Let’s Breakdown The Concept of Pain

We recently finished another round of the increasingly popular Physiopedia Volunteer Orientation Course. As part of the final assignment members were tasked to write an original piece of work to share with the profession, the contributions were of the highest quality. Below is the great piece of work written by Nina Myburg.

Pain is something that we’ve all experienced. Pain is also a subject that has been studied and questioned from very early on. Conditions associated with pain is a big problem globally and a massive financial burden. It has been suggested that about 20% of adults worldwide suffer from pain, and 10% of adults have chronic pain[1]. It has been reported that about 39% of people in Africa has lower back pain.2 The world health organization (WHO) reported that low back pain is among the top 10 diseases and injuries that lead to disability, time off work and activity limitations. It leads to increased economic burdens on families, the individuals themselves, companies and governments[3].

Patients often ask about pain and often medical practitioners struggle to explain it properly. After all, it is a complex science.

What happens when we experience pain?

Let’s go through the process happening in your body when you experience pain. Say that you were to touch a burning hot stove top. You would immediately feel it burning your hand and pull your hand away very quickly. Most probably you would feel pain in your fingers where you’ve been burnt. This all happens in a few milliseconds, and it is something you don’t even have to think about doing. This whole reaction can be broken down into steps. Firstly, some nerve endings in your muscles, skin and joints will be stimulated by you touching the stove top. Secondly, a message will be sent from those nerve endings to your spinal cord and then to your brain to say that something dangerous could be happening. Thirdly, this message will be processed by your brain. Your brain will decide how dangerous the situation is by evaluating the situation, what you are seeing and what previous experiences you have had like this. Only then will a message be sent back down to your hand. And only then will you experience pain and pull your hand away from the stove top. Everyone has a nervous system that works through the same process. However, the efficacy and sensitivity of every person’s nervous system.

“Why do I experience pain?”

Many theories and explanations have been given to describe pain, and to answer people’s questions: “why am I in pain?” or “what is causing my pain?” It has however been proven that your brain is responsible for any pain that you are feeling. But that doesn’t mean that the pain is only ‘in your head’.

Let’s get to the reason why we experience pain. Pain is there to protect us. Pain is something that motivates us to take action, to avoid injury and to give our tissues a chance to heal.

Pain is something that every person will experience quite differently. Pain can only be measured by what you say it is. Only you are able to describe it. We could try to measure pain intensity by asking you if you can score your pain on a scale of 1 to 10. You could describe your pain as dull, burning or sharp. People also respond very differently to pain. One person might be distracted by pain and will take much longer than usual to do a certain task. Someone else might use tasks as a distraction from pain. There is no right or wrong regarding what you should feel. However, it is becoming more and more evident that we should look at pain differently.

The International Association for the Study of Pain (IASP) gives the following definition for pain:

“An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”[4]

Different types of pain

Acute pain: could be described as pain that is experienced for a few days, weeks or months. Usually, it is experienced together with an injury or tissue damage. In general, you will be encouraged to keep on moving and gradually get back to your normal activities and work as the healing process takes place.

Chronic pain: could be described as pain that is experienced for 3 months or more. This is pain that persists even after your injury and tissue damage have healed. Health professionals can agree that most tissue damage will heal within 3 months. So, it is clear that with this kind of persistent pain the issue is not within your tissues.

Unfortunately, there is no clear solution to chronic pain. It is a really big problem worldwide.

Having a brain that keeps on producing pain even when your body tissues are healed is not something that you would want. It leaves a lot of people thinking that there must be something really wrong with them. Your body learns to feel pain from a very young age. The same way you learn new skills like reading or writing, the same way your body learns to detect and feel pain. The longer you experience pain, the better your body becomes at it. Almost like it is becoming more sensitive to pain. Like an alarm system going off without an intruder in the house. So we have established that persistent pain produced by your brain is not so much about structural problems within your body, but more about the sensitivity of your nervous system. Something that could help with this is retraining your brain and retraining your nervous system.

To do that, it is helpful to look at some things that affect your nervous system and may be contributing to your individual pain experience.

6 Things to think about with treatment of pain

1) Medicine

Taking medicine can help, but often only to a limited extent. Active approaches are necessary to retrain your brain. Using medication for pain relief definitely has benefits and can help to get you going. The medication can then be tapered off and stopped completely within time. Some people consider having surgery. This could also be beneficial, but when it comes to chronic pain, it isn’t always the best or only solution. Remember to consider all things.

2) Thoughts and Emotions

Consider how your thoughts and emotions could affect your nervous system. Pain has a big impact on people’s lives. This could affect your mood and stress levels and even leave you with feelings of depression or hopelessness. This, in turn, affects your pain levels. All these thoughts and emotions are also formed by your brain. By learning how to reduce your stress and wind down your nervous system, helps with your emotional wellbeing. This can reduce your pain.

3) Diet and Lifestyle

Our modern and busy lifestyle might not always be good for us. Your lifestyle will definitely contribute to the way you experience pain. This includes many things like smoking, nutrition, amount of hours sleep, amount of hours at work and how you choose to relax. Addressing any of these issues might be a good beginning.

4) Personal Story

Remember every person experiences pain differently. Step back and look at everything happening around the time your pain started. Often people can connect a worrying period of life with the pain they are feeling. You might have had more problems at work, with family, finances or relationships. Possibly something traumatic happened to you. For many people, it is part of the healing process to think through their deeper emotions and feelings.

5) Physical activity and function

Get moving at a comfortable pace without experiencing fear to exercise. Fear leads to your brain feeling the need to protect and causes pain as a way of protection. Set goals for yourself that would be easier to achieve, and gradually you’ll be able to move more, improve your fitness level and even decrease the pain you’re experiencing.

6) Physiotherapy

A physiotherapist could help you to identify which of these above mentioned things you could focus on to manage your pain. A physiotherapist could treat soft tissue pain and help to work out a physical activity plan adapted for your needs. They can also give you lots of advice about posture, exercise, fitness and how to try and manage your pain in your daily routine.

Pain is not an accurate measure of damage in your tissues. Pain is a protector. The better you understand your own pain, the less you will fear it, and the more you will see what your body is able to do. Have hope and rather get someone to help you understand your pain.

References

  1. Goldberg SD, McGee SJ. Pain as a global public health priority. BMC Public Health. 2011. 11:770. https://bmcpublichealth.biomedcentral.com/articles/10.1186/14712458-11-770
  2. Morris LD, Daniels KJ, Ganguli B, Louw QA. An update on the prevalence of low back pain in Africa: a systematic review and meta-analyses. BMC Musculoskeletal Disorders. 2018. 19:196. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6055346/pdf/12891_2018_Article_207 5.pdf
  3. World Health Organization. Priority Medicines for Europe and the World Update Report 2013. Available from: https://www.who.int/medicines/areas/priority_medicines/Ch6_24LBP.pdf (accessed 26/02/2019)
  4. The International Association for the Study of Pain. IASP Terminology. Available from: https://www.iasp-pain.org/Education/Content.aspx?ItemNumber=1698 (accessed 27/02/2019)

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