Pain Series! Part one.
Pain! Everyone will experience pain in their life, some more than others. It is the most common reason someone seeks help from an osteopath or other health professional. Chronic, or persistent, pain is the bread-and-butter stuff of osteopathy and I discuss it with my patients every day. It is so essential for people to know what pain is and why they are experiencing it.
Pain is incredibly complex and is one of the body’s most important tools in keeping us safe. It can also become a difficult and isolating experience when it goes on for too long. Due to its complexity, persistent pain requires a full-person approach, which is why we see so much of it in clinic.
In today’s post I want to discuss what pain is and how that process plays out in an ideal situation. This will help us when we discuss persistent pain in more detail in the rest of this series.
Before we get started, a quick note on terminology... in recent years there has been a shift in language when talking about pain. There has been a shift away from the term ‘chronic’ in preference for ‘persistent’ pain. Throughout this Pain Series blog I will be talking about persistent pain but please know the words are interchangeable if you decide to do further research on your own.
Pain is defined by the International Association for the Study of Pain (IASP) as ‘an unpleasant sensory and emotional experience associated with […] actual or potential tissue damage’. Pain, in its essence, is a mechanism that the body uses to protect itself from PERCEIVED harm. I place particular emphasis on the word ‘perceived’ because pain is not always a result of true tissue damage.
A common misconception is that pain occurs at the site of tissue injury or damage – which makes total sense! ‘I rolled my ankle and so my ankle is sore.’ However, pain is a lot more complicated than this. Our central nervous systems (brain and spinal cord) are responsible for running the show – they tell muscles what to do, how fast the heart should pump, when to release certain hormones, etc. Think of it as our control center – and it’s determined to keep us safe and alive.
To keep everything running smoothly, our brains require information. This is received through our peripheral nervous system (think receptors and nerves). Different receptors exist for different sensations – heat, stretch, pressure, and more.
So, what happens in the example of a rolled ankle? When we roll our ankle there are receptors in our ligaments that say ‘hey! We've been over stretched!’. This message is sent to the brain and is processed, along with a lot of other information, to decide what happens next.
This next point is very important... IF the brain perceives that there is a risk of injury then it will send out a pain signal. I really want to emphasise this point - pain is an OUTGOING signal from the brain, NOT a message from the site of injury. Because ‘risk of injury’ is assessed by the brain in the context of all the other information its receiving, pain can present differently for different people at different times in their life.
Most people can relate to this if we sit and think about an example. If we roll our ankle slightly whilst playing tag with our child, then we are more likely to shake it off and not think about it again. Whereas, if we were to roll our ankle (to the same degree) whilst stepping up a gutter hastily because we didn’t see a car coming then we may be more susceptible to feeling more pain. This is because amongst all the other information the brain was receiving there was also an ‘ARGH! Where’d that car come from?!’.
The goal of sending out pain signals is to protect. If we roll our ankle and tear some fibres of our ligament, the only way the brain can communicate ‘protect this area’ is by generating a pain signal – we limp or take more weight through our other leg which allows our ligament to heal. As healing occurs and the brain gets less information regarding risk, and more regarding recovery, it reduces the pain signals – we start to walk on that ankle more and before we know it we’re back to normal! Ideally...
This is how ‘typical’ pain signaling works and is called acute pain. When pain is still present after three months it is considered persistent – all tissue healing will be complete within 6-12 weeks. Persistent pain occurs when there are more factors involved than simple tissue injury.
I hope this post has helped explain what pain is and how it works in and for our bodies. In our next post we discuss how persistent pain differs from acute pain and what makes someone more susceptible to developing it.
See you next time!
Zo xo