Understanding Pain

Persistent pain can be a puzzling and confusing condition to live with. After all, most of us grow up understanding that pain will go away. So how can we make sense of pain that doesn’t go away – pain that becomes persistent?

The reasons for your pain are likely to be a combination of the following:

The structural source of the pain

When you have a new injury (acute pain) it is easy to guess which bit of you is causing the pain e.g., the bruise or broken bone. With persistent pain, it is much more difficult. Often, no obvious structural cause can be found. This can be frustrating and confusing. You know you have pain but even the best scans only give a ‘snapshot’ of your body. The part of you that is hurting does not look any different from the part that is not hurting.

Even when doctors do find structural changes on scans or x-rays it is still very difficult to say if these are causing your pain or not. Just because we are not able to give you a specific ‘diagnosis’ or tell you exactly which structure is causing the pain, it does not mean that your pain is not real. It means that there is ‘nothing nasty’ going on. That the pain is hurt not harm.

The good news is that we now understand so much more about how the changes in the nervous system happen and so we are able to help you understand your condition and improve your function and quality of life, in ways that are helpful for you.

Changes in the nervous system

Pain can be very puzzling. To think about this, let’s consider a couple of different situations:

Some athletes injured in sports events or soldiers injured in battle, do not notice or feel pain at the time they are injured; they only become aware of it later. In these examples there is clearly tissue damage, so how come they don’t experience pain?

On the other hand, people who have had a limb amputated can still experience pain in the limb even though it is no longer there. This is called ‘phantom limb pain’. How can this be the case when there is no limb to hurt?

Clearly pain is very complex! Nerve messages can be altered as they are processed in the tissues, spinal cord, and brain. This can mean that messages may become: bigger (we call this ‘wind up’ or ‘sensitisation’); altered (messages that start out as touch can be experienced as pain) or generated within the nervous system (messages sent with no tissue damage needed).

Changes in how you move

Reducing activity or limiting certain movements, e.g. bending and twisting

This is a common response to pain. Many people try their best to rest or avoid activities that make the pain worse. You may sit, stand, or walk differently which can affect other joints and muscles. Your muscles can become ‘deconditioned’. You may put on weight and become less ‘fit’. When joints don’t get moved regularly, they become stiff. Our bodies need to move, ‘Motion is Lotion’!