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Pain - in a nutshell

Some people love it, most people hate it - pain, that sweet & sour sensation that rains on our parade and stops all the fun (or makes sex all the better - but that's another story for another time!).

So what is pain and how does it work?

Pain is a sensation, like light touch, temperature, hunger are all sensations.

It is also an emotion, like anger, sadness, or ecstasy.

Pain can lead to behaviour change - just like hunger makes us eat, pain can make us avoid certain movements or actions, take time away from work, family, friends and doing things we love.

The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.

The key is in this last bit there.

All pain (and this is where it gets a bit confusing) comes from the brain. No brain, no pain. When our brains perceive THREAT it often kicks off a pain signal in order to protect the body part where the pain is felt. This is often confused as suggesting a person is inventing or making up their pain. This is not true - the pain is real, it just might not be caused by something other than structural damage.

In case you have doubts about the brain's involvement in pain, consider phantom limb pain - some amputees experience pain in a limb that is no longer there.... That's because the neurology or wiring in the brain remains in place despite the lack of limb. It can manifest as pain or intense itching and they consciously know that the limb isn't there but pain is being produced on an unconscious level by the brain.

Pain can make us believe that we have damaged ourselves more than we really have (and conventional medicine tends to promote this idea) which can make us think and feel all sorts of things as we then compound the pain with MEANING and beliefs about pain.

Pain is highly complex and multifactorial.

So while there is often some sort of injury or damage to a particular area, there can be pain in the absence of injury. This is surprisingly common and often results in people chasing test after test in order to identify a specific tissue to pinpoint the problem on. This can be useful for identifying other health issues that exist silently (a friend of mine for example discovered a gallstone from a spine MRI that showed nothing on his spine. The gallstone was unrelated to his pain) however, it often leads to tremendous frustration when all the test come back normal, or if the MRI shows some structural change that then becomes the fixation when actually it is unlikely the cause of the pain.

The paradigm that pain equals damage has existed for a long time, and with the availability of medical imaging, has increased this belief in patients and professionals alike. This means that many patients (and medical professionals) fixate on the idea that there is a structural issue causing the pain. As an osteopathy student, I was taught to identify the specific structure causing the pain. Sometimes it simply wasn't possible and this led to huge frustration, confusion and feeling inept.

However, more and more recent studies have found that the relationship between structural change and pain are not one and the same. For example, there is common belief that conditions such as arthritis, disc degeneration and spinal stenosis (and many more) are major causes of pain. However, these conditions tend to worsen with age, yet pain often DECREASES with age, which tells us that the pain and structural issues are not related. Instead, the pain is stress-related.

Then there's cases of severe injury but no pain - that's the funnest one of all, and what happened with many wounded soldiers during the First World War - the conditions in the war were so horrific that enduring a severe injury like having a limb blown off resulted in NO PAIN. I'll repeat: the severely injured soldiers had no pain.

Why? Because the meaning the soldiers gave their pain - that they could go home and get away from the horrors of war - was more powerful in their minds than their actual injury.

Beliefs around pain are major contributing factors to how we experience pain. Believing that we are damaged, that we might not be able to function properly, provide for our families, do the things we love all amplify pain.

When perceptions of threat are changed, and the meaning is changed, feelings of pain change too. If we see pain as an opportunity, a messenger trying to get us to do something different, often the pain decreases because our brain no longer perceives a threat. We can also train our brains not to kick off a pain signal through movement re-education. A double-pronged approach often is the most effective at bringing down threat levels, rewiring the brain and calming the nervous system and thus reducing pain.

So the soldiers who were wounded severely and waiting to be sent home had an immediate down regulation in their nervous system - suddenly they felt so much safer being away from the battlefield - so their brains didn't need to protect them with a pain signal. The meaning changed, the pain changed.

So if you have been experiencing pain, it's important to be aware of the meaning we give it, then change that meaning if necessary. When we look for safety within and around us, our nervous system calms down and the pain with it.

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