The Neighbourhood Clinic was established to provide excellence in healthcare to our local community. Part of that role we see is sharing important clinical and scientific messages. Pain is a condition that is rife in our society and there is so much misinformation about what it is and how it works that we thought this series may help to be part of the solution.
This series is about how pain is weird, how it isn’t linear and how pain can be from a muscle, bone or joint but can also be from your brain.
Todays story is about 3 different people, 3 snapped achilles and 3 different stories of pain.
Person 1 is me, your narrator who usually hides behind the collective ‘we’ of the The Neighbourhood Clinic. I’m in my 30’s, a health care practitioner that lectures on pain at university. Person 2 is a farmer, in their 50’s with a partner that didn’t like them limping. Person 3 is an elite NFL player that gets paid to run and jump and be an athlete.
Person 1 was playing football, felt a bang in their leg like someone had kicked them, they reached down, felt a gap where the achilles should have been and limped off the field.
Person 2 stepped out of the shower 4 years and thought they had rolled their ankle. But being cropping season couldn’t justify taking the day off to go to the doctor.
Person 3 described their pain “instantly excruciating with the months to follow significantly worse.”
Person 1 coached the rest of the game, addressed the team and then went to hospital. Self reported pain 2/10. The next day 10/10. Over 2 weeks the pain eased back to 0/10.
Person 2 went to the doctor after 4 years of limping and was told that they had snapped their achilles and would require surgery. They refused. They hadn't had pain since the initial shock of ‘’rolling their ankle’’ when stepping out of the shower.
Person 3 had surgery but has repeatedly said that the pain of the injury was the worst they had ever experienced.
How is it that three people, with the same injury, can have such different levels of pain? Because pain is highly individual and based on the brain’s assessments of risk, knowledge, priorities, beliefs, fears... as well as tissue damage.
Person 1 knew exactly what had happened, there was none of the fear that can cause worry/pain. But the next morning when the nerve endings started sending messages to the brain, the brain started its protective mechanisms. Pain. Lots of Pain.
Person 2 had no idea what was occurring but thought that they had rolled their ankle. Which is fine. They then drove tractors for the next month and limped a bit.
Person 3 felt the achilles go. Person 3 relied on the strength and stability their body provided for their identity and their income.
The ramifications of snapping an achilles for person 3 was far far far far far far greater than that of Person 1 or 2. And therefore their pain was far far far far far greater.
So? Pain is weird. Pain is individual. Pain is subjective. Pain is always real. Pain has many causes. Pain has many influences.
Even when there is vast damage to a tendon pain is still very much influenced by the brain.