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Published on March 17, 2017

Understanding the complexity of pain

By Ashley De Los Reyes | LMH Therapy Services

Tuesday, March 14, 2017

We usually think of pain as being simple; for example, you sprain your ankle and now you have pain. It makes sense to assume if you hurt or damage your body, then you will have pain.

But what about those times you have pain without a cause? People often say they have pain, but can’t recall a specific injury. What about people who experience a terrible injury and are hardly affected?

An extreme example would be the dramatic story of a man hiking in Utah who fell and was trapped under a boulder. He was stuck for 127 hours until he was able to free himself by amputating his trapped arm with his pocket knife. Despite his injury and pain, he was able to rappel down a 65-foot canyon wall and walk 5 miles to safety.

How is it that people can experience pain so differently?

Ouch or not

Think about when you stub your toe. Stubbing your toe really hurts, but you don’t rush to the emergency room every time you stub a toe. Oftentimes after you stub your toe you think to yourself, “I broke my toe,” but then a few days later you forget it even happened.

The past experiences you’ve had when stubbing your toe have trained your brain to know that the extreme pain you experience doesn’t necessarily determine the severity of the injury.

Brain-body connection

Pain is not determined by a specific injury that happens to a tissue. How you experience pain and to what level is a conscious decision by the brain.

We all experience and deal with pain differently because of patterns in the brain and nervous systems. Why do we differ on how we experience pain? Why is it that one person might experience severe joint arthritis with little pain and someone else may have severe pain with minor joint arthritis?

The intensity of pain and how the body responds to it depend on how the brain processes pain. Research shows that many things, including stress, anxiety and past experiences, influence the pain response.

How you were raised as a child can be a big part of how you experience pain. Did your parents tell you as a child to “get back up, dust yourself off and get back on the horse,” or did they take you straight to the emergency department?

Current research is leading to a different understanding of how we can retrain our brains to be calmer about pain.

Sensations: pathway to the brain

Think of pain as simply an input to the brain. It is a sensation that at first you do not know if it is bad for you or simply seems bad. You bump your elbow on the edge of the table and have a sharp pain. Did you injure your arm or is it just that you tapped your funny bone? If you give your brain a moment to assess the injury, you calmly realize that you are fine, and the pain fades away.

When the pain message travels up a nerve, the signal travels the spinal cord to the brain. It is the brain’s job to process the input. The brain processes the information, taking into account your past experiences, environment at the time of the event, stress in your life and other factors.

Finally, the brain sends a signal out to your body. Pain might be the outgoing signal or you might feel tingling. At the same time, you are interpreting these signals and deciding if you should ignore the feeling or do something about the sensation. If the sensation doesn’t stop and the pain is constant, then you should seek help to find out why and what you can do to resolve the problem. Always consult with your health care provider if you are having pain.

Take heed and take care

Pain is still our body’s best protection against further possible damage. Pain alerts you to danger. When you step on a nail, you feel pain and pick your foot up. If you didn’t have pain to warn you, you wouldn’t notice the nail and would continue walking, potentially causing serious injury.

It is important to listen to your body and not be fearful of pain. Pain is not always a bad thing. It can be a good indicator that something could be wrong. If you are having pain, respect it, don’t fear it, and seek appropriate care and treatment.

Physical therapy can be a good resource to help you learn to manage pain and determine good versus bad pain. A physical therapist can train you to improve your posture, strengthen your body and help you win control of your life again.

— Ashley De Los Reyes is a physical therapist with LMH Therapy Services. She specializes in sports and joint/spine orthopedic rehabilitation at LMH Baldwin City Therapy Services. LMH is a major sponsor of WellCommons.

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