Pain Management

We all experience some amount of pain on a daily basis. Either from a stubbed toe on that dresser you always run into, or chronic low back pain that has debilitated you for years, or even emotional pain from the loss of a loved one. No matter what our pain comes from, it is important to recognize how pain is experienced in the body in order to become pain free.

So what is pain? The definition of pain is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or describe in terms of such damage.” That means that pain can be experienced even without the onset of tissue damage. This is especially important for those suffering from chronic pain (pain lasting more than 3 months).

There are a few pain management principles that I would like to share with you today that might help you understand your pain and help decrease the severity of your pain:

1. Damage does not equal pain. A good example of this is imaging of people who do not have back pain. A study found that 50% of 30-39 year olds without back pain still have disc degeneration, disc height loss, and disc bulges. Although these people have the “signs of damage” of what we commonly associate with back pain, they in fact have no symptoms.
2. Nociception does not equal pain. Nociception is the body’s ability to sense danger. It is a constant signal in the body that lets you know of potential harm. For example, there is nociception that occurs when you have a full bladder that lets you know that if you don’t go to the bathroom, there is the potential of harm. It senses possible danger, but it doesn’t necessarily mean that there is any current damage.
3. Pain is an output of the brain, not an input. Have people every told you, your pain is all in your head? This implies that the pain is made up, which is not true. All pain is real. However, we need to understand that pain is not actually experienced outside the brain; only the danger messages from nociceptors are sent to the brain. As the signal goes from the nociceptors up the spinal cord and even to the lower centers of the brain, still no pain is experienced. It isn’t until the lower brain centers combine with higher brain centers that we finally have the pain experience. So physiologically speaking, the only place pain is experienced is in our head.
4. There is a slippery slope with pain. If we choose to focus on words like “arthritis”, “slipped disc”, or “degenerative joints” our brain creates a connection between the neurons for these words and the neurons for pain so that even thinking about these words can increase our pain. There can also be changes where the body misinterprets movement as pain. During an acute injury, pain during movement is a protective mechanism to prevent more damage. However, if pain persists our brain can build a connection that thinks movement equals pain. Then even when the tissues are healed, we still get pain. With more pain the brain thinks there is more tissue damage, and with more tissue damage, there are more dangers signals, and with more danger signals there is more pain… and so the cycle continues.

So what can you do about it? First, refrain from using language that will worsen your pain. For example, instead of telling people that the arthritis in your neck is really hurting, say that your neck feels a little stiff. Stiffness tells your brain that it is something that can be fixed, while arthritis does not. Second, try to avoid being fearful of movement. Pain is a reaction to something that puts our body in danger. If we start to anticipate that something is going to be painful before we do it, we are only reinforcing those faulty connections in our brain that say movement = pain. Breathe, relax, and move the way your body wants you to. Third, become educated on pain. Talk to your physical therapist about pain so that he or she can help you through it. Your physical therapist can also teach you proper movements to help your body move better so that there are less danger messages sent to your brain.

Reference:
Van Gelder L. Effective Pain Education in Physical Therapy Practice. Fall MPTA conference. September 2015.