Pain Facts and Self Care Strategies

This month we are revisiting the topic of pain because it is such a common phenomenon in our patients. Many people come to our clinic struggling with pain that they have had for years and looking for help. Luckily, new research is continually improving our understanding of pain which allows us to help those affected by chronic pain.

What is pain?

The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage” (1). Let’s break this down.

  • We all know that pain is not fun.
  • Pain results in many emotions such as worry or fear, anxiety, and depression. This can increase your pain experience. (More on this later).
  • Pain can occur whether you have an injury (tissue damage) or not! If your brain thinks you are in danger of being injured you can experience pain, even if nothing has happened to you! This leads to the next interesting pain fact.

 

Pain and tissue damage do not have a one-to-one relationship

Simply put, the amount of pain you feel does not equal the amount of damage done to your body (2). Consider these two examples:

  • A tiny paper cut is not a life threatening injury, but it can hurt like heck!!
  • People who experience significant trauma, such as soldiers in battle who lose limbs, have reported feeling no pain at all. If you lost a limb in an explosion, you would expect this to hurt, right?

 

Pain is an output of the brain

What does this mean? Let’s break it down. Your brain is constantly taking in large amounts of information from the external environment—everything you see, smell, taste, touch, and hear—as well as from your internal environment—stretch and pressure receptors from your skin and muscles, as well as information regarding your joint position and location in space. All of this information is analyzed nearly instantaneously in your brain (2,3).

 

At the same time your brain takes into account your prior experiences, memories, thoughts, and beliefs about the situation. All of this information is put together. If your brain determines that you are in danger, then it will cause you to feel pain. If your brain decides that your body is not threatened, then the end result will be no pain. There are no “pain receptors.” Pain is an experience created by your brain to motivate you to change your behavior. Yes, the pain is all in your head; however, that does not mean that your pain is not real to you (2,3).

 

Your brain and nerves adapt to chronic pain

Peripheral adaptation: changes in nerves

Having pain for a long period of time changes the way your brain and nerves function. In chronic pain, the endings of your nerves build more ion channels. This causes the nerve endings to be more sensitive. As a result, your nerves are more easily excited. This is why a light touch can cause pain. Normally, this type of sensation would not excite the free nerve endings that transmit danger messages; however, when you have chronic pain, even harmless stimuli can trigger these nerves and result in pain (1-3).

Central adaptation: changes in the brain

Changes also occur in the brain. The primary somatosensory cortex is the area of the brain where we become aware of sensations in different parts of our body. This area is organized like a map of the whole body with larger areas devoted to the most sensitive parts of our body. The hand, lips and mouth have relatively large areas in the brain because they are so sensitive. When someone touches you on your hand, this area of your brain lights up (2).

 

In chronic pain, this virtual map of the body, instead of being crisp becomes “smudged.” The result is that when someone touches your hand, you may feel pain at your wrist. This is because the brain area of the hand has become smudged into the area associated with the wrist. Similar smudging can happen in the primary motor cortex, the area of the brain that allows us to use different body parts. Smudging in the motor area can make it more difficult to use a body part. The result may be weakness or poor coordination (2).

 

Why would our bodies do this? Researchers think these strategies help our bodies heal by making it harder to use a body part that is injured. Also, when surrounding areas are more sensitive, we are are more likely to protect the injured area. The good news is that smudging can be reversed.

 

Different things can increase or decrease the level of pain you feel

Many factors can cause you to feel more pain. The good news is that these things can be controlled. Some examples include (3):

  • Your own attitudes and beliefs about pain, what causes it, and whether you have control over it
  • Stress, anxiety and depression
  • Negative mood states and negative thoughts
  • Increased attention/focus on pain
  • Lack of sleep
  • Trigger foods including sugar, fats (especially trans fats), dairy, gluten, and processed foods

 

Luckily, there are many factors that can decrease the level of pain that you feel. These are often ways of coping with pain and can include (3):

  • Your own attitudes and beliefs about pain, what causes it, and whether you have control over it
  • Relaxation
  • Positive mood states and neutral/positive thoughts
  • Distractions that engage your brain in other activities such as recreational pursuits, work related tasks, chores around the house, interactions with other people, etc.
  • Getting enough restful sleep
  • Eating a plant forward diet
  • Movement and exercise!
  • Learning about pain
  • Graded motor imagery
  • Reconnecting to what gives your life purpose and makes you a unique individual
  • Meditation and mindfulness training
  • Massage therapy, acupuncture/dry needling, chiropractic, etc.

 

Additional resources

If you are interested in learning more about pain, here are some very useful books, workbooks, podcasts, and YouTube videos.

  • Explain Pain Handbook Protectometer, Butler and Moseley
  • Explain Pain, Butler and Moseley
  • Painful Yarns, Moseley
  • Pain Reframed podcast
  • Understanding pain in 5 minutes (YouTube)
  • The Pain Management Workbook (Amazon)

References

  1. International Association for the Study of Pain. “IASP Announces Revised Definition of Pain.” www.iasp-pain.org/publications/iasp-news/iasp-announces-revised-definition-of-pain. Accessed August 25, 2021.
  2. Butler, David and Moseley, Lorimer. (2013) Explain Pain. NOI Group.
  3. The Painful Truth—Lies, Deceptions, and a Hopeful Way Forward Conference, Colorado Chapter of the APTA, 16 May, 2021. Lecture.