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Understanding Pain

The Introduction

To Understand pain – each person has an objective opinion

Pain is a sensation that majority of people associate as unpleasant, it is unavoidable – if you are alive and it is perfectly normal to experience it.  To understand it makes everything easier.

Some people seek it and others avoid it, but it is a sensation that we all have to deal with at some point in our lives. 

Understanding pain

The unpleasantness of pain is what makes it to be so effective and forms part of an essential part of life named The warning system, that acts to protect you by alerting you to danger before or while you are being injured.

Pain has the ability to change the way you behave, move and think.

It is essential to force you to stop, pause and take a step  back to allow your body to start the healing process.

It is a very subjective experience and the pain that YOU are feeling cannot be felt by anyone else but you. The fact that I cannot feel your pain though, does not mean that I cannot understand your pain. To understand the concept of pain, you have to think wider than just injury = pain. You might have noticed that you can experience different intensities of pain, for different things. Like when you bump your toe and keep on bumping it against the coffee table that causes you tremendous pain, versus a major cut that does not hurt until you see the blood coming from the wound.

Let me explain…

For you to feel pain, you need a brain. Yes, you have to be conscious in order for you to experience pain. This is somewhat controversial if you think about it carefully, but once you start to realise why you feel pain it will make sense. Pain is not something that your body makes and sends to the brain, it is rather a response by your brain to something that it perceives as a threatening situation. The brain makes pain, for you to be able to survive.

Pain is your body’s alarm system, which forms part of a bigger picture and involves all the body symptoms, and once again all the responses are aimed at protection and healing. The body reacts naturally and the brain can react to situations but also remember and adapt behavior to prevent future injury/pain. The experience of pain or just the thought of it is sometimes enough to motivate you to change something in terms of behavior, movement or habit. Pain might be so effective in its role that it consumes all your thoughts, movements and your focus.  This system may become ineffective and start to overreact, and lead to chronic pain conditions that will be explained in the next article. It is safe to say that although pain is a normal response, it is very unpredictable.

What is the definition of Pain:

“Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.”

–International Association for the Study of Pain (IASP) 

If we have to unpack this definition – we have to consider that pain is not only a biological condition, it is an integrated model consisting of three factors.

The biopsychosocial model is important to consider when doing an assessment, but also when developing a treatment plan – we have to address all the contributing factors that can add to your pain.

The integrated biopsychosocial model

Pain is not just something that can physically be felt, but is something that can be psychologically experienced – in terms of loneliness, grief, sadness, alienation, anger etc. Emotional pain may have exactly the same effect on you as physical pain or even make you feel physical symptoms – which draw back to the fact that ALL pain involves thoughts and emotional contributions.

There is a misconception that the amount of pain that you are experiencing is the direct result of the amount of tissue damage. It all depends on the amount of threat that your brain perceives. As an example – during a fight on the battlefield a soldier might experience that he has been shot, but his life depends on his reaction and in order for him to survive he almost feels no pain, merely just a bump. Mothers who were burnt themselves were able to run back into a burning house to save their children; or sportsmen who can persevere till the finish line despite a severe injury. In all these situations the final goal was bigger than the current situation and survival was the most important.

In contrast, to get a paper cut is one of the most irritating, sore and silly injuries – there is no real damage, it is not deep, yet it really hurts. Pain relies on context and the brain decides whether the pain response is appropriate or not. This could be the difference between life and death.  

Lorimer Mosely wrote it so perfectly:

“Many and varied cues may relate to the pain experience, but it is the brain which decides whether something hurts or not, 100% of the time, with no exception.”

But, to feel pain does not mean that you are crazy and that it is all in the mind. It is perfectly normal. The processes might just become mixed up and your system might over or under react. This is a whole new can of worms and will be discussed in the article about chronic and acute pain.

Your social, emotional and physical context determines the amount of pain, for example: if you have a terrible boss and you are under a lot of stress at work, your paper cut might be a lot worse than when you get a paper cut at home while paging a magazine.

Pain is dependent on its perceived cause, regardless of what is actually happening in the tissues. If the cause is seen as more threatening, the result will be more pain. Although your context is important, the people around you while you injure yourself also plays a role.  You might feel the pain more intense if your mother (or someone that is attentive and caring) is present in comparison to a work friend (who does not really care).

Age, gender, culture and religion also play a role in how you experience pain. It is the way in which you have been conditioned to deal with pain that will influence your response.

The Alarm system

The sensory system (the nerves that are responsible for us to feel, touch, smell, taste, hear, see) constantly gives the brain information about the changes in the body tissue, and the brain responds unconsciously. The alarm system forms part of this response and tells the brain about the amount and nature of the danger. This system is very important in order for you to survive.

In some cases the alarm system is faulty, for example diabetes and the injury to a toe that can lead to gangrene without the patient even being aware of it.  So it is important to rely on all your senses in order to stay healthy.

Because this is part of our sensory system, we depend on sight, hearing, smell, touch and the other senses to keep the body from hurting itself – you actually alter your behavior to prevent yourself from falling off a cliff, slipping on ice or bumping into a shelf.

This is one of the things that make us advanced over the rest of the animal kingdom, we can learn from our environments and ‘predict’ the outcome and react accordingly. It is a combination of senses, memory and reasoning that helps us to avoid danger.

The nervous system relays the information to the brain and the brain chooses the correct output, however, if you have been injured the sensitivity of your tissues increase and the threshold for your brain to perceive something as a threat lowers – there for your experience of pain might be altered. This concept will be discussed further in the article about acute and chronic pain.

In conclusion, pain can be a real pain, but once you understand a bit more about it, you will just want to learn more and more. All the information regarding pain can be quite overwhelming, but the concept of it is so interesting because it affects all of us in some or other way.

Next time someone complains about pain, think about the person as a whole – consider their injury (if there is one), emotions and environment. This might change your reaction to be more empathetic or even sympathetic. At the end of the day, pain is something so unique to each one of us that to support someone in pain you have to understand more than just meets the eye.

The idea of an injury is often more painful than the injury itself