Updated: Jul 8, 2019
Being in pain sucks, like a lot. The whole process is just one big pain in the ass. You're uncomfortable, getting good sleep is out of the question, and being on edge with family and friends is an understatement.
For most of us, pain is a short term experience that is a necessary response to a threatening situation. If your pain could talk, it would go something like this:
Pain - "That stove is smoking hot; please take your hand away."
You - Automatically moves hand away from the stove to avoid getting burned.
Pain - "Hey Brian, you've just fractured your leg, please don't put weight on it. If you do, I'll be forced to create an uncomfortable sensation so you don't do it again."
You - Unconsciously develop a limp to avoid putting weight on your leg.
The problem for a lot of us, is what happens when the pain doesn't go away?
The evolutionary role of pain.
In modern society, pain has evolved not only to protect us from physical danger such as damage to tissue but to emotional distress as well. This isn't a bad thing, however, it does create important implications.
Over the last thirty years, the medical model has been heavily biased toward the biological state of tissue. Moreover, the prevailing thought was if we couldn't "see" the cause of pain or it didn't show up on an X-ray, MRI or CT-scan then your treatment options were limited. To add insult to injury, if something did show up on imaging, we were quick to declare the said finding as the reason for your pain.
Cue the over prescription of pain medication, unnecessary diagnoses of non-specific conditions, the creation of irrelevant surgeries and the skyrocketing cost of healthcare.
The reality was the system in which our healthcare was founded upon, didn't and still doesn't have a complete understanding of the human experience of pain. However, as the research grows, it is becoming understood that pain is a complex situation based on a multitude of physical, psychological and social experiences (3).
Because pain can exist long after the body has healed from physical damage, things like someones:
2. Cultural or religious expectations
3. Current emotional status
4. General medical status
5. Pre-existing pain problems
6. Prior experiences and expectations regarding pain
7. Subconscious beliefs
all have an influence on someone's experience of pain. Everyone responds to and experiences pain differently, which explains the chronic pain epidemic in a nutshell (3).
How does this happen?
A typical pain response goes something like this:
1. An injury to the body occurs (fracture, cut, sprain, strain, etc) and specialized nerve endings specific to pain are engaged. These nerve receptors send signals to the spinal cord, which then acts as a relay center, sending even more messages up and down the spinal cord.
2. Once these signals reach the brain, the brain in all its glory interprets these signals and sends the appropriate messages back down the spinal cord and to the site of injury.
3. The results are physical and emotional experiences of pain, swelling, guarding, and tenderness.
4. Depending on a multitude of factors these signals to and from the brain can be amplified or dampened.
4. The whole process is entirely normal and protective. Depending on the area of the body, we can have different pain experiences. For example, skin and bone are highly innervated with these pain receptors and can send "louder messages," while, pain from internal organs can be more difficult to discern.
5. Referred pain is also a normal experience of the body. Nerves from different areas of the body can share the same pathway and thus overlap. A common example is shoulder pain during a heart attack.
When things go wrong:
Because the brain receives and interprets these incoming nerve signals, it can alter our physiological experience of pain. The brain does this at a subconscious level (see above). Picture someone who hurts their back at a job they dislike versus someone who injures their back during a championship basketball game. How each person would respond given the context of the situation can be very different.
Perception is reality. The experience of pain is no exception.
Now here is where things get tricky. Like we just stated, the brain can ramp up or dampen these incoming pain signals based on the person's subjective experiences. If for some reason, the brain perceives an area of the body to be a constant threat or danger-zone, despite the lack of tissue injury - a chronic, hyper-vigilant, pain state can occur.
Think of this as your brain automatically over-reacting to protect you despite you wishing it would stop. This phenomenon is called sensitization, and everything becomes dangerous.
It's like if all the signals your body sends to your brain (pressure, temperature, stretch, muscle contraction, etc), instead of getting divided up and separated into their appropriate categories, are reorganized into one large funnel and interpreted by the brain as a threat.
Now things like cold weather, tight-fitting clothing, stretching, bending over, sitting for too long, walking and many more examples create an experience of pain despite the lack of injury or tissue damage.
Talk about ramping up your nervous system too, sympathetic states or increased stress hormones such as cortisol also can trigger the brain to perceive areas of your body as painful or threatening. Without any correlation to tissue injury, a patient's pain perception might well be a "10" on a day when the patient is emotionally upset or anxious, and a "2" or a "0" when that same person is excited or happy (1).
Crazy stuff right?
How Do We Treat This?
It depends on the situation at hand, but in many cases, the answer lies within a process called graded exposure. The prevailing thought is to introduce the offending behaviors in novel, non-threatening situations. As your exposure to these "threatening" activities safely increases, your body's pain response habituates and returns to baseline.
Education is a huge part of solving the problem as well. Understanding that your pain is profoundly affected by the "human experience" is empowering. You become the driver of how you feel, which is a huge part of the recovery process (2).
What are my best options?
Without shamelessly tooting our own horn, we can help! We are experts in getting people out of pain and back to the activities they love.
The first thing you need to do is get assessed by one of our professionals. Everyone's different, and before we can create a game plan, we need to understand you.
What are we?
We are the Vital Six, offering the best recovery, performance, physical rehabilitation services in the Kansas City Metro.
We help our patients get out of pain and get back to doing what they love 2-3x faster than the industry average.
To see if we are the right fit for each other, schedule a completely FREE discovery session. This meeting will help us understand your situation, discuss essential treatment options, and find the best solutions for reducing your pain and returning you to activities you love.
What are you waiting for? Call us at 913 303 0032 now to get back to the life you deserve.
1. Parr JJ, Borsa PA, Fillingim RB, et al. Pain-related fear and catastrophizing predict pain intensity and disability independently using an induced muscle injury model. J Pain. 2012;13(4):370-8.
2. Bräscher AK, Witthöft M, Becker S. The Underestimated Significance of Conditioning in Placebo Hypoalgesia and Nocebo Hyperalgesia. Pain Res Manag. 2018;2018:6841985. Published 2018 Jan 28. doi:10.1155/2018/6841985
3. Meints SM, Edwards RR. Evaluating psychosocial contributions to chronic pain outcomes. Prog Neuropsychopharmacol Biol Psychiatry. 2018;87(Pt B):168-182.