Understanding and Overcoming Chronic Pain

We all share the common experience of pain, but how and when we experience it differs from person to person and changes according to our current environment or situation. As unpleasant as it may be, pain is a normal part of life and actually serves a very important function. It is a highly complex process of communication that our bodies use to become aware of a potentially dangerous situation (i.e. a cut in our skin that could lead to excessive loss of blood or introduction of dangerous pathogens). This helps to ensure our physical protection and preservation. When injury or damage to our tissue occurs, our nerves help us to become aware of it and then our brain determines an appropriate reaction.

Nociceptors are the nerve receptors that identify potentially harmful situations that may be causing damage to our tissues. When nociceptors sense dangerous stimuli, such as the scalding hot water, they send that information to our brain so we can decide 1.) is this a truly dangerous or harmful situation and 2.) If it is a dangerous situation that puts us at risk, what can we do about it to protect and preserve ourselves.

It’s important to note that the body does not have specific pain receptors and that nociceptors don’t send “pain signals.” They relay information about potential threats to our tissues so we can make a decision to modify our environment or behavior to protect ourselves. If the brain determines that there is a dangerous situation, we experience pain. If the brain doesn’t perceive a threat to our tissue, we generally do not experience pain.

What does this tell us? Pain is perceived by the brain.

“Pain is the end result. Pain is an output of the brain designed to protect you. It’s not something that comes from the tissues of the body.” – Lorimer Moseley

Pain is an experience that is formed in the brain and is not necessarily proportional to the degree of actual tissue damage. This experience is based on the brain’s interpretation of information about the condition of our tissues received from nociceptors as well as information learned from previous experience. For example, let’s say you injured your back bowling a couple of years ago and now, in a bowling alley, you start to feel a back ache after your last bowl even if you didn’t actually reinjure your back. The brain has learned to interpret the motions of bowling and the environment of the bowling alley as a previously dangerous situation resulting in tissue damage. In this way, pain is no longer serving a functional purpose and is existing beyond the extent of true tissue damage. This type of non-functional pain is referred to as “chronic pain.”

Chronic pain, by definition, is pain that has lasted for longer than 3 months. It is characterized by long standing pain that remains long after actual tissue damage has healed. However, an active inflammatory process may still be present. Chronic pain, although usually not caused by tissue damage, is very real to those who suffer from it. No, it is not “in your head.” These individuals have a developed a nervous system response that is sensitized to activities or stimulus that should normally not be painful (i.e. bending over, walking, sitting, etc). Chronic pain is not rare, leaving about 20% of Americans  in suffering and in search of solutions. 

Physical therapists are experts of the movement system and are well versed in the applications of pain science. Over recent years, physical therapy is changing the game and helping people to reclaim their lives from pain, decrease the need for harmful and addictive opioid pain medications, and prevent millions of unnecessary surgeries.

Through understanding pain and its processes, we can learn how to better manage it and reduce its impact on our daily lives and functioning. This begins with shifting away from our previously held traditional view of pain as an indicator of current tissue damage or disease to a marker of the perceived need to protect the tissues of our body.

Please Note: This understanding of current pain science and research should not be interpreted to minimize the experience of chronic pain suffers. This new approach to pain should bring feelings of hope and empowerment; we have power over the experience of pain. Your body isn’t irreparably “broken.” Movement doesn’t have to be and shouldn’t always be painful. If you are experiencing pain with movement, seek out the help of a physical therapist who can review pain management strategies with you and establish functional and healthy movement patterns that are not only pain-free, but actually feel good!

Pain is highly complex. There is much more to read and understand about pain science. If this peaked your interest and you want to learn more about how you can overcome chronic pain check out these helpful resources:

• Body in Mind
• Tame the Beast
• Why Things Hurt
• Explain Pain by David Butler

References: 

1. Moseley, L. Explainer-What is pain? Body in Mind. 2016 Jan 5. https://bodyinmind.org/what-is-pain/
2. Moseley, L. Explainer: what is pain and what is happening when we feel it? The Conversation. 2015 Nov 18.
3. Ingraham, P. The 3 Basic Types of Pain: nociceptive, neuropathic, and “other” (and then some more). 2019 Mar 17. https://www.painscience.com/articles/pain-types.php
4. Dahlhamer J, Lucas J, Zelaya, C, et al. Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults — United States, 2016. MMWR Morb Mortal Wkly Rep 2018;67:1001–1006.