Pain What is it Really?

Pain is a phenomenon that has baffled physiotherapists and other allied health professionals for a very long time. It is an extremely complex issue which is, of course, not limited to the physical.
The big question being, ‘why does individual suffering vary so greatly for the same injury?’
There have been many attempts to define pain such as;

An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

The International Association for the Study of Pain. (IASP)

An unpleasant sensation and emotional response to that sensation.

The American Academy of Pain Medicine.

Pain is a complex concept that is produced by the brain when it perceives that damage to body tissue exists and that action is required. All dimensions of pain serve to promote this objective.

Lorimer Moseley 2003.

Fortunately, over the past decade there has been some ground breaking research – including that by former physiotherapists David Butler and Lorimer Moseley – into understanding the mechanisms regarding the concept and perception of pain.

We now know that pain is most likely relative to how much danger your brain ‘believes’ you are in NOT how much danger you are ‘actually’ in. Why such a disconnect can occur continues to be the subject of research.

According to Professor Moseley more and more evidence indicates that our individual thoughts, beliefs, behaviors, diet and relationships can influence our perceptions of danger and any change in what we perceive as danger can also affect our perception of pain.

As a physiotherapist, I often see injuries exacerbated or prolonged by the fear of pain – that is, the pain a person avoids in returning to normal bodily movements after an injury, especially in clients who have had chronic lower back pain.

In these cases, avoidance of movement creates a very stiff, rigid spine analogous to a brittle twig. Compensatory movement patterns develop to avoid normal spinal movement and the pain associated with it and when this happens the recovery process can lengthen significantly.

Learning how to move again – with control and without fear – can reverse the changes of what is termed ‘central sensitization’ but it requires awareness and commitment. Very simply, central sensitization means the ‘winding up’ of the nervous system to the point that normal stimuli, such as a soft touch or warmth, is interpreted by the brain as pain (Allodynia) and normal painful stimuli such as a pinprick causes an exaggerated perception of pain (Hyperalgesia).

Imagine an alarm system fitted in your home that is activated when an intruder enters. Each time the alarm is activated it is reset but with more sensitivity than the previous alarm – now the alarm is tripped by a dog or cat and then an insect and so on – creating the same amount of distress as the original intruder even though the house is safe.

This is a very simple analogy of a very complex process but may help to give some insight into how people can misjudge the cause and effects of pain.

Key Points to Active Recovery From Chronic or Recurring Pain.

  • Make a plan to challenge your boundaries – don’t over do it though – set small realistic goals for example if you get pain after sitting or walking for 10 minutes then aim for 11 then gradually 12 but at least aim for a personal best every few days or so.
  • Take a good look at your life-style and what positive changes you can instigate. Set longer-term goals by imagining yourself in three to five years time – where do you want to be and what do you want to achieve?
  • Expect relapses – they are normal – but over time the incidences will reduce as your nervous system ‘unwinds’.
  • Work with your physiotherapist to identify fear avoidance movement patterns or compensatory movements due to muscle imbalances – Learn to move well and progress your exercises to become functional.
  • Often a multi disciplinary approach is initially required. For example cognitive behavior therapy and learning how to distract yourself from the sensation of pain can initially be very useful.
  • Be optimistic and stay positive – studies indicate that those with a more positive and optimistic attitude live longer and healthier lives.

What to Avoid.

  • Inactivity! If you can’t walk on land then walk in water, get on a stationary cycle – recumbent if necessary but get moving!Don’t just sit or lie around waiting for recovery to happen. The less active you become the lower the threshold and tolerance for pain you will develop.
  • Passivity! Understand that you have the power to overcome your pain. Specialists can help but they can’t do everything – you have to work for it!
  • Pessimism! It’s hard not to get down about your pain but you are far more likely to overcome it if you are positive and motivated.
  • Blame! Even if another person is to blame for your condition – they cannot help in the recovery. Only you can do that.

Additional Information

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About the Author

Jennifer Kellett established Hawker Place Physiotherapy in 1991 and is the principal practitioner of the family run practice. Jenny has served the local communities of Belconnen and North Canberra with commitment and pride for over 26 years. She is a strong advocate for maintaining fitness, health and well being across all age groups and has a keen professional interest in combining Pilates with weight training for treating postmenopausal women at risk of osteoporosis.

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