Finding Ease in the Effort: Understanding Pain

Hey everyone! My name is Anna Daburger, a physiotherapist at Insync Burnaby. I will be writing a blog series about pain – what it is, what it means & doesn’t mean, and what you can do to manage it better (and how physio can help!). This first post will be about understanding pain a bit better. Read along if you’re interested!

Do you remember the last time you experienced a paper cut, or a hang nail? Who would have known such a small cut in the skin could produce a disproportionate amount of pain? On the other hand, have you ever found a mysterious bruise somewhere on your body with no recollection of how it got there? The amount of pain is not necessarily indicative of the amount of damage sustained. You can have pain with damage, no pain with lots of damage and lots of pain with no damage. 

I wanted to preface this discussion of pain with these questions to highlight how complex it is. Some other misconceptions in regard to pain include:

  • No pain, no gain. Persisting in the face of pain can be helpful initially, but use of this strategy can become maladaptive as time goes on, and it can actually cause more pain and triggering episodes (1). It is important to find the right balance between persistence and avoidance.
  • Hurt equals harm. Unfortunately, pain can be a poor guide. When we experience pain, this does not necessarily mean we are causing harm (2). The hurt that is experienced is sometimes less-so an indicator of tissue damage, and more-so an indicator of sensitivity of the nervous system – especially when pain has persisted past the tissue healing time frames.
  • Rest is best. A common traditional approach to pain has been favoring rest over activity. However, we now know that our bodies need movement to recover, and avoiding activities may make you more fearful of and sensitized to them in the long term. So, when you have pain or injury, there should be a period of initial rest; however, the next step will be reactivation of movement and resumption of activity. Physiotherapy can help you navigate it all!

Why do we have pain?

The purpose of pain is to protect you and to motivate you to change what you are doing. Pain is an alarm and alarms are designed to create action. With many acute injuries, the pain alarm is very useful, as it prevents you from keeping your burnt fingers on a hot surface. But the problem with many alarms is that they keep going off long after they are useful. 

The alarm system, or the brain, can start to lose touch with reality and gets very used to the pain & alarm response, even after our tissues have healed. In a way, it “learns” pain and this response becomes a habit (3). You become better at perceiving pain as your brain has become more and more familiar with it - like practicing a language over and over. You can think of it as a sensitive smoke alarm that goes off even when there is no fire. 

It is important to think of pain in the BioPsychoSocial framework; meaning that there are elements at the tissue level (bio), psychological level (emotions, beliefs and stress) and the social level (your support network and work life) that all can contribute to the pain experience. With this in mind, we can look at pain as the overflowing of a cup, an analogy I like to use from physiotherapist Greg Lehman (1):

The cup represents our life and all of the stressors we have in it. As pain persists, it becomes less about tissue damage and more complicated in terms of all the different life factors that can play a role. You can have a lot of physical, mental, emotional and social stressors and have no pain - but at some point, a new stressor can put you just over the edge. The water overflows, and now you have pain. 

Often people will have more pain when there are changes in the stressors in their life; pain can occur, or get worse, when we fail to tolerate and adapt to all the stressors.1 This means that we have a lot of options to help you feel better; and rarely is there just one thing that must be ‘fixed’. We can help to get you better by improving the things in the cup - like getting you exercising or sleeping better - or we can help you to build a bigger cup, so that you are more resilient to the stressors. Your physiotherapist can help you to do both of these things. 

References

  1. Williams AC, Craig KD. Updating the definition of pain. Pain. 2016 Nov;157(11):2420-2423
  2. Pain Science Workbooks [Internet]. Greg Lehman. [cited 2019Jun26]. Available from: http://www.greglehman.ca/pain-science-workbooks/
  3. Siddall PJ. Neuroplasticity and pain: what does it all mean? The Medical Journal of Australia. 2013;198(4):177–8.