What is pain caused by?

Whether it be acute or longstanding, one of the most common presentations that brings people to see a physiotherapist is pain. In this blog, our physiotherapist Tegan Skipworth delves into what factors contribute to pain.

What is pain?

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 basic function of pain is to protect us from harm. It acts as an alarm system to our body, similar to outputs of fatigue, hunger and depression, all of which prompt a subsequent reaction. Pain is the message that causes us to protect injuries, withdrawal from danger, and do no harm. This understanding serves very well for circumstances of acute injuries such as torn muscles, strained ligaments or traumatic injuries. However, what it doesn’t explain is the scenario of small injuries causing substantial amounts of pain. For example, how does a paper cut cause such large amounts of discomfort or why do amputees report pain in an area of the body that doesn’t exists such as phantom limb pain.

What is pain caused by?

Pain is a very individual experience. Simply put, it an output from our brain that draws on biological, psychological, and social experiences. These factors interact in a complex way to determine ones’ unique pain experience. Our previous understanding of pain was that was caused by tissue damage. We now know this is not always the case.

Pain that is the result of tissue damage, such as a torn muscle or strained ligament, is the result of nociception. Nociception is the process where specific receptors in our periphery respond to a potential or actual damaging stimulus. This message is then relayed to the brain via the spinal cord. Most of the time, our symptoms with resolve as the damaged tissue heals over the course of a predicted rehabilitation period. During this early stage, pain relief, hands on physiotherapy techniques, and exercise intervention are almost always appropriate.

What qualifies as chronic pain?

When pain continues for a period of greater than 12 weeks, we refer to this as persistent pain. Commonly, any previous tissue damage has usually healed. Symptoms of chronic or persistent pain are usually becoming vague or diffuse. Persistent pain is a result of our alarm system becoming hypersensitive as the pain is no longer is the result of danger or damage. It can be challenging to manage this type of presentation. A greater understanding of what is contributing to an individual’s pain is usually necessary. Persistent pain can be influenced by past experience, memories, emotions, thoughts, and even background or culture.

If we review the example of phantom limb pain. It is very obvious that a limb that does not exist cannot be the source of pain. In essence, this pain is being caused by the complex interactions within our brain. What might be happening is that the individual could be experiencing triggers that cause the same output of pain to occur as with the initial injury. For example, if a limb was lost as the result of trauma, any potential trauma or recall of trauma could cause an individual to experience pain.

What influences pain?

Pain can be amplified or reduced by context. In the clinic we commonly see this when a patient believes their pain is associated with a particular setting or activity. A good example of this could be certain exercise types. Deadlift exercises are usually perceived as bad or harmful by individuals who have experienced back pain before. However, the deadlift is a simple hip and knee hinge movement that very closely correlates to movements we perform on a daily basis. When someone picks something up from the floor or bends to lift a heavy box, they may not have fear or back pain. However, labeling that movement as a squat or a deadlift can result in the individual becoming fearful of pain or even experience pain. Of course, this exercise is not always appropriate for everyone. However, this is a simplistic and basic example of how a label or past experience of movement can influence our pain.

How do you manage pain?

Whilst pain can be incredibly complex, it is important that you do your best to understand all of the factors that may be contributing to your pain. This can be very helpful for your physiotherapist or health professional to know when considering how to best help you. If it is all a bit confusing, ask for some references or readings that might help you better understand the complexities of pain. Once you have got your head around the fact that many things could be contributing to your pain, it is all about coming up with an individual and specific management strategy. This will be a process that occurs with yourself and your health professional to assist in coping with your pain on a daily basis.

Just remember, in the same way that we are able to amplify our pain, we can train our brain to reduce pain output for a happier and healthier life!

If you are experiencing pain, don’t hesitate to book your appointment by calling us or booking online.