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Pain Science

By Katie Lauder, DPT.

Pain is an odd thing, isn’t it? It’s a very individualized experience; it is hard to describe and hard to relate to. Yet we all experience pain at some point in our lives. So what is pain? 

Somewhat counterintuitively, neuroscience research suggests that pain is a danger detection system… not a damage detection system. 

Here’s how the system works: when the human brain makes the judgment that the body may be in danger, the brain can elicit pain. That’s correct – your brain creates the pain experience. The brain takes in many factors before eliciting the pain sensation like emotion, situation, past experiences, and context clues from your senses. 

Consider these two stories:

A case study from the British Medical Journal published in 1995 discussed the case of a 29 year old construction worker who stepped on a 7 inch nail at his construction site. The patient came into the ED writhing in pain, so significant that he was taken to the ER and sedated. Here’s the thing, when the doctors removed this man’s boot the nail was sitting in between his toes; it had not punctured his skin at all. There was indeed not an injury, but the pain was real. The circumstance, the visual cues, the emotion associated with the event, the stress of imagining being out of work were taken in by the brain and the danger detection system reached a threshold and elicited a serious pain response.

Another report discusses the case of, yet again, a construction worker, who was using a nail gun. It unexpectedly discharged and knocked him in the face. He thought he had made it for the most part unscaved with a mild toothache and some bruising under his jaw. He went to see his dentist 6 days later and upon taking an x-ray they found a 4 inch nail in his face that was partially inserted into his brain. This is a situation that could put this man in grave danger, but because of the context clues and his perception of the situation, the danger system did not activate and the alarm did not ring.

How is this information about pain useful? There is comfort in knowing that pain does not necessarily mean the body is being damaged. There is also new science to suggest we can train our pain systems – decreasing acute and chronic pain and decreasing the disabling affect pain often has. 

It should also be noted that pain can be very useful. Most people have figured out early on that if you touch a hot surface you will feel pain. This pain response has been effective (hopefully)  so that you do not keep your hand on the hot surface and burn the flesh off. 

So how can we determine if our pain system is giving us a good signal? Consider feeling knee pain every time you run. Is your brain trying to tell you that your meniscus is gradually wearing away with the excess pounding from running? Or is your brain responding to your emotions (I hate running! I know so many people who have injured their knees from running!). Physical therapists are trained in teasing out where your pain is coming from. Interestingly, people’s pain is often the result of actual tissue damage as well overactive pain signals from your pain. This means the treatment for that knee pain is multifaceted.

Consider this information and please stay tuned for next week’s blog, Pain Science part 2: pain management strategies.

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