Understanding Pain
Understanding pain helps decrease pain and helps us make better choices in the treatment of it
The biggest thing you should understand is that pain doesn’t necessarily mean there is damage to your body. Thus you can have pain with damage, no pain with lots of damage and lots of pain with minimal damage. Pain is affected by and influenced by other areas of your life. Emotions, sensations, cognitions (beliefs about pain) and social aspects (social withdrawal is common with pain) are involved with persisting pain.
The point of pain is to get you to do something. Ideally, to protect yourself. Pain is an alarm and alarms are designed to create action. Pain is the same thing. With many acute injuries the pain alarm is great and helpful. It stops you from walking on a broken leg. But the problem with many alarms is that they keep going off long after they are useful. The long term pain alarm is not a very good alarm. Meaning it is disconnected from the initial problem. Pain is also poor for telling us where the problem is. Where do people feel pain when they have a heart attack? Their arm, neck, chest and back. There is nothing wrong with their arm, chest, neck or back. This is how we need to think about pain. It is just an alarm that goes off.
Pain is multidimensional and as it persists it becomes much more about other triggers of sensitivity than about damage to a part of your body. When pain persists it is almost as if we get better at producing pain. We can become more sensitive and activities or movements that we could previously tolerate are now triggers for pain. Depression, anxiety, fear of movement,lack of sleep,work stress,lack of support, the loss of meaningful activities or poor coping strategies are factors that might influence your sensitivity and ongoing pain.
While a number of factors can make you sensitive, it also means that we have a number of ways to desensitize you. Sometimes you can address specific factors that might make you sensitive like addressing a fear of movement or changing the way in which you move. Other times, we can do general approaches that help get you healthier. Exercise, resuming hobbies, starting more physical activity or going out with your friends can be general strategies that essentially make you healthier and can help with desensitizing.
It does seem odd when you are in pain to be told that resuming activities is important for recovery. But responding to stressors is what humans do quite well. Here are some examples of where stressing the body and person are important for healing and recovery: – after a hip or knee replacement, people are up and walking the same day. There is still a lot of damage around that joint but it is the gentle movement that helps with pain and stimulates healing. – after cardiac/heart surgery, a huge component of recovery is exercise. It is a must for these patients. Exercise is a stressor on the heart and the heart responds positively to this. It heals, gets stronger and gets healthier.
As pain persists it becomes less about tissue damage and more about anything in your life or something particular about you that can make you more sensitive. Remember, pain is normal but what happens when it persists is that we get better at it. In a sense, we become over-reactive. It’s easier for the pain to be “triggered’ and multiple things in our lives can contribute to this. It’s not just about muscles, tendons and joints (although they are sometimes important). Look at pain as the overflowing of a cup. Many things contribute to what is in that cup. You can have a lot of physical, mechanical, emotional and social stressors and have no pain. But at some point a sudden increase in one of those stressors or a new stressor puts you just over the edge and the water flows out and now you have pain. Often people will have more pain when there are changes in the stressors in their life. It is the inability to adapt to the new stressor that contributes to pain not necessarily the amount of the stressor in your life. Pain occurs when we fail to tolerate and adapt to all the stressors in our life. We need to keep that cup from overflowing to stay out of pain.
Good treatment should try to address as many different factors that influence pain. The significance of everything above means that you can have damage. You can have joint degeneration and certainly can have the normal wear and tear associated with arthritis. What’s great is you can change the amount of pain that you feel without ever changing the amount of arthritis, wear and tear or even damage in different body parts. Treatment helps turn down the sensitivity of our nervous system.