Does pain mean damage is being done?

The main reason we're told to stop doing something because it's painful is due to the understanding that pain is a signal that damage is occurring.

Walking on a broken ankle may cause further issues with your bone. Or that using a muscle that's already strained can cause further tearing.

However, this isn't always true, and the main distinction (although not exclusive) is between acute and chronic types of pain.

If someone has had back pain for 10 years, there's a chance that, on the inside, everything has healed, yet they're still in pain.

Classic models of pain view it as a 1-1 relationship with damage in the body. If you cut yourself, the level of pain will correspond with how much damage there is. Breaking my femur will hurt more than stubbing my toe.

The biomedical model of pain.

This is the biomedical model of pain. It assumes that symptoms are the result of tissue pathology and that there should be an organic solution for all symptoms. At this point, the biomedical model is considered reductionist in that, according to it, all pain is a simple signal of tissue injury.

It makes logical sense to stop here until you reflect on your own experience of pain. When I accidentally bang my elbow on the end of something, why do I start rubbing my elbow to help relieve the pain? And why does this work? Does my other hand have magical healing properties?’ Why do I sometimes feel pain while doing nothing to trigger it?

The interesting thing about pain is how many different factors and variables change pain signals and how we perceive them. An injured zebra running from a lion won’t feel much pain during the chase. But after the stressful event is over and it’s licking its wounds, you can bet feelings of pain will increase. This is also a survival adaptation. If the initial wounds and the following pain were enough to incapacitate the zebra, it would have no chance of getting away. Instead, it blunted the pain signals temporarily to have the capacity to escape.

Once we have a chance to realize the pain is there (or once the stressful event is over), the signal has set the alarm off.

Let’s dive deeper into how this works. The sensation of pain originates from receptors located all around our body. Cut yourself with a knife, and we slice open various cells, releasing chemical messengers that bind to pain receptors, triggering pain. The tissue injury also triggers cells of the immune system to flock to the injury site, which promptly swells. This is called inflammation, which triggers chemical release that makes pain receptors more sensitive.

Going back to other factors that affect pain perception, the strength of a pain signal can be blunted if other sensory information is coming in at the same time. As mentioned earlier, if I bang my elbow on a wall and then rub my elbow with my other arm, I’m supplying another sensory input which interferes with the pain signal. This is partly why massages feel great (albeit temporarily). Even chronic, throbbing pain can be blunted by this other sensory input.

When something goes wrong with these pain pathways (your nerves talking to your spine), you can end up feeling pain long after the pathological signal has stopped or your injury has healed. Sometimes you can even get a pain signal for something that shouldn’t be causing pain at all. This is referred to as allodynia, the feeling of pain in response to a normal stimulus.

Have you ever had back pain, but one day felt pain in your hip or other areas as well? This happens when inflammatory cells dump their chemical messengers at the site of injury (which is normal), but these chemicals find their way to other surrounding areas, thereby increasing pain sensitivity even though it’s not the problem area.

Not only can pain signals be variable based on many factors, but your brain’s interpretation of these signals is extremely subjective.

For example, a study in the 1980s studied a decade’s worth of records regarding how many painkillers were requested by gall bladder surgery patients. It turned out that the patients who had views of trees from their windows requested significantly less pain medication than those who looked out on blank walls. Manipulating psychological variables, such as a sense of control over events, dramatically changes the quantity of painkillers that they request. The same pain stimulus was present (gall bladder surgery), but the response was different based on other factors (the presence of trees and a sense of control).

Pain exists to protect us from potential threats and shows up as a response to these threats. What we often fail to understand is that these threats are not always physical. Pain isn’t solely related to a sign of damage and can also be related to the “perception” of a threat.

Many factors affect why we're in pain.

And because pain is affected by perceptions, our feelings about pain can make us feel more or less pain in a given situation. Our nervous system is pretty smart, but our emotions and feelings make us far less logical and objective than we often claim to be. And these pain pathways, remember, are not foolproof.

A broken bone will hurt more than a bruise. But if we catastrophize our bruise, it can feel as bad as a broken bone.

With chronic pain, I liken it to a fire alarm. The fire can already be put out, but the alarm is still blaring, just like your pain can still be around long after the physical damage.

This particular post isn't meant to give you a solution to your pain, but rather to help you better understand how pain works. There's nothing more frustrating than being in pain and having no idea why it's there or how to help it. Education and understanding are a good first step to reassurance that you can and will recover.

To your good health,

Coach Stephen

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Thanks for reading.

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