What is pain?

What is Pain?

What is Pain?

When I think about what the word ‘pain’ means a few words automatically spring to mind, words like ‘ouch’ or ‘drat’ or to be more truthful words like ‘@£%#’, ‘<^*!’ or ‘£*+#!?€ @#*¥$€%’.

When I think about what pain is the image that generally pops into my head is one of damaging myself somehow – stubbing my toe, burning my hand or falling flat on my face (thankfully the latter rarely happens to me anymore, although my niece does it on an almost daily basis – but she’s 3 so I guess she’s allowed). For most men I assume it’s the proverbial blow to the ole jingle jangles that flashes before their eyes when asked ‘ what is pain?’.
The point being, for most people the word ‘pain’ conjures up images of that immediate relationship between doing something that causes you physical damage and feeling pain, and because of this, pain can seem like a relatively simple subject – hurt yourself and it will hurt! But think a little more carefully, scratch just the very surface and trust me it’s not.
Pain is a BIG subject.

The International Association for the Study of Pain (IASP) defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”

The key phrases to pick out here when trying to understand pain are:
‘sensory and emotional experience’ and ‘actual or potential damage’

This is where I’m going to start off.
In this first piece of the series I will explain what the latest scientific research is teaching us about pain:
– that pain is an output from the brain
– that pain is an individual experience greatly affected by our emotional state
– that more tissue damage doesn’t necessarily mean more pain and vice versa

Have you ever got out the shower & noticed bruises you don’t remember getting & that don’t hurt?
Have you ever cut yourself & not realised until you see blood dripped around the place?
Have you heard of the term ‘phantom limb pain’? (Amputees feeling pain in limbs they no longer have).
Have you ever been lying in bed & out of nowhere been struck suddenly by a sharp pain that vanishes as quickly as it arrives?
Have you ever had a paper cut!? World of pain – tiny amount of tissue damage.
Do you know anyone who’s been in pain as long as you’ve known them but all tests/scans have come back fine and doctors can’t work out why they’re in pain?

What these questions help to explain is that the amount of pain we feel & the amount of tissue damage there actually is are not in fact relative. You can have a serious injury and feel little pain – we’ve all heard stories in the news of people with horrible injuries being able to help other people in danger and get them to safety.
On the flip side most of us will have experienced an extremely minor injury and been in a world of pain – banged your funny bone lately? Not funny at all!

The reasons behind this are complicated to say the least and scientists still don’t fully understand the way pain works. But what they do know (well they’re pretty sure anyway!) is that pain, like any other feeling or emotion is actually an output from the brain and does not actually originate in the tissues, even though that is where we ‘feel’ it.
When referring to ‘the brain’ i’m talking about the unconscious part of the brain, that’s not under our control so don’t confuse this with the notion that pain is all in the head, that someone is making it up. Pain is real and you cannot will it away but having a greater understanding of why you are in pain can help with the recovery process. This will be discussed in detail in another piece.

So how does it work?

Stimuli are detected in the tissues/skin, information is sent and the brain decides – based on many factors including (but not limited to) previous experience/knowledge, your emotional state, how potentially dangerous it thinks a situation might be and then it determines what the appropriate pain levels should be for that situation and communicates this ‘pain’ to the tissues, where we feel it. As demonstrated by the examples listed above, what the brain thinks is an appropriate level of pain and what we think is an appropriate level of pain may not be the same!

Previous experience
People who have broken the same arm twice (on different occasions) often report that it hurt more the second time.
Link to a very funny story (told by a very clever neurophysiotherapist) that explains this principle far better than I could – it involves a twig, a poisonous snake and a sarong……

As part of a clinical trial doctors told volunteers that they would be receiving two different stimuli, the first one they were told they would barely notice, but the second one they were very sorry to say, would hurt, a lot! In actual fact the two stimuli were exactly the same but the majority of volunteers did indeed find that the second stimulus was extremely painful, while the first was not. Proving that when told by an authority figure/someone in a position of trust that something will hurt, it probably will.

Another example of this is when a small child falls down and looks over the their parent/guardian to see their reaction; if the parent/guardian laughs instead of looking shocked or worried, most of the time the child will laugh too.

Emotional state
Just like when you’re feeling tired or stressed things bother/upset you more easily, the same principle applies to pain. When you’re stressed or upset things hurt more and for many people suffering with chronic pain this becomes a vicious cycle: the more pain they feel, the more stressed they get, the more stressed they get, the more pain they feel and so on. Similar injuries will affect different people differently because of how they see their situation and how they feel about it.

How potentially dangerous a situation is
Pain is our bodies most sophisticated protective mechanism & so if the brain feels there is potential for damage it may send pain signals, even if the tissues are in fact fine. Many people with chronic back pain for example attribute it to an accident or a herniated disc they had many years previously and regardless of what you may have heard or think the body is designed to heal itself (I am in no way saying medication is not required) and after a period of time (dependant on injury) the tissues will heal themselves, but for many people the pain persists. This is because the brain still thinks there is potential for damage and wants you to be careful with yourself, it basically gets stuck in a loop – a cycle of sending out pain.

The brain learns
In the same way that if you practise something you get better at it, the more pain the brain produces, the better it gets at doing it.

So if pain is an output from our subconscious what can we do about it?

Thankfully lots and scientists are constantly researching new ideas to help people in chronic pain, but that’s another big subject and as such deserves its own piece.

If you have any questions feel free to comment or get in touch directly.

Jemma Fordham is a clinical massage therapist who specialises in the treatment of chronic pain conditions based in Brighton.
She works with her clients to help facilitate their bodies own healing through bodywork, exercise and education.

If you would like more information or need to book an appointment please call 07843 666 806 or use this form.

Posted in Pain.