Breaking down pain

​What is pain?
 
When it comes down to it, pain is a safety mechanism. It’s meant to detect potential threat and alert our brain to that threat, so that we do something about it. “Hey, your hand is burning, take it off the stovetop now!”. It’s hugely important for safety, survival, and preventing or stopping injury from becoming worse; and as much of a literal and figurative pain it can be, we’re far better off being able to experience pain than not. It helps us address a dangerous situation that may be threatening to life or limb, alerts us when we’re ill, tells us to change position to protect our body, and motivates us to stay away from things we’ve learned to be threatening and painful in the past. We can’t survive for long without pain – let alone thrive – no matter how much of a nuisance it can be. 
 
How does pain work?
 
Pain is completely, 100%, created by the brain. Yes, we have nerves that send messages from different parts of our body to the spinal cord, and eventually to the brain. However, the information they send doesn’t state ‘pain’ or ‘no pain’. It is simply a message that we’re feeling something; but nerves cannot interpret what that is. Our brain receives this info, processes it, and ultimately creates the final sensation that we experience consciously and deem ‘pain’. This processing happens so very quickly, which I’m sure you can all relate too; however, in that split instance, the brain considers so many different things in making that decision. 
 
These factors include your immediate environment during the painful experience. Is their danger? Are you embarrassed? Is a crowd around, or are you alone? How about blood, is there blood? Am I supposed to be hurt right now? How do people usually respond when something like this happens?
 
It also considers past experiences. Has this happened before? What was it like last time? Did I make it out okay, or was that experience terrible? I’ve broken my wrist before; did I do that again?
 
It may also consider your current state. Are you hungry? Did you sleep well last night? How about water? Are you feeling stressed about something in your life?
 
The above are just a few of the components considered in this decision-making process of the brain; but ultimately the brain decides something is threatening enough to be painful. This sensation of pain will motivate us to address the situation whether that be removing ourselves or removing the stimulus. 
 
What is pain not? 
 
Pain is not always an indicator of tissue damage. Neither the presence of pain, nor the intensity or amount is correlated with the presence of tissue damage. Someone can experience pain without having any sign of injury or tissue damage, while the next person can have a significant injury and feel very little pain. All the factors described above, and more, play a role in how that pans out. Pain is a signal that we need to listen to. But we also need to consider so many other variables to determine whether that pain equates to damage, whether we are safe, and how we might best address it. 
 
Pain is a large problem for many individuals, and a massive problem for our healthcare system with nearly 20million people managing chronic pain in the United States alone. We can’t ignore it, and it is not “all in your head”; however, we need to approach it differently than “fix the tissue issue” because often there isn’t one. 
 
This is the first blog of a 3-part series about pain. Follow along next month when we discuss what happens within the nervous system when pain becomes persistent!

Cheers! 

Elle Carlson, PT, DPT