting that pain is "all in your head". Our brain and body are interconnected as a unit, and just as there can be real changes in the brain, there can also be changes in the body - this is referred to as sensitisation. Sensitisation occurs when the nervous system becomes more reactive, which can amplify pain. For example, after an ankle sprain, sensitivity can persist long after the actual injury has healed. This heightened response is the body's way of protecting a previously injured area, though it can sometimes persist long after the injury has healed.
Wrapping Up
Understanding pain is key to managing it effectively. By recognizing that pain isn’t always just about tissue damage. By understanding your condition, and having an appropriate treatment and management plan with your osteopath, you can take control of your situation, navigate recovery and get back to the things you enjoy doing.