“Arrrghhh I’m in pain” – see cheesy stock photo above! Or maybe picture generic footballer rolling around on the floor clutching a random body part. Why are there so many different types of pain? As one of our clients so eloquently put it “we have a smorgasbord of pain available to us at any instant.” Lucky us!
Pain can be achey, sharp, stabbing, we can have bone pain, pins and needles, numbness and tingling and these are just the basics. Then we get into the more peculiar pain that people sometimes describe “It’s like I’ve got spiders constantly running across my back”, “it’s like there’s permanently hot water on my skin” and “I feel like I’m being constantly stabbed with a knife!”
Is My Pain Normal?
Thankfully yes. All pain is normal. All of those “flavours” of pain we mentioned above are perfectly normal and can be explained away. Some are muscular, some involve nerves, some involve fascia, some might involve the adipose (fat) layer if new research is to be believed. Most pain involves all of the above.
Before we go further a little aside on nerve pain. If you do have nerve type symptoms – that’s bone pain, pins and needles, numbness and tingling – unless you have a been in recent high speed accident or in a disagreement with a horse or other such large animal – you have not damaged the nerve! It’s also highly unlikely you’re having a heart attack too! Don’t even get me started on the expression “trapped nerve” – thousands of years of evolution have seen to it that such things don’t happen. Yes, there may be tension on the nerve, yes the nerve may be contributing to the sensation you are currently feeling but it is not trapped! Rant over.
Back to pain being normal. Have a read of the thoughts of our friends from the NOI Group, pioneers in increasing our understanding of pain:
“We believe that all pain experiences are normal and are an excellent though unpleasant response to what your body judges to be a threatening situation. We believe that even if problems do exist in your joints, muscles, ligaments, nerves, immune system or anywhere else, it won’t hurt if your brain thinks you are not in danger. In exactly the same way, even if no problems exist in the body tissues, nerves or immune system, it will still hurt if your brain thinks you are in danger. It is as simple, and as difficult, as that.”
That may have twisted your brain a little bit but in short it is ultimately your brain that determines the amount of pain that you feel. Take someone who is fearful of damaging their back or making it worse, they move around gingerly fearing every pain they feel is making the condition worse. Does this holding themselves tense for fear of the pain make the condition better or worse?
Equally and very differently, take the stories in the battlefield of one solider with a leg blown off reporting no pain as he crawled across the battle field to save his or his comrades life. Or in the film 127 hours where Aron Ralston cut his arm off with a penknife. He describes it as feeling weird but not painful. His brain judged that feeling pain was not necessary as he was saving his own life!
What Is Pain?
Is a fantastic question! We’re still trying to fully work it out. What seems sure is that it’s complex! Have a read of these two paraphrased quotes and then I’ll translate below:
- “Pain is a multi-system output that motivates and assists the individual to get out of a situation that the brain perceives to threaten the integrity of the tissues (Moseley 2003).”
- “The pain intensity, location, quality results from interactions of environment and psychology(FM Blyth 2007).”
All very good and well but what does that mean in real terms? Put simply if by one measure or another your brain thinks something is going to hurt, then it will. If you fear something is going to be painful then it is. If you’re having a bad day it’s going to hurt more. In short pain is merely a warning. Not catastrophic.
The best practical example I can give of this idea is if you’re walking down the road and you ‘go over’ on your ankle. You immediately get a shot of pain, maybe roll around on the floor like a footballer, then realise you’ve not damaged it as you thought and continue on your merry way. We’ve all done it. The pain was there as a warning before we damaged any tissues. That is what pain is for.
Of course if something stopped us from correcting ourselves and we did damage some tissues then of course it’s different story. More pain, swelling etc, but don’t worry it will all be fine in 6 weeks!
So You’re Telling Me It’s All In My Head?
Errr, well yes and no. So pain is all in your head yes. That seems to be true. Functional MRI research seems to suggest it is. These multiple systems referred to previously are all brought together in the brain to determine how relevant and important it is. If you’re running away from a lion your brain is unlikely to tell you that your knee hurts a bit!
Conversely if you’re sitting around feeling sorry for yourself the brain is more likely to tell you that your knee hurts and if your in a negative frame of mind then it may mean the end of the world as we know it. A nice bit of catastrophisation which we all like to do from time to time, but it all adds to our pain experience.
So what are these multiple systems? Firstly the bit that hurts! Yes, finally, there may even be a problem with the tissues on the bit that hurts. But this is just the start. Your immune system has been shown to have an impact on the level of pain your feel – just consider how many body parts you feel when you have a cold or flu. As we’ve already discussed the psychology affects the level of pain – the more you think it’s going to hurt, the more it will. But the system I’d like to dwell on is your nervous system.
Many of you will be aware of the fight or flight response. Simply put this is our “stress response.” It is a safety mechanism to make us more aware of our body and our surroundings when we feel threatened. Just think how good your hearing is when you think someone is burgling your house! In modern life we have so many lesser stresses and strains we sometimes struggle to get out of this heightened awareness situation.
If you want to get technical our autonomic (that just means bit we don’t have to think about) nervous system becomes sympathetic (the bit that keeps us on edge). Simply put you constantly feel everything in your body more. Pain included. This is the concept of central sensitisation.
So You Still Think It’s All In My Head?
Well no, and er yes! Back in the day Physios used what they call a psychosocial model to explain pain they couldn’t fix. Basically what they were saying is that it is either a social cause e.g. issues with family, work or surroundings, a psychological problem or a combination there of that manifests itself as pain in the body.
In these enlightened times we have changed! We now have a biopsychosocial model. Which in real terms means that emotional factors are still considered to be a factor in everyone’s pain experience but there is usually an issue with the tissues aswell – we just feel it more when we’re stressed out, run down or just plain annoyed!
Lets Get Fluffy!
No many years ago when I was just a geek and not a muscle-geek this next section would have really annoyed me. I include it just for debate as much as anything. There is a branch of research called meta medicine which goes into more detail about how we actually feel about life can manifest itself in how we feel our body.
For example if you feel betrayed, like you’ve been stabbed in the back, then maybe your symptom will feel like a knife in the back. Like I say interesting food for thought. Apologies to any meta-medicine gurus out there for my simplistic explanation!
So I hope I’ve made a half decent fist of getting some very complex ideas across in my witterings above. It really is all very interesting and great new research is flying around almost weekly leading to new advances of our scientific understanding of pain. There’s some amazing ideas and more research is ongoing to continue to explore and try to put more evidence on these amazing ideas.
Ultimately you’re fine. We’re all fine. All pain is normal. All pain I believe can be eased and removed.
If you have pain that you just don’t believe will ever go then the lack of belief is the first thing we need to sort out. Come on in and let us help you with that. We specialise in showing people that their bodies can return to the greatness of old.
A few wizzy tricks from us to show you how range of movement can be quickly restored, pain patterns removed and you’ll soon be feeling more positive about your condition – and then we’re tapping into the psychology of the condition. If we make you feel more positive about your condition you feel the symptoms less. It’s that simple. If you’d like to have a chat about any pain condition please call us now on 01273 921831 or mail us at info@BrightonSportsTherapy.co.uk.