Ouch! Why does this hurt?

Updated: Nov 9, 2020

Person in pain
Tell me why this hurts

Pain is protective. Always. We currently know more about pain in the last 10-20 years than we ever have before. The original schools of thought was that pain = tissue damage. However, we now know that this explanation is not adequate. Receptors in the body, called nociceptors, are responsible for detecting changes in body that may be associated with an injury. This change is then sent to the brain for interpretation, where it decides on the output, i.e. the pain felt by the person.

In its simplest explanation pain is a basic part of human survival. Imagine if you did not have pain? Such are the rare cases of people with congenital insensitivity to pain (CIP), that is, those that are unable to perceive pain (Zhang et al, 2015). While that may sound like a dream, the presence of pain provides a distinct advantage to survival – it changes our behaviour. Children with this condition present with frequent injuries of sometimes unknown cause. This is because they have no internal controller that stops them from hurting themselves. Repeated injuries cause further investigations to be made, often taking many years to diagnose the condition.

Acute pain is short term and associated with an injury, for example stubbing your toe or breaking a bone. It serves a functional purpose, that is, to tell you to stop doing whatever is causing the pain and subsequently protect the area to allow adequate healing. Usually healing will take place in under a three-month time frame. But when pain persists for longer than three months, that is when pain is no longer so simple.

The definition of chronic pain is that it persists beyond the normal expected healing time frames of three months. In recent times, there has been a move to change the term ‘chronic’ pain to ‘persistent’ pain. What has prompted the change in terminology? It is becoming more and more evident that the language we clinicians use, has a significant impact on the patient. The term ‘chronic’ has negative connotations of being severe pain. The aforementioned definition however, mentions nothing of type, quality, intensity – just the duration. This makes ‘chronic’ not quite an accurate definition. Therefore ‘persistent’ pain is the all encompassing umbrella term I will use from hereon in.

The thing is with persistent pain is that the signals between the body part in question and the brain become amplified. Take for example, in the case of low back pain – bending is commonly a movement that is painful. Episodes of back pain usually settle within 4-6 weeks but in that time, if you have been avoiding certain movements due to pain, a natural movement pattern doesn’t automatically happen when you recover. Instead, the brain has learnt that bending is ‘dangerous’ therefore interpreting each time we bend as painful. Thereby we stop bending, muscles in that area become weak, which leads to more pain, which leads to further weakness, conjuring up images of a vicious cycle. However, making sense of pain does not stop there. Other factors are also at play in influencing the pain system. Such things include stress levels, quality of sleep, past history and emotions.

So why is this important? It is estimated that one third to one half of the UK population suffers with chronic pain. Back home, in Australia, it estimated that 1 in 5 Australians suffer with it, costing the economy approximately $34 billion per year. As a clinician that has worked with countless patients, I was finding more and more that a vast majority of us could do better at explaining how pain works in the body. When I did become better at explaining pain and the relevance to each individuals’ condition – that is when I noticed my patient’s outcomes significantly improving. They would make remarks that despite having this pain for, sometimes decades, no one had taken the time to explain it to them. So began the birth of Pain Train Co. Learning as an important tool, as an adjunct, to empower people to take control of their pain.

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