What is Pain?


Last week we introduced our new pain program in this post http://wp.me/s3PbeT-pain.  Over the next few weeks we will be focusing on pain in our blog.  What it is, Why we have it, What to do about it when we can’t make it stop.  Pain is a huge problem in modern society, one of the most costly problems we have in health care.  And, it can make a lot of people’s quality of life very poor when it gets out of hand.  Over the last couple of decades pain science has changed how we think about and can treat pain.  The problem is it is counter to what the prevailing knowledge about pain was and sometimes counter intuitive.  Many people, including health care providers, are not integrating this new science into their practice of treating pain.  Over the next few weeks we will discuss how that works and can actually negatively affect outcomes.  Today we are going to try to define pain, what it is and why we have it.


To define pain I went to our favorite research tool, Wikipedia and got a couple of quotes. 

  1. Pain is an unpleasant feeling often caused by intense or damaging stimuli, such as stubbing a toe, burning a finger, putting alcohol on a cut, and bumping the “funny bone”
  2. The International Association for the Study of Pain‘s widely used definition states: “Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”
  3. Pain motivates the individual to withdraw from damaging situations, to protect a damaged body part while it heals, and to avoid similar experiences in the future. Most pain resolves promptly once the painful stimulus is removed and the body has healed, but sometimes pain persists despite removal of the stimulus and apparent healing of the body; and sometimes pain arises in the absence of any detectable stimulus, damage or disease.

I think most of us would agree on those definitions and descriptions.  Notice something though in the statements.  In the 1st it says pain is “often caused by damaging stimuli”.  In the 2nd it says pain is caused “with actual or potential tissue damage, or described in terms of such damage”.  In the 3rd it says “sometimes pain persists despite removal of the stimulus and apparent healing of the body; and sometimes pain arises in the absence of any detectable stimulus, damage or disease”.  These all are very important points about pain.  Much of the time pain can indicate some level of damage to the body, however sometimes you can get pain without any damage, and sometimes you can have all kinds of damage and it doesn’t hurt.  Pain and injury don’t always match.  This has become very important in our thinking in how to treat pain.  We will be discussing this a lot in the next few posts.

Most people I speak to about pain think that it is an output from their body.  In other words if something bad happens, say you cut your finger, sensors in your tissue, the skin, muscles, bones, joints affected, will send pain signals to your brain to alert your brain that you were cut.  In reality it works a bit differently.  Pain is actually produced from your nervous system, your brain, spinal cord, and nerves.  It does get signals from your finger that something happened.  The brain takes those signals along with many other factors including, context, chemicals, memories, and emotions and decides what to do with it.  Sometimes this comes out as pain, sometimes it becomes just another sensation.

So why does this come out as pain?  The main reason is for protection.  When our brain gets these signals and feels your body is in danger, it gives you pain to make you deal with the situation.  Imagine if you got a cut on your body and didn’t know about it.  You might bleed a lot without stopping it, you might not pull out the thorn and make it worse, or you might not take care of it and get infected, putting your body in worse danger.  So,pain in that context is a good thing.  But the brain is not perfect.  It doesn’t always know which stuff is dangerous or just potentially dangerous.  And it is basing its decisions with all sorts of incoming information and experience.  Which is why 2 similar situations in different people can get very different perceptions.

So, pain is an important adaptation for our body to have.  It is helpful in all sorts of situations of injury, illness, and disease.  Kind of like the check engine light in our car.  It is nice to know when something might cause more damage or need repair.  Of course, pain can become a problem in itself.  Just like when your check engine light comes on and your mechanic says nothing is wrong.  Now the problem is you are worried about your car all the time. If something really does happen how will I know the light is on? Is this going to be expensive? Am i going to break down in the middle of nowhere at 2am? Does the mechanic really know what he is doing? Even if 5 people check your car and say the same thing you will still have that knowledge, stress, and uncertainty to deal with.  The light is still on.  That is what can happen in our body with pain.


Now that we have defined pain and have a better understanding of it we can explore pain science more in depth.  Over the next few weeks keep an eye out for posts on how pain can go from an injury to just pain, and ways we can deal with it.







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