Pain is a normal, human experience.
Without the ability to experience pain, humans would not survive. In the last several years our knowledge of how pain works has increased considerably. In many persistent pain states, focus has shifted to the nervous system and the brain as the main contributors to pain. This is for all pain, regardless of where it is in the body and how long it has been going on.
The good news is, tissues such as muscles, ligaments and joints generally heal between three to six months.
But, why does your pain continue?
In this article I hope to help your understanding of pain, what variables influence pain and how to get back to training.
Firstly, what is pain?
Pain is simply a message delivered to you from your central nervous system and it’s a message that can be altered by dozens of different factors. Depending on your current situation, your personal history and what other things are happening in your life, you can be more or less sensitive to that message.
Acute Pain: This occurs when you touch that hot pan or break your bones. It’s a very quick and immediate sensation along the nerve pathways sending warning of tissue damage. Acute pain tends to resolve on its own and simply requires activity modification.
We’ve all experienced different types of pain and understand the difference in feeling between the pain of stubbing a toe (acute) vs a nagging back ache that just won’t go away (chronic pain).
Chronic Pain: This is where things get more complicated. Chronic pain is defined as pain lasting over 12 weeks. This is seen with the millions of people dealing with a variety of back, neck and extremity pain. Estimates from the Australian Bureau of Statistics 2017–18 National Health estimate about 4.0 million Australians (16% of the population) have back problems. The 12-week definition is based on the normal wound healing processes and theoretically by the end of that cycle pain should end.
What does the latest science reveal?
The latest science reveals that there can be little to no correlation between tissue damage and perceived pain. For example, you can take two MRI scans of different people that show similar structural problems and one will report no pain while the other person can barely move without wincing.
It’s important to know that persistent pain is more due to the sensitive nervous system and how the brain processes information from the body and the environment. Your nerves monitor your body and inform you and your brain of anything and everything going on in your body. If you were to step on a nail, the nerves in your foot need to send the message to your brain so that action can be taken.
When there is danger the nerves increase electrical activity and ‘wake up’ sending a lot of danger messages to your spinal cord and brain. The brains action’s may include walking funny, producing stress chemicals in your body or even using a choice word or two. In this case, your brain produces pain in your foot so you are alerted and take action. Once action is taken the alarm system will gradually settle down and return to normal resting level of activity.
This applies to the entire body. When you hurt yourself, have an accident, undergo surgery or experience a lot of emotional stress the same process as the nail in the foot occurs.
Understanding Pain Thresholds
When you have pain in a certain body part whether it be your back, elbow or shoulder the nerves in these areas wake up. In some people the nerves that ‘wake up’, to alert you to danger in your tissues calm down very slowly and remain elevated and ‘buzzing’.
In this state it does not take much activity such as sitting, reaching, or bending for the nerves to fire off danger messages to the brain. The nerves become extra sensitive.
This response is actually quite normal but it impedes on movement and function a lot.
In the diagram above, the healthy system (before you developed pain), you were able to perform any task quite easily and for long periods. But since you developed pain (sensitized system) it now doesn’t take much to experience pain.
No wonder it feels like something is wrong. Think of all the activities that you used to do such as exercising, house chores and walking the dog. Now think about how limited you are with the level of pain you now experience. The main issue is increase nerve sensitivity resulting in a lower pain threshold which often traps people in a dangerous cycle.
How do I know if my alarm system is too sensitive?
• Your activity level before reaching pain has decreased a lot
• Pressure on your skin or around the painful area is very sensitive
• When you move certain body parts you are very sensitive
Why do some people’s nerves stay more sensitive to others?
There are numerous factors that can contribute to someone’s pain experience. Some key reasons include
1) You feel stressed when you’re not sure what treatment options you should follow as everyone has a different opinion. This uncertainty will leave the alarm system elevated while you seek answers.
2) Family and Job- Pain has impacted your family life and job. These concerns provide little incentive to your brain to turn the alarm system down.
3) Failed treatment- you may wonder why your treatment hasn’t worked. This leads to more concerns that keep your alarm system elevated.
4) Fear- Considering the failed treatments, various explanations for your pain, job issues and family concerns there is bound to be a lot of uncertainty. This is quite common but it is shown that fear of injury or re-injury and fear of exercise or movement will keep the alarm system turned on rather than off.
The Pain Cycle
Psycho-social inputs such as stress, anxiety, depression and the belief that you can’t get better is a huge input on the system that will greatly affect your outcome. The stress and emotional components of suffering don’t imply that the pain is ‘in your head’ or that your pain is not ‘real’.
In fact the pain is very real.
It’s to make the point that pain can increase or decrease based on everything that is happening in your life and its influence on the nervous system.
Key points about pain and nerves:
• When you develop pain, your nerves increase their sensitivity to protect you
• This is normal response that happens in every human being
• These sensors are constantly updated based on your environment
Adding to the recipe, if nerves in one area are constantly setting off an alarm system then nerves in other areas also begin to be awakened as the nervous system is completely connected. It isn’t uncommon to then experience some sensitivity, such as aches and pains or to sense a general spreading pain.
Recognizing this is an important part of addressing your condition as it often can create a cycle that is difficult to deal with and break.
Take control of your pain
Ok so what things can you do to start taking control of your pain?
- Knowledge- Understanding the neuroscience of your pain will help ease some fears, explain some unknowns and provide some hope as pain doesn’t equal tissue damage. If you start to understand pain is complex, how you think about pain is vital to how much pain you experience and that a big cause of your pain is heightened sensitivity you are well on your way to recovery. Remember pain doesn’t’ = tissue damage. Studies show that nerves start to calm down once your awareness regarding the root of your pain increases.
Exercise- Research shows that exercise that gets your blood pumping and oxygen through your body helps calm nerves down. This can be as simple as a brisk walk for 10-20 mins. Also remember the more you exercise it can lead to better sleep, weight loss, decreased stress levels and help depression. All these factors will help calm nerves down
Sleep- Few things effect your health greater than your sleep. At least 7-8 hours is recommended. People in Australia average less then 6hrs and people in pain often less. Changing sleep habits is hard but important for recovery.
There are many other strategies but these are my big three to help you get started. The information presented is based on numerous research studies and if you would like more information about them or have any questions don’t hesitate to ask.