What is Pain, a quick exploration of the concept of acute pain.

Pain is a fascinating thing. It's the reason you come to see us, and it’s something many of you know all too well.   ​If you have been in pain for a while you’ll know a bit about it. You can describe your pain and what it stops you from being able to do, or be, and how that effects your life. But do you really know what it is? Why does that body part, or movement hurt? And how does it work? If you can understand this, it will help you gain control over your pain.

Let’s start by explaining what pain is not . It is not something that is picked up by ‘pain nerves’ and sent to the ‘pain area’ of the brain. There are no ‘pain nerves’, and there is no ‘pain area’ of the brain. It is a much more complex and multifaceted, protective mechanism. ​

​But what is pain?

Firstly, we need to recognise that it is an output, not an input. That is to say, pain comes FROM the brain… bear with me here.   

Think of the scenario where you kick your toe. Yes, this almost always hurts, but the process is a little different than that described earlier. Here nociceptors (nerves that pick up temperature, touch, and chemical changes) pick up the message and relay it up to the brain.
The brain is in charge of all of our perception, reasoning (conscious and unconscious), and action. The nerves from your toe that picked up the message and took it to the brain are simply messengers. The brain is the interpreter, and will now decide what this message means. If the brain determines that this stimulus is threatening to your safety, you will have pain. ​

​A definition of pain.

A physical and emotional experience that we have when our brain has perceived that there is a potential threat to our body.   This may be influenced either by a physical threat (like an injury or potential damage to our body), or a psychological threat (like a stressful or traumatic situation), or both.

​How do we know this?

There have been many studies investigating pain, aiming to understand how it works, how the same finding on an MRI can cause one person pain and not another, or how the context surrounding someone’s injury can affect their pain.

​An example of this is demonstrated in a 2007 study by former Physiotherapist, now Neuroscientist, Lorimer Mosley. He conducted a study to see whether it is the stimulus, or the context surrounding the stimulus that causes pain.

He had the participants in this study touched on the back of their hand with a probe. Firstly, they were touched with a blue light and reported minimal pain. The second time they were touched, a red light was shown, and here participants reported significantly higher levels of pain. What they were not told was that it was the exact same probe, at the exact same temperature both times.
The physical stimulus they were receiving had not changed, but the context surrounding the situation had. The brain detected the red light as hot and therefore a threat to their safety and hence they experienced pain. ​

​What results in your brain perceiving “threat” or no threat?

Let’s finish that above example of you kicking your toe:

Your brain has received a message that you’ve kicked your toe, now using all that it knows from your previous experience, your beliefs, and current context (your environment, current stressors, how much sleep you’ve had, etc.). Your brain will try to determine if there is more ‘danger’ than ‘safety’ surrounding the information it is receiving. E.g. you kick your toe, you’ve done this before and broke it, and you also didn’t sleep well last night because you’re stressed about your financial situation. It’s easy to see that in this scenario your brain will likely perceive a threat, and determine that you feeling pain right now is important for your safety.

​This pain response is a protective mechanism, your brain is all about survival, there are many historical accounts of people being shot, or even losing a limb, experiencing no pain. In these scenarios, their brain has determined that having pain right now would not aid in their survival, and hence they didn’t experience pain. ​

​To sum it all up.

This short post (it could be much longer, trust me!) is a quick exploration of the concept of acute pain. Ongoing pain states follow the same path, though in an ongoing pain state the brain is perceiving that there is a continued ‘danger’ or ‘threat’. When this goes on for long enough our nervous system begins to adapt, changing to become more sensitive (protective), and we can become stuck in a continual state of pain. This is called central sensitisation, or ‘chronic pain’. The good news though? We are bioplastic, our bodies and brains are always changing, adapting, and moulding to their current environment. Your bioplastic nature is what has lead you into this ongoing pain state, and it is what can lead you out.

To learn more about pain and finally get on top of it come in and chat with us, we’re always happy to help.

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Blog written by Jay Wildrick Physiotherapist.  Jay has an interest in chronic pain management and works hand in hand with Dr Peter Spittaler, Neurosurgeon.  Jay is available 5 days a week, call 4940 0730 for an appointment.