Pain …Let’s Talk About It – with Lewis Craig
National Pain Week – Pain…Let’s Talk About It
This week, the 20th-26th of July is National Pain Week. National Pain week is an initiative from Chronic Pain Australia, to help encourage discussion regarding persistent pain and reduce the unnecessary suffering of Australian’s living with persistent pain. In line with theme for the National Pain Week, “Pain…let’s talk about it,” POGO Physiotherapist Lewis Craig, explains important pain physiology and keys to help you manage ongoing pain.
No-one really wants pain. Pain is an unpleasant experience, yet an effective and essential part of life. Pain alerts and protects you from danger, often before you are injured or injured badly. It alters the way you think, move and behave. It is often difficult when in persistent pain to see how pain can be beneficial or deeply understand why things still hurt. An understanding of pain biology can change the way you think about pain, reduce its threat value and improve management of pain (1).
Most commonly, pain occurs when the body’s alarm system alerts the brain to actual or potential tissue damage. The body does not have pain detectors, pain nerves or a pain centre, as you may think. The body has ‘threat’ detectors, termed nociceptors. Stimulus to the body that has the potential to be dangerous is detected by nociceptors. When a significant amount of nociceptors are activated, the potential threat message is relayed to the spinal cord. When a large number of danger messages are relayed to the spinal cord, this ‘sensitises’ a second set of nerves, which relay the danger message to the brain. Not all threat messages will reach the brain; the body has many mechanisms to help regulate potential danger messages.
As the danger message arrives in the brain, the brain combines this information alongside many other incoming messages, such as the environment, movement, emotions and memories. All of this information and much more, is processed through multiple areas within the brain. If the brain concludes that the body is in danger, than it will produce pain. The numerous areas of processing in the brain, means that attitudes and beliefs, emotions, behaviours, memories and the environment can also influence the pain experience. In acute pain, this is favourable and will lead to several systems activating to help get you out of danger.
It is important to note that pain is always an output from the brain. The phrase ‘Are you saying it is all in my head?’ is common. Truthfully, yes, all pain is an output of the brain, No Brain…No Pain. This does not mean that the pain isn’t real, its 100% real. Poking and prodding on parts of your body that hurt, are the result of information from your brain telling you this is the case. This is true for whether there is or isn’t damage to the body tissues. Following an acute injury the body’s response to pain, leads to an inflammation response and many other mechanisms that help resolve tissue damage. Healing times differ for different tissues in the body, with the majority of tissue injury resolved in 3 months. As tissue healing occur danger messages from the tissues decreases.
In persistent pain, the brain determines that a threat still remains, despite the tissues having time to heal. There are explanations for why this occurs, which include changes in the body’s alarm system and sensitivity within the nervous system. This leads to the brain telling the body that there is more danger in the tissues than there actually is. An important understanding from this is that hurt does not equal harm. Although movements or activities may be painful, it is not a sign of underlying or ongoing tissue damage.
Even when pain is persisting, it’s because the brain has concluded, that you are still threatened and in danger. It thus becomes important the to find out why the brain has come to this conclusion and help decrease those ongoing danger messages.
Pain is complex and can be difficult to understand. Today’s post has discussed only the tip of the iceberg. An understanding of pain biology, questioning and challenging yourself and your health care professionals about why thing hurt, is the first and arguably the most important step in managing persistent pain. It is critical in order to manage pain, to understand it. So for those looking for more information, continue the pain conversation, speak with your physiotherapist or health care professional. Pain…let’s talk about it. Great information can also be found at the National Pain Week website and Pain Australia websites – http://www.nationalpainweek.org.au/ , and in the book Explain Pain (reference below).
Lewis Craig (APAM)
- Butler, D. S., & Moseley, G. L. (2013). Explain Pain:(Second Edition). Noigroup Publications.