Pain: What is it and why is it so complex?

We have all experienced an episode of pain in our lives. It could have been a short-lived experience, or the pain persisted a little longer than you anticipated. 

Perhaps you have felt pain but could not explain why, with no injury or reason behind the pain. I remember an odd dream from a few years ago in which I somehow walked across broken glass. Ouch! When I woke up, the soles of my feet were sore and tingling; I even struggled to put my feet down. Fortunately, after a few moments, the pain disappeared completely. 

The most interesting aspect of this experience is precisely that. Pain is an experience and is not always linked to injury or physical trauma. How is it that I had foot pain without any physical injury? 

Firstly, the International Association for the Study of Pain (IASP) describes pain as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.” Note the ‘potential tissue damage.’ In this example, my mind tricked my body into thinking I was experiencing physical harm or ‘actual tissue damage,’ which was not the case. Phew!

As Physiotherapists, we are very accustomed to seeing patients who are experiencing pain. It is likely obvious, but it’s one of the key reasons patients access our service. 

Even though the experience of pain is very individual, we can categorise pain into types:

• Acute pain (short-term pain). An example of this could be a sprained wrist after a fall or pain experienced during a brief illness. This is very normal and a means of your body warning you of potential or actual threat/s. 
• Persistent pain (long-term pain). This is pain that typically persists for longer than three months. Pain can sometimes continue beyond the regular healing periods, even without injury or damage. Like a faulty computer, the body can generate signals causing pain that are not necessary or required. 
• Neuropathic pain. This is pain generated due to damage or a process that impacts nerves. It is often felt as a shooting, stabbing, or burning sensation and can produce pins and needles. 
• Nociceptive pain. Pain that is caused by damage to body tissue. People often describe it as sharp, aching, or throbbing pain. It is usually caused by an external injury, a rolled ankle, for example. 
• Radicular pain. A specific type of pain originates from one or more of the nerves in the spine. The nerve/s can become compressed or inflamed. A good example of this type of pain is sciatica. 

Although there are different types of pain, it’s helpful also to understand that pain is a personal experience and is impacted by both biological (e.g., age, medications, genetics), psychological (e.g., stress, coping strategies, mood, beliefs, and expectations), and social factors (e.g., social support and cultural factors). If two people experience the same injury with the same level of damage but report varying pain levels, does this mean one person’s account of their pain is wrong? Absolutely not. Pain is often poorly correlated with the level or type of injury (if there is any). 

So, what can I do to help minimise my experience of pain? 

• Talk to someone – firstly, seek advice from a healthcare professional to understand what might be happening and advise you further. Secondly, do not suffer in silence. The support of family and loved ones can make such a big difference in the experience of pain and even aid recovery. 
• Stay positive – pain can impact our emotions and sometimes cause us to spiral. Most often, pain does subside and is short-term in nature. 
• Get sufficient rest and manage stress – stress and burnout often coincide with pain or a heightened experience of pain. Taking a break, booking some leave, or trying to manage your workload when you are experiencing pain is essential. 
• Exercise and activity – Being active might be the last thing you consider if you are experiencing pain. Depending on the nature of your pain and advice from your healthcare professional, exercise within reason can often positively impact pain and our experience of pain. Just be sure to exercise within your current limitations and not to push yourself too hard.
• Rest – if the injury is acute or you have suffered trauma, ensure you rest the area. Ice the area if possible and elevate and compress to reduce swelling. Seek medical advice as soon as possible. 

Take a look at the impact our Virtual Physiotherapy service has on reducing pain.