Pain is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage” (IASP, 2019).
Pain is not just about tissue damage – there are many factors that influence what you feel. Biological factors, like inflammation, tears or bulges make up only a small part of the input and are poorly linked to severity of pain (Moseley, 2017).
Other factors can include:
The experience of pain is an output by the brain and is a mash-up of all the different factors merged together. For example, an ankle sprain done on a basketball court may be extremely painful and stop you walking normally for a week or two. That same ankle sprain when being chased by a tiger may be seen as a minor nuisance because the brain decides there are other factors that are more important to our survival. We also commonly see that pain is worse when we’re stressed or highly anxious – not necessarily because the injury is worse, but because some contributing factors can amp up the output.
This does NOT mean that pain is all in your head. Even pain in the absence of tissue damage, or pain that persists after the damage has healed IS REAL PAIN. Treating these types of pain can be a little more difficult though, as it’s not a matter of just strapping, resting or massaging an area, it’s about re-training the brain to interpret signals differently, and making that output change from painful to relaxed. In some of these situations, it can be about working through the discomfort gradually, changing how we view things (maybe even with a psychologist’s help), and reassuring yourself that those movements aren’t as dangerous as your brain is perceiving (Tompkins et al, 2017). This should be done in conjunction with your health professional’s opinion and help initially, with the aim to getting you able to manage your own pain outside of a treatment room or office.
The biggest take home is that pain DOES NOT equate to amount of damage, and pain can exist completely independently of injury. This doesn’t mean you’re crazy, it just means you’re human, and there is much more to experiencing pain than many of us realise.
If you’re in pain, talk to your local health professional, or find someone with additional training in pain management to make sure you can look at all the influencing factors and how to modify some of the triggers you’re experiencing. If you’d like to know more, a great place to start is with the book Explain Pain by Moseley & Butler.
References:
IASP (2019). IASP’s Proposed New Definition of Pain Released for Comment. Retrieved from https://www.iasp-pain.org/PublicationsNews/NewsDetail.aspx?ItemNumber=9218
Moseley, L. (2007). Reconceptualising pain according to modern pain science. Physical Therapy Reviews 12(3), 169-178
Tompkins, D. A., Hobelmann, J. G & Compton, P. (2017). Providing chronic pain management in the “Fifth Vital Sign” Era: Historical and treatment perspectives on a modern-day medical dilemma. Drug and Alcohol Dependence 173(1), S11-S21
