Sometimes it hurts, sometimes it’s a mystery.
Scientists agree that pain is a complex and highly sophisticated protective mechanism. I am a big believer in understanding pain in order to better manage the factors that contribute to pain.
What is pain?
Pain is a normal sensation. It really is no different to feeling happy, sad, angry, frustrated or anxious.
And it isn’t necessarily always caused by something being wrong or by tissue damage. Have you ever had a bruise that you didn’t weren’t aware of when it happened or how it happened? This is a classic example of bleeding in soft tissue or muscle with no sensations of pain. Likewise, you often hear stories of sportsmen who experience horrific injuries but can continue to play without any awareness of pain.
Conversely, amputees can experience pain from ‘phantom’ limbs. These examples show that pain isn’t simple. As a matter of fact, in a lot of cases, the amount of tissue damage has very poor correlation to the amount of pain experienced.
How do we feel pain?
Nerve structures known as nociceptors are responsible for sending ‘danger’ messages from body tissues to the brain. What we actually experience or feel is then determined when these messages arrive in the brain. When nociceptors send messages to the brain, the question the brain needs to answer is “How dangerous are these messages?”.
The extent and complexity of how these messages are received is incredibly fascinating. Research has shown that many regions of the brain are involved in addressing the messages and those regions vary from individual to individual. The brain gathers all the information it can, including memories of previous experiences, thoughts and beliefs and other sensory cues to determine whether we should feel pain or not.
What affects pain?
Pain can be turned on or amplified by anything that provides the brain with evidence that the body is in danger and needs protection. These messages can also be reduced or extinguished if the body decides that they are not dangerous.
Stress and anxiety have been shown to have a dramatic impact on pain. When we experience stress, our bodies release a hormone called cortisol. Cortisol acts as an amplifier of these messages, resulting in increased awareness of pain from a smaller stimulus.
Incorrect preconceived thoughts of musculoskeletal conditions can also influence levels of pain. When the brain uses inaccurate information to evaluate these messages, it can naturally increase levels of perceived pain.
In contrast, other factors and activities can actually decrease and extinguish these messages. Activities that bring pleasure increase hormones such as dopamine and endorphins. These are released when we exercise, spend time with friends or family, or even when we eat chocolate! These hormones have been shown to actually decrease these messages, resulting in less pain.
What can I do?
The more we learn and know about pain, the better. Pain is by no means a simple matter, but any treatment that includes an understanding of how it works has been shown to gradually reduce aching and disability overall. Likewise, we know that activity-based treatments such as exercise are more effective. Gradually building up an exercise regime is a huge part of long-term relief.
Lorimer Moseley has written books, including Explain Pain, which are a great resource for those who suffer from pain.
Jason Lee APAM
Malvern East Physiotherapy
Jason is happy to answer any questions you may have. Simply send an email to firstname.lastname@example.org
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