Why Do I Have Pain?
Many of us wonder why we have pain or why our pain tends to persist after the normal tissue healing time. Pain is defined by the International Association for the Study of Pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. Almost everyone has experienced some type of persistent or nagging pain. We recognize how frustrating and debilitating it can be. We also treat patients everyday with pain problems ranging from acute pain episodes to long standing complicated pain conditions. Below are 5 facts about pain that might surprise you and help you reduce it!
We hope that these 5 facts about pain may give you a better understanding of this complex problem! Pain is never simple and often times you need a TEAM of doctors on your side. This team may include a physician, pain psychologist, counselor, health or life coach, supportive family, friends and of course your PHYSICAL THERAPIST!
#1. Your pain is real!
Your pain is real! You especially need to hear this if your pain is chronic. Chronic pain can be a debilitating condition, but on the outside you may look just fine. You are likely still going to work, caring for your family, going out with friends, and trying to enjoy life and be active. Because of this, many people may not understand or question your complaints and concerns. This can be extremely frustrating, but always remember that the pain you are feeling is REAL and it is not “just in your head.”
#2 Pain is a top down phenomenon
This means that the brain makes the determination of pain (not the body part where the pain is located.) For example, if you accidentally touch a hot stove with your hand, you want to know about it so you can take your hand off of the hot stove. When you touch the hot stove, your brain receives a danger signal via nerve fibers to your spinal cord and up to your brain. The danger signal tells your brain, “Something is going on at the hand, what should we do?” The brain analyzes the situation, taking into account potential tissue damage, the context of the situation, reactions, your thoughts and beliefs and many other factors. The brain then decides, “HOW DANGEROUS IS THIS?” If the brain determines the situation is dangerous enough, you will have pain. Pain is our body’s HARM ALARM! We need pain to keep us out of danger. Pain is a good thing and it is our brain that determines when we have pain, not the body part where the pain takes place.
In some cases, however, the body’s harm alarm can “stay turned on.” When this happens, we call this chronic pain. Chronic pain, as defined by the International Association for the Study of Pain, is pain that persists well beyond the normal amount of healing time. The time frame is usually around three months. By three months the acute injury should have healed and the pain eliminated. In some people the pain persists well beyond this three month time frame and that is when things get tricky. If the tissues are healed why are you still having pain? We will answer this with fact #3.
Check out this great Tedx talk by professor and researcher Dr. Lorimer Moseley for a more in depth explanation.
#3. Pain does not equal tissue damage!
If you have pain, it does not mean there is tissue damage and if there is damage to the tissue, it does not mean there is pain. Here are a few examples:
1) You have a bruise (damaged veins & capillaries) but you have no idea how you got it and have no pain.
2) If you get a 4th degree burn, you will not feel pain because the nerve endings are severed. However, there is significant tissue damage in this case.
3) If you take 50 asymptomatic people on the street and take an MRI if their lumbar spine, over 50% of those people will have some kind of incidental finding on their MRI. Ex: disc herniation, arthritis, stenosis, facet joint hypertrophy
All three of these scenarios are examples of clear tissue damage, yet the brain did not think it was dangerous to send a HARM ALARM to the system. On the flip side, many times you will experience pain and have no tissue damage or the injured tissue has already healed.
So to answer our question from #2 on why do we continue to experience pain?: Tissue damage is not necessary for pain! Your nervous system (brain, spinal cord, nerves) is running the show when it comes to pain...especially with chronic pain conditions. Your nervous system loves you so much that it is being overprotective...just like an over protective parent!
#4. Should I take an opioid?
So what should I do about this overprotective nervous system? Should I take an opioid for my pain? We are often prescribed an opioid drug after an acute injury, after a surgical procedure, or for common problems such as low back pain. For an acute injury or if you just had surgery, an opioid should work really well for short term use to help control your pain. BUT, that is where opioids should stay: FOR SHORT TERM PAIN RELIEF after a surgery or acute injury. When opioids are used for a long period of time or for those with chronic conditions such as low back pain, neck pain or headaches, opioids will actually make the problem worse. Research shows that long term use of opioids can increase the efficacy of the danger pathways by sending more danger signals to the brain and increasing volume of those signals. This will cause your nervous system to become more sensitive and therefore it takes less input to the system to cause pain. Due to this, after taking opioids for long term use, they will stop working for your chronic condition and cease to give you the relief you are looking for.
Then, you will need to find something else! We recommend hands on, manual physical therapy in combination with exercise. There are so many things a physical therapist can do to help calm your hypersensitive nervous system and give you relief of the chronic pain you have been experiencing. This does take time and work though and will not happen overnight!
#5. Fearful avoidance of movement will make pain worse
Finally, the most important point about pain. Often times we hear blanket statements such as, “Don’t ever bend forward or you’ll hurt your back,” or “Don’t squat because it will make your pain worse.” As a physical therapist, I hear daily comments such as, “My doctor told me to never bend, twist or lift heavy objects OR I haven’t squatted since I hurt my back doing it over 10 years ago.” Have you ever avoided an activity or said to yourself, “I can’t do that movement because it will make my pain worse?” These are all examples of fear avoidance thoughts that often become fear avoidance behaviors. These behaviors will lead to lack of use of the musculoskeletal system, social isolation, and hyper vigilance to your pain condition. It makes you think you are damaged.
Research shows that fear avoidance behavior will actually make your pain worse and it can become chronic. This is why it is SO important to keep moving in any way that you can pain free. Our bodies are made to MOVE! If you want more guided education on movement, see your physical therapist. We want you to remain as active as possible. Our goal is to break the cycle of your pain by putting positive input into your brain. Movement does not equal harm!
-Empower Movement Physical Therapy Team
We want you to know that pain is something that can be manipulated and controlled. We have the tools to help you deal with both acute and chronic pain in a holistic manner to keep you as healthy and active as possible. Our number one goal is to keep you doing the things that you love, everyday!