Know pain, Know gain

Written by Alexis Ordelheide, PT, DPT, CMPT

Most of us have experienced pain at some point or another in our lifetime. Pain is normal but living with pain is not. Pain is produced by the brain and is a unique experience that occurs when the brain concludes the body is in danger and an action is required. Unfortunately for some, a continuous activation of danger occurs even after the perceived threat is over resulting in chronic pain. Chronic pain affects around 20% of people worldwide consisting of 15% to 20% of physician visits. Unfortunately, this population is under treated resulting in worsening of symptoms.

Over the past decade, there has been an increase in research to help us better understand chronic pain and to discover more effective treatments to help improve the quality of life for people living with chronic pain. Through the research, the evidence has shown that if the individual has a better understanding of their pain followed by aerobic exercises, education in good sleep hygiene and goal planning their treatment will be more successful.

Through this blog series on chronic pain, Advanced Rehabilitation Services would like to provide information to their patients and community in hopes of reducing the number of people suffering from chronic pain.

The number one question patients want to know is “why do I have consistent pain?” To better answer this question, we have to better understand how pain is produced. Usually pain begins from a tissue or joint injury. Our tissues contain “danger receptors” (nociceptive receptors), not pain receptors. The “danger receptors” send a signal to the brain where the brain determines whether or not we need to experience pain based off of the threat.

According to Adrian Louw, “Pain is 100% produced by the brain when it perceives a threat.” Now this does not mean it is all in your head. Let’s imagine a scenario that Louw describes. On a beautiful sunny day, you are crossing the street when you step on a crack and roll your ankle. You immediately fall to the ground, grabbing your ankle in pain. If I were to ask you, “does your ankle hurt?” You would look at me as if I was crazy and say “of course it is painful!” Now in a split second, a speeding bus is coming at you. Does your ankle hurt now? No. You would get up and run across the street on a sprained ankle to avoid being killed by the bus. Do you see how our brain determines what pain we experience based on the threat to us? Again, according to Louw, “Pain is a decision by the brain based on perception of threat.”

The good news is, tissue heals after injuries. So why then, do individuals experience lasting pain? Not only does our body receive input from our tissues, it also receives input from our environment. Environmental influences can either be positive or negative. Research shows that individuals who experience pain or injury in a positive environment are less likely to develop chronic pain. Imagine a child playing contact sports. They are constantly being pushed around resulting in bumps and bruises. They associate those injuries in a socially friendly environment allowing the brain to not perceive it as a major threat. Research also shows that individuals who experience an injury in a negative environment, such as a motor vehicle accident or combat, have a higher risk of developing chronic pain. The brain has now perceived their injury as a major threat because the injury was associated with an unpleasant situation. Both tissues and environments play a role in the amount of pain we can experience. Our nerves send signals to our central nervous system to provide our brain with information. If our central nervous system is constantly bombarded with information, we begin to have changes in our nervous system resulting in a more sensitive system possibly contributing to chronic pain. When life is good, our nervous system is balanced. When life is bad, our nervous system is unbalanced.

Even though pain can be complex, it does not mean that you have to live in pain the rest of your life. Understanding why you suffer from chronic pain is the first step to healing. Tune in next time to learn about the biggest pain killer...movement.

(Disclaimer)***As always, the best course of treatment is to follow up with a Physical Therapist to develop a treatment plan that is specifically designed for you.

References The How-to of Teaching Patients about Pain-Adriaan Louw; Medbridge Webinar https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4450869/