Let’s face it, no one likes to be in pain. However, people who do not experience pain usually pass away at an early age because they are unable to protect themselves from substantial tissue injury they are unaware of. Pain is the number one reason people visit healthcare providers, especially physical therapists.
The pain experience is a complex biopsychosocial experience—meaning the tissues (biology), cognitive beliefs (psychological), and context (social) involved in an injury (or perceived injury) all play a role together to determine if we will experience pain or not. This makes pain a much more complex process than most people, including many healthcare providers, understand.
The most widely accepted definition of pain is: “an unpleasant sensory and emotional experience that is associated with actual or potential tissue damage or described in such terms,” a definition which was developed by the International Association for the Study of Pain. The purpose of this article is to educate people on the pain experience and dispel some common myths about pain.
Myth 1: Pain always occurs when you are injured.
How many times have you finished yardwork or gardening and gone inside to get something cold to drink and noticed several cuts and scratches on your arms and legs? Have you ever woken up and noticed a bruise somewhere on your arm and didn’t remember how it got there? These are both examples that your body had tissue damage yet you didn’t feel any pain.
To give a more extreme example, there have been several studies involving people who are asymptomatic (have no pain or symptoms) but have undergone medical imaging (X-rays, MRIs, CT Scans, etc.). A lot of the results would surprise you. For example, 40% of individuals had a bulging disc on an MRI, low back degeneration starts occurring when many patients are in their 20’s, and one in four people had meniscus degeneration. When they were scanned five years later, 90% had not improved. Remember, NONE of these patients had any pain or symptoms, despite the issues found on their scans.
Myth 2: Chronic pain means that an injury hasn’t healed properly.
Almost every tissue in the body will heal within six to twelve months from the time of injury. Contrary to popular belief, extensive studies have shown there are no special pain fibers in your body. More accurately, we have nociceptors, which are special nerve fibers that send information from tissues to the spinal cord and up to the brain if the spinal cord thinks the brain needs to made aware of something. Nociceptors can send messages even in the absence of tissue damage, which can be interpreted as danger messages by the spinal cord and brain. This can give us the experience of pain even though the tissues are normal and have already healed. Confusing right? This is one reason why long after tissues have healed people can still experience pain.
Myth 3: The body tells the brain when it is in pain.
Even though understanding the complexity of pain can be difficult, the basic concept of pain is simply an output of the brain that is the result of thousands of inputs. Just a few of these inputs include: movement, stress, thoughts, temperature, blood flow, and your immune system.
Remember those nociceptors that we just talked about? Studies have shown that decreased blood flow to tissues will cause increased nociceptive activity. This doesn’t mean pain. Think about how long you’ve been sitting in your chair while reading this article—have you shifted your body position at all? Leaned forward or backward in your chair? Crossed one leg over the other? The nociceptors in your body told you to move around because they weren’t getting enough blood flow, you probably didn’t even notice that you changed positions until right now.
To summarize, pain is complex and effects each of us differently. The one constant among everyone is that knowing more about pain can help decrease our experience of it. Pain is an output from the brain meant to protect us from actual or potential damage, and it can be modulated by our body based on the context of the situation when we experience it. This is why we can have tissue damage without feeling pain, and why we can feel pain when the tissues are completely normal. The nervous system is highly plastic, which means that it can make adaptations, both positive and negative, extremely quickly. As a result, there is a lot of hope for people who experience chronic pain in the absence of tissue damage.
Finally, I want to leave you with a few fun facts about the nervous system:
- The body has 45 miles of nerves
- The brain uses 20% of the oxygen in our body
- Your brain has about 100 billion neurons
- The average number of thoughts by a person per day is 70,000 (so think happy thoughts!)
If you have any questions about pain, or if you have an injury a physical therapist could help you with, please contact your local Foothills clinic today!