• Nigel Peek MSc (chiro) PGDip (pain) PGCert (acu)

The Amazing Science of Pain

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. Attention can drive the intensity of pain up, and distraction can do the opposite.

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. 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.

"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 like an emotion - there are several areas in the brain involved in processing the level of potential threat we face in our environment.

The mistake most often made is the understanding that nerves transmit pain signals from the body to the brain. This is not true. Information from the body is transmitted by various sensory pathways. This information reaches the brain and is scrutinised, and if determined to be threatening or dangerous the outcome is pain (this is why damage - if not processed as threatening doesn't always result in pain). The brain and central nervous system determine the pain experience not the state of the tissues. Therefore, pain is an OUTPUT not and input mechanism.

"The brain and central nervous system determine the pain experience

not the state of the tissues"

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.

Commonly when pain becomes poorly managed and patients are unresponsive to standard treatments or the cause of their pain cannot be isolated they are labelled with “its all in your head”. To clarify, pain 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.

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