Why does it hurt so much?
Lorimer Moseley is one of the best when it comes to pain education. This is a video I use regularly to help clients and students understand why things hurt.
Pain is a different experience for everyone. I remember when I had my first knee reconstruction as a 20 year old and the nurse asked me after the surgery what my pain was out of 10. I found it a frustrating question to answer because I was in a considerable amount of pain (rupturing my ACL was the most painful experience of my life at that point) but I was pretty confident that there would be situations that were more painful (I can’t remember if I said it out loud or not cause I was still a bit drowsy but my thought at least was ‘I’m pretty sure if you cut my arm off with a chainsaw it would be more painful’) I find using a 1-10 scale for pain is pretty useless because everyone’s experience of pain is different. We all know someone who has a ‘high pain threshold’ (or they at least like to tell you they do) and we all know someone who seems to be in pain all the time. Why do some people experience more pain than others? As Lorimer explains in the video, pain is a creation of the brain 100% of the time. The pain signal that the brain sends out is dependent on a lot of factors. Two main factors to consider are the stimulus that the body is experiencing and the persons individual experience with that stimulus. Lorimer’s snake bite story is a great example of how personal experience changes the brain’s reaction to a stimulus. The other thing to look at is how the same stimulus effects different people. Take a rugby league player for example, they spend a lot of time getting tackled in a way that would cause the normal population a considerable amount of pain, but they get up and go through it all over again. Their experience of the stimulus is different to ours and their brain adjusts accordingly.
I am not a neuro-scientist but pain is something that I have to deal with in clients on a daily basis, so I need to have an understanding of how the brain and the body interact in painful situations. In a healthy body pain is used as a protective mechanism. When the body is injured or perceives danger it creates pain to protect itself from further injury. If you roll your ankle the brain makes it painful to stop you from continuing to walk and cause further injury to the structures. If you touch something hot your brain sends a painful sensation so you will pull away and prevent yourself from being badly burned. We tend to view pain as a bad thing but it has an important role to play in our lives.
When things start to get problematic is when the pain sensations from the brain do not match the original stimulus. Like writhing in pain because a stick touches the outside of your foot, the brain can sometimes send a painful sensation because a previous experience required a painful sensation. Chronic pain is an example of the brain not sending correct responses to stimulus, or sending painful responses to no stimulus at all. If we continue with our rolled ankle example, the normal recovery from an ankle sprain would be to allow the body to go through it’s natural healing process and gradually build up strength in the ankle and return to activity. We would expect that when we return to activity, fully healed, that it would not be painful. Average tissue healing time in the body is 4-6 weeks after that there should be no damage to the tissue so there should not be any painful sensation to protect us from further injury. If, however, once tissue healing has been completed the painful sensation remains we are in a chronic pain situation.
I find this situation more challenging than dealing with tissue injury. Tissue injury is what I’ve studied and what I know. Chronic pain is very common and a large number of Australians deal with chronic pain on a daily basis. The challenge with chronic pain is trying to get into the mindset that my body is not actually injured. This is incredibly difficult when you are experiencing pain because the natural thought is that if there is pain then there is injury. Starting to understand the way that the pain response occurs in the body is the first step to overcoming chronic pain. Then we need to gradually build up confidence with exercise to strengthen the body and correct the neural pathways that the brain is using to send painful sensations.
If you would like further information on pain Lorimer Moseley and David Butler are probably the best minds on the topic at the moment.
If you are experiencing chronic pain and would like to start your journey to a pain free life you can book an appointment here.