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What is pain?

No one really wants pain. Once you have it you want to get rid of it. This is understandable because pain is unpleasant. But the unpleasantness of pain is the very thing that makes it so effective and an essential part of life. Pain protects you, it warns you about dangers, often before you actually become injured. It is your body’s alarm system. It makes you move differently, think differently and behave differently which also makes it vital for healing.

It is believed that all pain experiences are an excellent, though unpleasant response to what your brain judges to be a threatening situation. Even if problems do exist in your joints, muscles, ligaments, nerves or anywhere else, it simply won’t hurt if your brain thinks you are not in danger. The opposite is also true and concerns many chronic pain sufferers. Even if no problems whatsoever exists in your body tissues, nerves or immune system, it will still hurt if your brain thinks you are in danger. The best way to prove that statement is to look at phantom limb pain.

Phantom limb pain is the experience of pain in a body part that does not exist (mostly after severe trauma or amputation). Seventy percent of people who lose a limb experience a phantom limb which appears extremely real to them. It can itch, tingle and hurt. The phantom limb’s symptoms worsen when the person becomes stressed. Some people have reported feeling rings on phantom fingers; others reported phantom legs that “can’t stop walking”.

So if these people can feel pain without any structures causing it, chronic pain sufferers can feel their pain without any injury or damage to their tissues. So is the pain all in their head? This is probably the most frequently asked question from people learning about pain physiology. We have to be really honest here and say, “yes- all pain is produced by the brain- no brain, no pain!” This doesn’t mean for a second that it is not real- much to the contrary- all pain is real. But it’s the brain that decides whether something hurts or not, 100% of the time, with no exceptions.

This concept is hard to accept because we’ve always assumed that if there is pain, it means that something is wrong. But when someone has been in a car accident and many years later still feels intense pain, the tissues are no longer being damaged. The inflammation and the healing process are over now and the pain is felt for other reasons. I must be very clear here when I talk about chronic pain sufferers. These concepts apply mostly to people who are in pain following a specific injury: people who have hurt their back long ago, or broke a leg or had surgery years ago, and simply can’t seem to move on with their lives without being in intense pain. People with systemic conditions such as rheumatoid arthritis, fibromyalgia and crohn’s disease, to name a few, are victims of ongoing inflammation and tissue damage and these concepts are not applicable here.

Through scientific research we are now aware of some of the thought processes which are powerful enough to maintain a pain state long after tissue damage is over. (1) Some of these thought processes can have you saying things like “I’m so afraid of my pain and of injuring my back again that I’m not doing anything”. These fears will naturally cause increased stress, which releases a hormone called cortisol in your body. Persistent increased levels of cortisol has been linked to slow healing, loss of memory, depression, despair and a decline in physical performance. (2) These fears will also cause you to drastically decrease your physical activities. But inactivity has tragic consequences on our overall health and healing abilities. Joints adore movement and regular compression which keeps them lubricated and well nourished. Moving keeps our muscles strong, increases blood flow, improves our lung capacity. Our bodies were simply made to move.

At Back in Motion, our physiotherapists and the rest of our team can greatly assist chronic pain sufferers. By educating people about pain physiology, it is scientifically proven to reduce the threat value of pain. (3) Educated movement is brain nourishing. It helps restructure pathways in the brain laid low by fear and ignorance. This can help the brain understand that our body is no longer in danger, and tune down the level of pain signals you perceive. Physiotherapists can act as “coaches” and encourage patients to gradually increase their level of activity as well as understanding their fluctuating levels of pain. There are many methods used to achieve this and every treatment method will be customized to suit every patient individually. By being compassionate, enthusiastic and informed, your physiotherapist can assist you in mastering your situation.

(1) Price, D.D. Psychological Mechanisms of pain and analgesia. Vol. 15. 2000,
(2) Lovallo, W.R. Stress and health. 1997
Martin, P. The sickening mind. 1997
(3) Moseley, Hodges, Nicholas; A randomized controlled trial of intensive neurophysiology education in chronic low back pain. Clin J Pain (In Press) 2003

Additional reading: Explain Pain by Butler and Moseley 2003

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