What is Pain?
The evolution of the study of pain has provided us with new insights. The experience of pain is not exactly what we have been taught to believe. For the most part medicine has targeted the principle that pain solely a direct result of disease or damage to the body. We are conditioned to believe this explanation, but it simply falls short of the true complexity of the pain experience.
Pain is a sophisticated, necessary survival mechanism to PROTECT us from harm.
Pain can occur in the absence of harm or damage. In other words, the purpose of pain is to TELL US something, it does NOT always tell us WHAT or HOW MUCH.
Pain is similar to an alarm system; it is not always an accurate measure of damage.
This may seem obscure to suggest that pain does not equal damage, but if you consider there are often times when we can bump or bruise ourselves and can’t relate it to a specific event, or perhaps we scratch ourselves on a passing twig and only notice later that we are bleeding. Therefore, it matters that we are paying attention when we are injured, and it also matters what is happening at the time that influences our response to injury.
I think we can all relate to the fact that when we are stressed our emotions are heightened and we are easily angered or irritated by situations that wouldn’t normally have that effect. Pain is no different, when we are stressed, run down or coming down with an illness we are more sensitive to old aches and pains.
This means that the experience of pain is not only about the state of our tissues but also on the CONTEXT of our experience at that specific time. We have all noticed at some time or another that when we pay attention to pain, the experience changes and when we are distracted the sensation is diminished.
Pain is an EXPERIENCE; therefore, it can only be measured through the lens of the person living with the pain. This makes pain SUBJECTIVE.
Different people have different sensitivities and express pain differently.
Remember* you cannot understand or judge another person’s pain experience because it is not YOUR lived experience.
Pain is 100% unique to each individual, brain research shows us that pain is processed much like an emotion. There are several areas in the brain involved in pain processing.
The mistake most often made is the understanding that nerve fibers transmit pain signals from the body. This is not true. Information from the body is transmitted by sensory nerve endings. This information reaches the brain and is scrutinised before the brain produces pain. The brain and central nervous system determine the pain experience not the tissues. Therefore, pain is an OUTPUT not and input mechanism.
To summarize; pain is an experience, determined by multiple factors that may or may not include damage to the body. Pain is uniquely expressed and dependent on multiple individual factors (behaviours, past experiences, genetics, tissues factors and psychological factors are ALL relevant to the lived persons experience of pain, this applies to every experience, most importantly these factors are always all a part of what determines the overall pain experience).
So, what does this mean and why is this important?
Current pain management strategies emphasise the need to address the mechanism or disease process, this primarily leads to a diagnosis and a plan to address that specific biological mechanism. The problem with this model is that it doesn’t take the PERSON into consideration. i.e. the context, psychological state or other social and cultural factors that are integral to that individual at that time.
Pain is in your Head??
Commonly when pain becomes poorly managed and patients are unresponsive to standard medical treatments they are often labeled with “its all in your head”. To clarify, pain is not all in your HEAD, it is a complex experience that is unique to each individual, it is true that the brain is the main processing system that determines the experience, however, it is not the sole determinant, we cannot simply switch it on and off. What we can do better is help people with pain to understand its nature and how we respond to its purpose.
The medical system has become very successful in developing technologies that can help us see the inner working of the body, MRI technology has given us the ability to see all the faults and underlying tissue abnormalities. This is useful to a point particularly when we need to identify serious such as cancer. MRI has unfortunately become over utilised when trying to determine the source of pain. We now understand that when patients are exposed to detailed imaging early in the course of pain, they have higher utilisation and healthcare costs associated with their condition. These findings are interesting, but also confirmation of the fact that when we are exposed to detailed information and told that we have some sort of damage in the body our pain experience is heightened and more prolonged as a result. In other words, too much information about our “broken” body is sensitising and compounds the pain experience.
Furthermore, research has also demonstrated that many of the findings we see on MRI scans and x-rays are common in pain free individuals. A label such as “degeneration” is in fact a part of life and does not have to imply that we are broken or damaged. Perhaps we could view degenerative processes a “normal process” not a disease? These findings also confirm that we have over emphasised findings that are incidental and not highly associated with pain. This also confirms our understanding of pain, that it is not always a product of damage. Rather a protective system designed to help us remove ourselves from threatening situations that may cause further harm.
Some food for thought?