P A I N

Pain can sometimes occur for really simple reasons, other times it's a little more complicated. Here's a tip to starting off on the right track to get the support you need...

'DON'T LET YOUR MATES, THE INTERNET, OR SOCIAL MEDIA DIAGNOSE YOUR PAIN'

Any symptoms of pain should be assessed by a qualified and registered medical professional (such as a doctor, paramedic, physiotherapist, or in an accident and emergency department) 

ACUTE PAIN

Nociception

Nociceptors are sensory receptors in the nervous system that respond to anything that has the potential to cause damage to the body. To put simply, they could be called 'Pain Receptors'.

Acute pain relates to pain that is experienced immediately after or near to the time of injury (such as falling on a wrist, or rolling an ankle).

Nociceptors become stimulated by a sudden (acute) injury, and cause the feeling of pain. It's natural purpose is to stop the person continuing whatever it is that has caused the injury in order to prevent further harm to the body. 

Extent of Injury

When it comes to acute pain from a nociceptive stimulation (sudden injury), the amount of pain is often related to the level of damage to the body, whether that's damage to the muscles, ligaments, bones, skin (for example).

Basically meaning if somebody has undergone a very severe injury, there is the potential for the person to experience a higher level of pain, and possibly for a longer period of time. For smaller, less severe injuries the pain may be less, or for a shorter period of time.

How it goes away

What's good about acute, nociceptive pain is that it generally starts to disappear as the injured area starts to repair itself, and should have eased off significantly (or completely) by the time it has healed.

This depends on many factors that are covered in the 'Chronic Pain' section below.

WHY PAIN SOMETIMES LASTS LONGER THAN EXPECTED

Tretment

Treatment for acute pain can vary depending on the structure that has been damaged, and how severe the injury is.

In the early stages of minor Soft Tissue injuries, POLICE is often used. And for minor broken bones, pain medication alongside immobilisation is often used while the bone heals.

There can, of course, be a surgical need for any type of acute injury if it is severe enough. This could make the pain management plan a little more complicated.

CHRONIC PAIN

WHEN PAIN LASTS LONGER THAN EXPECTED

Nervous System

Research suggests that chronic pain is related to physical changes in the nervous system (system of nerves that send signals from the brain, down the spinal cord, and to the rest of the body).

 

Repetitive activation of the nociceptors (pain receptors) through repeated injury or some of the topics discussed further down the page, can over time start to cause neurons in the spinal cord to become hypersensitive.

 

This can start to cause normally non-painful (non-nociceptive) signals to be misinterpreted as painful signals. 

In simple terms, things that would normally not be painful now have the ability to cause pain.

War Zone

Let's now consider two scenarios:

'A soldier has a serious injury on the battlefield but does not experience pain in that exact moment. When they return to safety, the pain starts to kick in'

 

'Somebody with a minor injury, such as a pulled muscle in the lower back, can feel extreme pain if they are worried about it or if they have previously had a bad experience with the same situation' 

Influence

The point made by the previous slide is that cognitive and emotional factors seem to have the power to influence the way that people experience pain, in both a positive and negative way.

 

Returning to the nervous system, the area of the brain that influences the excitability of the same neurons that can become hypersensitive in chronic pain, is under control from the areas of the brain that are involved in processing anxiety, cognition, and attention. Studies have also shown that increased brain activation of the limbic system (the area that is involved in emotion & memory) is evident in people who struggle with chronic pain, anxiety, depression, catastraphizing, and anger.

 

This shows that behavioural and emotional factors can have an impact on pain.

Burglar Alarm

A way that some people explain chronic pain is by comparing the human body to a house with a burglar alarm:

'If the alarm went off in a house, one may start to worry there is a burglar there, and call the police. However, if the alarm regularly keeps going off but the police never find a burglar, then what is going on? One would have to have a look for themselves, only to find that the alarm settings are set too sensitively'

Here the alarm system represents the nervous system that processes pain. It's become over-excitable, setting off the alarm (causing pain) when no physical damage is actually occurring (no burglar).

Common Signs

Common concepts that can keep the alarm going off with chronic musculoskeletal pain include:

'Fear of movement'

'Worrying that movement and exercise will cause more bodily damage'

'Worried about returning to work because when they are at work their pain will get worse again'

'Mental health factors such as stress, anxiety, depression, and negative thought processes such as catastrophizing'

Treatment

So what do you do about all of this?

Well, the short answer is getting support from a healthcare professional who understands pain, and from there they can help to discuss which factors may be influencing the pain of an individual. Treatment needs to consider biological, psychological, environmental, and genetic factors.

Understanding the well-rounded picture of a person who is struggling with chronic pain is key to helping them to manage it better with basic strategies such as promoting exercise and movement, while addressing any stress or anxieties that could be having an impact.

Remember

We have spoken a lot about the nervous system in relation to pain. But we cannot forget that..

'Pain is still a very physical feeling, whether it's due to an injury, or excitability / hypersensitivity of the nervous system'

We've spoken about how research suggests a relationship between behaviours, thought processes and pain. But that DOES NOT mean that the physical feeling of pain is not real.

Bail_edited.png

D O E S

P A I N

E Q U A L

D A M A G E ?

In acute pain, it can mean there is some bodily damage. In chronic pain, it does not always mean something is damaged therefore the approach to dealing with this type of pain will be different to acute.

This bail was me in London, 2011. The slam could cause initial acute pain from an injury. Once this injury heals up the pain should also ease up and return to normal. If, however, I was still experiencing this pain further down the line (passed the point of when acute pain should have eased off) then this could be chronic pain related.

IN RARE CASES, PAIN CAN PRESENT LIKE ONE THING, BUT IS ACTUALLY SOMETHING ELSE.

 

An example is: back pain coming from an internal organ rather than the muscles around the spine, or knee pain coming from an inflammatory condition like rheumatoid arthritis rather than a pulled muscle. This highlights the reason why pain should be properly assessed by qualified and registered medical professional.