A brief but common Q&A between a reasonable pain practitioner (GP, Osteo, EP, Psych) and a pain sufferer.
Why am I in pain?
Well it really depends on a lot of things but basically pain is a signal from your brain and body that it thinks there is something wrong.
It can be caused by stubbing your toe, sitting for too long, running into a wall or doing exercise for the first time in a long time.
Contrary to popular perception pain does not necessarily correlate with the amount of damage that has occurred.
In fact people that suffer Chronic Pain will often have no breaks or tears or strains at the site of their pain but they will still feel immense amounts of pain.
What? Chronic Pain Sufferers Pain Is All In Their Head?
Yes. But so is all pain.
Think about a time when you stubbed your toe.
Racing around doing something, not thinkingly you slam your toe into a step.
You screech, you swear, you hop, you put your foot down, you stamp it down, you start walking on it, 2 minutes later the pain has decreased to a smidge of what it was.
If the pain you felt when you initially stubbed your toe was a measure of how much damage you had done, then why within 2 minutes has the pain gone down to almost nothing?
Because pain is an output, a protective output. It is a projection of the brain’s assessment of risk.
In the case of the stubbed toe the brain is unsure of how much damage you have done to the toe.
You may have broken the toe, you may have just banged it, but the brain is unsure in those early stages as to what it is that you have done.
And so whilst the brain is filtering through the varying messages that are coming from your toe it wants to stop you from causing more damage.
How does it do that? By making you feel such exquisite pain that there is no way in hell you would put your foot down.
And then slowly but surely the brain comes to the decision that nope it’s not broken and it eases back the pain lever.
There may still be some pain present, reflective of some bruising and the need to be careful of the area but that all encompassing pain is gone.
What Does A Stubbed Toe Have To Do With People That Suffer Chronic Pain?
The sensation of pain is extremely complex, especially when it has been around for a while.
People that suffer Chronic Pain are often told that there is nothing wrong with them, that the scan of their knee, low back, wrist, etc is fine, that there is no sign of damage.
But as we know pain is not just a reflection of tissue damage.
The brain determines how much pain you will feel depending on what it thinks/determines is occurring.
And the Brain takes its advice from the information that comes from the body as well as some other things.
So If It Isn’t Just Info From The Affected Area That Influences The Brain What Else Does?
It really depends on the person and what they are doing.
Imagine your ancestor in the rainforest running flat out as a tiger is chasing them. They stub their toe leaping a fallen tree and keep going.
Do you think they’d feel much pain?
Most likely not.
Because the brain would be thinking, is it more important to stop and assess how much damage to a toe there was or to get the hell away from Fluffy’s ancestors.
But compare that to Brian, a father of two rambunctious daughters, on the worksite lifting a heavy plank.
Brian who suffered a crippling back injury the previous year, Brian who’s best mate no longer works due to a bad back, Brian who just read an article on how ‘you never recover from a back injury’* (factually incorrect, all things heal).
Brian slightly twinges a muscle in his low back when lifting. The information the Brain receives is that there is some small tissue damage.
But for Brian his low back has far greater connotations than the average punter.
Brian’s Brain will cross check the information coming from the low back with what it already believes about low backs.
Because of the previous injury and the article saying that back’s never heal. His mate that can’t work due to the low back. And the responsibility of two kids. Brian’s Brain is far more likely to assess the risk of damage in the low back as very high.
So when Brian bends forward to pick up his plank of wood at work and twinges his back, his Brain, and the protective nature of it, is likely to pull the pain lever to 10/10 to stop Brian causing more damage.
It is an overreaction but one that makes sense to a brain that is trying to protect it’s body.
Ok, Ok, Ok Pain Is Complex. But What Has A Stubbed Toe and A Back Injury Got To Do With Chronic Pain? Pain That Is Just In Someone’s Head????
The previous two examples hopefully illustrate the complexity of the sensation we call pain.
People that suffer Chronic Pain will often have nothing wrong with the muscles, bones or joints where they feel pain.
MRI’s CT scans and X-rays will be all be clear.
But for whatever reason their brain has assessed the risk of damage at that spot to be very high.
And because of that assessment of risk the Brain wants the body not to move too much because it is worried that movement will make it worse.
How does the Brain stop the body from moving an area it believes to be damaged, or at risk of damage?
So How Can Someone Be ‘Cured’ Of Chronic Pain?
Time, patience, education, movement, exercises, manual therapy and avoiding painkiller usage for longer than 24 hours.
It takes time, it takes trust and it takes work but chronic pain can be overcome or at the
barest of minimums managed in a much better way.
The first step is to understand it. To understand how pain works. And then to start moving again.
A large part of the recovery process is changing the way you think about the body and how it works.
Who should I see if I am in pain?
It really depends on the type of pain you are in.
If you have broken your arm you should see a GP or an emergency room doctor and they can put it in a cast.
If you’ve had a sports injury or lifted something incorrectly or had pain come on insidiously you should see a GP or an Osteo.
If you’ve had disabling pain for more than 6 weeks you should see a GP or depending on what they diagnose consider seeing a Psychologist and Exercise Physiologist together.
If you’re coming back from surgery then a team care approach of Osteopathy and Exercise Physiology is great.
If you have headaches an Osteo is usually great but a Psychologist may also be able to help if there is an underlying element of stress or anxiety is there.
The Neighbourhood Clinic: Excellent At Advising On Pain in Fitzroy North