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Coping with pain is frustrating and we believe knowledge is power. In this article, we provide you with the basic foundation in understanding pain science and the many factors that play a role in how you experience pain.
What is pain?
The updated IASP definition of pain as of 2020 is “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.” The purpose of pain is actually protection; it’s supposed to be our body’s way of getting our attention in the event of potential physical harm. Seems simple, right? However, the way our mind and body process pain is very complex and extends much further than a physiological reaction.
How your body responds to pain
In order to understand this concept, it’s important to have a working definition of the following terms:
• Nociceptors: receptors throughout the body that interpret noxious or painful stimuli categorized as mechanical (pressure, stretch, strain such as muscle tears, stubbing your toe, fracturing a bone), thermal (extreme hot or cold), and chemical (changes in inflammatory processes such as injured tissues, neurogenic inflammation, and immune system inflammation).
• Spinal cord: for the purposes of this article you can think of the spinal cord as a relay system responsible for communicating nerve signals between the body and the brain. These signals can be conveyed from the body (such as from nociceptors) to the brain, or from the brain to the body (such as a motor signal from the brain to move a muscle).
• Input: information coming from the environment and nociceptors that is being sent to the brain via the spinal cord for further processing.
• Output: information coming from the brain that is being sent to the body from the brain.
• The brain: the body’s control center.
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So, a very simplified explanation of the pain pathway is that a noxious or painful stimulus is interpreted by nociceptors, this input of information is then sent to the brain where it is processed. After it is processed, the brain sends output signals as a response to the stimulus - which facilitate a behavior (moving your arm) and/or a physiological response (increased swelling to an area). These signals are communicated with the necessary body systems. It is worth mentioning the spinal cord is capable of processing pain and producing basic responses called reflexes to quickly protect the body. However, all information continues to the brain for processing and further decision making.
While the above is a description of the physiological mechanics of pain, we must also remember pain is a multi-faceted and extremely personal experience.
Factors that impact how you experience pain
Pain can be influenced by items that fall into three main categories: biological, social, and psychological factors. Biological factors include age, existing medical conditions, medications, and genetics. Social factors include cultural beliefs, social support, where an injury took place, and activities of daily living. Psychological factors include stress, coping mechanisms, beliefs about pain, mood, and expectations.
The impact of social and psychological factors on pain are equally as important for consideration. For example, stress in particular increases production of cortisol and pro-inflammatory chemicals which weakens the immune system and causes sensitization of the nervous system. This sensitization results in a heightened experience of pain in response to a smaller stimulus (things that wouldn’t typically hurt so much, end up hurting a lot).
Additionally, the thoughts and emotions an individual has surrounding pain can also create physiological responses that modify the way their body experiences, interprets, and responds to pain. Research indicates that when a person is highly fearful of pain, believes the pain will never resolve, or considers pain to be synonymous with damage this actually amplifies the feeling of pain by increasing heart rate, anxiety, and even muscle activity and spasms. These beliefs also result in a hyper awareness and monitoring of stimuli which can result in interpreting harmless sensations as threatening and painful.
This is why it is a common misconception that experiencing pain is always indicative of tissue damage or physical harm – especially in regard to chronic pain. The body’s responses to pain may have been impacted by beliefs and emotions surrounding pain so while there is no physical damage or threat, the pain is in fact very real.
The role of medications in treating pain
It is worth mentioning that medications are often prescribed to mitigate pain and work in various ways depending on their drug classification. Many people deal with pain by taking anything from over the counter ibuprofen to prescription strength painkillers. While this may dampen the pain temporarily, it is only a transient solution that doesn’t address the root of the cause. In fact, the best medication for most musculoskeletal impairments that produces long term results is exercise. For more information on the specific effects of opioids and exercise, see our in-depth blog explaining opioids in detail and why movement over medication is the way to go.
Why it is important to battle pain with a holistic mindset.
As you can see, pain is not as straightforward as it is often portrayed. Effectively combating pain requires an approach that takes into account every facet described in this article, as well as the understanding that everyone’s pain experience is unique to them. A holistic approach, backed by evidence, and guided by a physical therapist is an absolute must. Want to learn more about pain science and how physical therapists can use evidence-based approaches to help mitigate acute and chronic pain? Listen to a OneStep Physical Therapist explain below:
Download the OneStep Digital Physical Therapy app to be automatically connected with a licensed PT and have access to our 24/7 chat where you can ask any and all pain related questions.
References:
Raja SN, Carr DB, Cohen M, Finnerup NA, Flor H, Gibson S, et al. The revised IASP definition of pain: concepts, challenges, and compromises. Pain. 2020; 161(9): 1976-1982. doi:10.1097/j.pain.0000000000001939
Garland E. Pain processing in the human nervous system: a selective review of nociceptive and biobehavioral pathways. Prim Care. 2012;39(3): 561–571. doi:10.1016/j.pop.2012.06.013
Sheng J, Wang SL, Cui R, Zhang X. The link between depression and chronic pain: neural mechanisms in the brain. Neural Plast. 2017;9724371. doi: 10.1155/2017/9724371
