The Problem with Pain and the Role of the Brain.

Before we start this post, I would like to assure you pain is not in your head...at least partly. Pain is a very real and necessary evil that is partly the reason we still continue to exist today. Pain is defined by the International Association of the Study of Pain (IASP) as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage". This definition serves to highlight that not all pain is mechanical or representative of physical tissue damage. When pain is described in such a way, as damage, or what feels like damage to the patient, it is a relevant subjective symptom specific to the patient.

The definition tries to reduce the association between pain and a specific stimulus, pain is a product of a complex pathway of nervous impulses and is not directly related to incoming sensations from the tissues in the body to the brain. Impulses result from real or potential damage to the body's tissues, so to point out, pain can be felt without physical damage to tissue. This may be difficult to understand but an obvious example of this is phantom limb pain in amputee patients. It is a common occurrence that pain can be felt in an amputated limb even though the limb has been removed, so pain can result without tissue damage to the affected area itself. This does not mean the pain does not exist, it is very real and very limiting, and it is much more complex than previously thought. What this definition also points out is that emotion and pain are directly linked. A broken heart does not imply that a heart is physically broken, but the distress and emotional stress results in a very real "pain" for the people involved.

Pain can also be categorised into acute and chronic depending on the amount of time pain has been present. Acute pain implies a sudden and sharp increase in pain associated with tissue damage such as trauma or surgery. This pain serves to alert us to the presence of damage or to seek help, it usually resolves quickly in a matter of days to weeks. Chronic pain is more complicated as acute pain lasts longer than 12 weeks. What is complicated is that, in most cases, tissues which are damaged initially during the acute pain process should have or have healed to its original state by this time. In some cases this form of pain is not linked to any form of tissue damage what so ever and becomes a condition in its own right. This occurs due to changes in the central nervous system and its ability to interpret seemingly normal impulses as pain.

Pain as we know is a product of a complicated series of neurological inputs. As there is no specific "pain nerves" our brain interprets sensory input from the body and reads the signal as pain. Sensory nerves have the capacity to tell our brain messages from the peripheral tissues (outside the brain) that a threat or damage could be occurring. These nerves interpret changes in thermal input, chemical input and mechanical input. Mechanical input includes increases in pressure or deformation in the structure of the tissues. These nerves are known as nociceptors as they respond to damaging or potential damaging stimuli in the body.

These messages are sent once a certain level of threshold is reached in the nerve and the message is blindly sent to the brain. The brain then decides whether this information is normal or considered to be painful. If it is normal the brain decides to do nothing and ignore the input, pain on the other hand would usually cause you to change or modify your behaviour to protect yourself from further damage. In most cases this system, although complex, functions normally, but can change in response to high amounts or prolonged exposure to painful stimuli. This can also be influenced by previous experiences of pain or personal beliefs about pain and your body. For this reason modern pain science has evolved to focus on the psychological aspects of pain in managing chronic pain conditions.

In summary pain does not always equal what we feel in the tissue or what we think we feel. There are plenty of examples of specific injuries that result in acute pain, but just as many result as chronic pain due to prolonged exposure or failed healing of certain tissues. It is important to speak to your medical professional about your pain and what your triggers for it may be. Pain is not simply a sensation, feeling pain does not give justice to the complexity of the process. It is better described as an experience. Our experiences shape our future reactions and beliefs about certain activities both painful and non-painful. For those suffering with pain it is important to have a plan to better manage your symptoms, you can discuss this with your GP, Specialist or Physiotherapist. Pain is normal, it just needs to be better understood and managed by addressing the other associated factors contributing to the global pain experience.

Lifecare Kingsway's Physiotherapy staff have had years of experience dealing with chronic pain conditions with patients and would love to share their experiences with you. If you would like to speak to one of our staff on how better to manage your condition book now on 9409 3993 or online at www.kingswayphysiotherapy.com.au