What is Pain?

Happy New Year and welcome to the first edition of STRONG & ADAPTABLE!

To launch STRONG & ADAPTABLE I want to shed some light on the question: “what is pain?”

Pain is the number one reason patients come to see me as a physiotherapist and understanding more about pain is a vital step in taking control and doing something about it.

Modern society has demonised pain as something that should be avoided at all costs. “Pain is bad and means something is wrong” is the message delivered by the media and often, sadly, by the healthcare industry.

However, while not being able to feel pain may sound like a blessing, it’s actually a serious condition with reduced lifespan and high injury rates: https://en.wikipedia.org/wiki/Congenital_insensitivity_to_pain

Pain is therefore essential to your survival!

A simple way to look at pain is as a protective alarm system. This alarm system gets a constant stream of information from: your body, your thoughts & beliefs, your environment, past experiences, your social circle and just about everything else going on in your world. All this information is evaluated and if the alarm system perceives you to be under threat or in danger then pain is the output.

This was nicely consolidated by some of the top researchers in the field into the following equations:

(Evidence of danger > evidence of safety) = PAIN

And, vice versa

(Evidence of safety > evidence of danger) = NO PAIN

This is nicely demonstrated by one of my favourite medical case studies from the British Medical Journal:

Nail through boot

For the builder there was a lot of evidence of danger (nail sticking up through boot) and little evidence of safety (everyone knows a nail sticking through your boot is a bad thing) and so the pain he experienced was a logical result.  Importantly, the pain was also 100% real, pain is never psychological or “all in your head”, it may be strongly influenced by psychological factors but the pain experience is always real and unique to the individual. When he was shown that there was no damage to his foot (strong evidence of safety and no evidence of danger) then I would imagine that his pain disappeared!

The principle message here is that pain does not always equal damage.

So where does this all leave us? Hopefully you can see that pain is an experience generated by the brain and body with many contributing factors and may not always be an accurate indication of damage or danger! This means there is rarely one cause for pain and theories that try to tell us pain is caused by a single factor are unlikely to be telling the whole story. Pain is a measure of sensitivity and perceived threat rather than a direct measure of damage.

Treatments for pain, therefore, should look to address the wide range of factors that can contribute to pain and aim to increase ‘evidence of safety’ and reduce ‘evidence of danger’. Put simply, this means that when you seek professional help for pain you should leave the consultation feeling more confident and ‘safe’ than when you arrived. The human body is incredibly strong and adaptable and pain can always change!

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This is a fantastic 15 minute video called ‘Why Things Hurt’ and relates brilliantly to this post:

Disclaimer: The information in this blog is not intended to provide or replace medical advice but to help you better understand your own body. If you are unsure about any symptoms you may have then please get checked out by an appropriately qualified medical professional.