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Let’s Talk About Pain

Most people will experience pain in some form, at some stage throughout their life. 

This blog post is going to talk a lot about pain, the science behind it, and our perceptions of pain. 

Importantly pain does not equal damage. It is influenced by a number of things in life, your body is just one of them. 

Here are some facts about damage and pain. 

  • 96% of athletes <22 will show changes on an MRI that some people call “abnormal” (but if everyone has them, how abnormal can they be?)
  • 37% of 20 year olds with no pain have disc degeneration in their spine
  • 57% of 20-50 year olds with no hip pain will have cartilage and ligament tears

Physical changes in the body are just one factor in your pain. 

Now let’s go through the definition of pain. 

Pain: an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

Pain is a distressing experience associated with actual or perceived tissue damage with sensory, emotional, cognitive and social components 

Pain can be influenced by any and all areas of life. 

The point of pain is to get you to take action, ideally, protect yourself. 

Pain = alarm. Alarm >> create action 

Continuing the alarm analogy.

With many acute injuries, having a pain alarm is very beneficial. It may stop you from walking on a broken leg or carrying something with a broken arm. 

The problem with alarms can come when they go off after they’ve been useful. The long-term pain alarm is not a very good alarm, it’s disconnected from the initial problem (think, faulty smoke alarm that goes off randomly in the middle of the night). Pain can be similar, when we have pain for a prolonged period we can increase the sensitivity of our alarm. 

Consider the following questions

  1. Does a smoke alarm tell you if there is a fire?
  2. Does a smoke alarm tell you how much smoke there is?
  3. Can alarms get more sensitive over time?
  4. If an alarm goes off, does it tell you exactly what the problem is?
  5. Can alarms go off for no apparent reason?

Now we will talk about two pain related terms; sensitisation and habituation. (I know that sounds boring, stay with me).

First let’s talk about sensitisation

  • Let’s consider a “normal situation” with a “massive reaction”. The “input” is the same, but the “output” can be very different, due to a number of factors. 
  • We can “get better” at pain over time, which leads to long-term sensitisation 
  • Sensitisation can occur centrally (in our brain or spinal cord), or peripherally (nociceptors aka pain receptors, around our body, get more sensitive and fire off more easily)
  • If we are in a centrally sensitised state, a normal input (e.g. small amount of pain reception from the body) leads to a large magnification of that pain reception as it’s processed through the nervous system
    • E.g. paper cut >> nausea, vomiting, excessive pain throughout the body
  • People with sensitisation often have pain that moves around, spreads to other areas of the body, can be sensitive to light or foods, and can feel pain where instead they should just feel pressure or touch 

Now let’s move to habituation. Habituation is the opposite of sensitisation. It refers to “turning pain down”

  • If we use the above analogy, habituation refers to the same input over time >> reduced output 
  • For example, when we first get into a hot shower it might be really hot and almost unbearable, however as we adapt and habituate we no longer feel that the same temperature is too hot 
  • Habituation is a crucial concept in pain management, especially persistent pain 
  • We can do things that hurt a little bit, especially if they are meaningful activities to us 
  • Remember, pain doesn’t always equal damage, and so by continuing to do meaningful activities, we build a tolerance and subsequently develop habituation and reduce our pain 

If you take one thing from this post, let it be that (a) pain is complex and more than just a representation of our physical state (b) you can still live well with some pain

Stay tuned for Part 2 where we further discuss the fascinating concept that is pain.

Based on information learned from “Recovery Strategies, Pain Guidebook” by Greg Lehman

Written by Jacinta (physiotherapist)

Post Author: YS Physio

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