Why Do I Have Pain?
You might have pain after stubbing your toe, having surgery, or having endometriosis. These are very different causes but pain is created the same way in all three circumstances, as well as every other way you may experience pain.
To experience pain, our body goes through several steps.
The sensors in our skin, muscles and joints experience a change. This can be temperature, pressure, stretch, or movement. Let’s say you are walking around the house and happen to step on a thumbtack or something sharp, the perception that you have stepped on something sharp is driven by this pain-perception system.
The nerves carry that message from the sensors up to the brain. This is called input to the brain. The nerves travel from your foot up to the brain with the information that something sharp has touched your foot.
The brain processes that information and decides what to call it. The brain may decide some is sharp or soft, a small pressure or high pressure, a comfortable stretch or uncomfortable stretch. The brain interprets that message and decides the sharp object is painful.
Then based on the brain’s interpretation of the input information, a signal is sent back to the muscles. This message, or output, tells the body how to respond. For example, you may look down at your foot and see what you stepped on.
This all happens very quickly; within fractions of a second in most cases. This speed helps keep us safe. It also helps keep us upright, walking and moving, without falling down. When we walk, our brain is making tiny adjustments to our muscles to keep us balanced. Our brain goes through this process millions of times a day for every sensation we feel. Pain is no different.
But wait! I haven’t even mentioned pain as a sensation yet. There are no sensors in the body for pain. We only experience pain when the brain interprets the input information as painful. That thumbtack in your foot wasn’t painful until the brain interpreted the sharp sensation as painful.
That doesn’t make sense? Let’s think of it a different way. Have you ever had a bruise but no idea when or where it happened. You probably ran into something right? That should hurt but it didn’t. Your brain decided that sensory information of you running into something wasn’t pain. It was pressure.
Still not sure about this? Have you ever stepped off a curb and sprained your ankle? That probably hurts. But what if a bus was coming down the street toward you? You’d get up quick and move, right? You might forget about your ankle for a few moments while you run to a safe place. Then, once that threat of being hit by a bus is gone, your ankle may start hurting again. The brain interpreted the sensations in your ankle as painful, but when you saw that bus priorities changed. The bigger threat is the bus and you need your ankle to move so the brain stopped interpreting the ankle sensations as painful and got you up and moving to the sidewalk. Once the bus had passed and you didn’t get hit the brain could refocus on the ankle.
Here’s one more example. Have you heard of phantom limb pain? This is pain that is felt in a previously amputated arm or leg that is no longer there. The person will continue to experience pain and sometimes other sensations in that leg. That can only occur if the brain is interpreting the signals, or in this case lack of signals, from the leg as pain.
The brain is key to our experiences of pain and all sensations. When people say it’s all in your head, they aren’t wrong! Though, that’s a rather insensitive thing to say! And those saying this may be implying that you are making it all up, but you aren’t. Some part of you hurts.
People with chronic pain are told this much more often than those with acute pain. Chronic pain works by the same process we discussed above. A signal is sent to the brain and the brain interprets that information and decides if it is pain or not. In the examples, there was a clear mechanism of injury that anyone can see as the cause of the pain. In chronic pain, it can be less clear. You may have had an ankle sprain that just won’t heal and now 6 months later it still hurts to walk. Or you may have never had an injury, but pain gradually increased and hasn’t resolved.
Your experience is real! Your pain is real!
But your pain may not be connected to tissue damage. Typical tissue healing time is within 12 weeks. Some shorter than that. So we know that after 3 months, the damage that had occurred is no longer there. (There are exceptions to this, but rare). The pain you are experiencing is your brain's interpretation of the input. The body is still measuring pressure, stretch, and temperature and passing that on to the brain through the nervous system. The brain is interpreting something as pain, even though that same sensation was previously not painful. Why would that happen?
The brain’s ability to accurately interpret information is influenced by a variety of factors:
Sleep quality and quantity
Emotional state - joy, fear, worry
Depression and anxiety
Beliefs about pain and the body
What other people tell you about your body
Work and home stressors
Each of these factors can positively or negatively affect your brain’s interpretation of the input signals. Being worried about an injury can lead to greater levels of pain vs understanding that the body will heal and that the pain will resolve in a few days or weeks. Having a job that you dread going to can lead to greater pain than a job you love. Not all of these factors will affect everyone, but everyone will be affected by at least a couple of these.
When working with clients with chronic pain, I address the tissues themselves and the above mentioned influences that affect the whole body. We will identify factors that are relevant to the client and develop a plan together to reduce or resolve these concerns.
Treating a person with pain is truly a holistic approach that must address every part of the person and not just a body part.