Pain is defined (by the people that study it) as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.
The key word here is EXPERIENCE, and it speaks to how different that experience is person to person, and the wide range of factors (that we don’t fully know yet) that actually go into the pain that someone actually experiences.
Over the years I’ve tried my best to try and explain pain to my patients. Sometimes it works, often I feel it doesn’t. I’ve found that analogies work better than all the science-y words. Here are the highlights of what I try to cover.
Pain is an output from the brain, not an input from the body
Pain is your brain asking ‘is this dangerous?”
Hurt doesn’t equal harm
Let’s review these concepts.
Intensity Receptors
Have you ever woke up one morning and noticed a bruise or bunch of bruises on your body and had no clue where they came from? (I’ve asked thousands of people this question - ONE person has denied this phenomenon) Despite there being enough stress to cause ACTUAL tissue damage, your brain decided whatever you were doing was so important that it decreased your pain sensitivity (increased your pain tolerance). It wasn’t until you were “out of danger” and all those natural pain killers coursing through you body wore off that you were able to notice tissue damage.
Keep in mind there are no “pain” receptors in the body, only intensity receptors, called nociceptors. These receptors detect temperature, pressure, and chemical changes. This is consistent with the rest of the body. You don’t have vision receptors, you have light receptors, and you don’t have hearing receptors, you have vibration receptors. These receptors get stimulated, that electrical signal goes to your brain, and your brain processes this info and “tells” you what to see/hear/feel.
Stimulation of nociceptors is called nociception. They are constantly being stimulated. You may feel SOMEthing, but it may not be pain since the brain doesn’t perceive that as a threat. You can feel pain without nociception, every heard of phantom limb pain?
Is this Dangerous?
Imagine sitting in a chair and I put my hand on your shoulder. Weird, but no cause of alarm since you feel something and see the actual cause of it. Now imagine same chair, but in a dark alley at 2 a.m. Same exact stimulus, but you’ll probably have a different reaction. Context matters. That’s a different environment, now imagine a different YOU. What if the entire scenario reminds you of some positive or negative experience? That will also change your reaction. You may freak out before anyone even touches you. Again, context matters, and “is it dangerous?”
The brain uses a whole bunch of different pieces of information to answer this question. Where are we? What are we doing? Are we alone? What are my thoughts/beliefs on what we are doing? Do I love my parents? Do they love me? And most importantly, has this ever happened before. It takes all of this information, and in a split second determines “Yes, this dangerous,” or “No, this is not.”
Pain is ONE of the ways the brain compels you to take action. The brain will take its best guess to WHERE /WHAT should hurt. The farther away from the spine, the easier it is to determine WHAT should hurt. That’s probably why stubbing your toe hurts so much. It’s much trickier closer to the spine (neck/back) since there are so many structures in that area that can make noise.
Hurt vs. Harm
Pain and tissue damage rarely go hand in hand, especially with persistent pain. Many people have actual tissue damage and ZERO pain, while some have no tissue damage and 10/10 pain (remember stubbing your toe?). Whether this be good or bad doesn’t matter, what it does mean is, man, this shit is complicated.
Practical Advice
Obviously you want to ensure there is nothing serious going on, but you want to get back to business as normal reasonably soon. No one knows your body better than you, but ultimately you’re going to have to do some experiment to see specifically what you can tolerate, then systematically doing more over time.
Baseline pain
One guideline is to not let baseline pain exceed +2/10 or get above a 6/10 on a 0-10 scale. So, if your baseline is 2/10, go do stuff. If pain increases to a 3 or 4/10, that’s fine, but when you get to 5/10, take a break, let the symptoms call down, then carry on. If a few hours later your baseline is elevated, you potentially did too much activity.
If your baseline is 5/10, you won’t be able to get the +2/10 since 6/10 is the hard stop. These aren’t hard and fast rules, some can tolerate more, some less. Ideally, over time, you will decrease your sensitivity and be able to tolerate more activity.
Know Thyself
People generally fall into one of two categories when dealing with pain. Copers generally push through pain, easily blowing through the +2/10 and 6/10 guidelines. They never let the nervous system actually calm down. A period of rest may be beneficial. Then, resuming activities, but at a reduced intensity/duration until you slowly get back to your previous levels or a level that makes sense.
Avoiders are the opposite. They stop all activity for fear of messing something up. After weeks/months/years, your tolerance will be so low that everything will be perceived as a “threat.” You have to start exposing yourself to those things. Not full bore, just a little here and there. It may just be the specific muscles that do a movement, then the actual movement, then adding resistance to the movement.
Either or, the +2/10 and 6/10 guidelines can be helpful.
Summary
The sensation of pain is very complex and comes from the interplay of many systems in the body.
Everyone’s pain is different, but the mechanics of pain are largely the same.
Nociception doesn’t always equal pain, and you can feel pain WITHOUT nociception
Pain intensity is usually not a good indicator of extent of tissue damage.
You have to balance getting back to normal activity levels with an appropriately dosed amount of stress.
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