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What is Pain?

A Modern Scientific Perspective


This information is brought to you by Eazol Pain Relief:
www.eazol.com

The International Association for the Study of Pain (IASP) defines pain as an unpleasant
sensory and emotional experience associated with actual or potential tissue damage, or
described in terms of such damage. This is an important definition as it recognises that
pain is an emotion, a sensory experience and a response to 'actual' and 'potential' injury.
This latter point is fundamental as the body will respond to a perceived threat in the same
way whether there is damage or not. A limitation of this definition would be the fact that
it is not made clear that pain is a conscious experience produced by the brain in response
to a perceived threat. All conscious experiences including thirst, hunger, what we see and
hear, are produced by the brain. There is a common misconception that pain is created by
the tissues in which you feel the sensation when in fact the pain is ascribed a location (by
the brain) that will motivate some action by the sufferer. This is the whole point about
pain, it is a motivator to take action, again similar to thirst whereby you would drink, if it
hurts you would move, rest, take a painkiller or seek advice and treatment.

It is important to understand that the science clearly tells us that pain is not an accurate
indicator of tissue damage. Some examples can help conceptualise this point: phantom
limb pain when there is no limb yet the individual experiences pain and other symptoms,
and the pain of a paper cut that can be intense yet there is minimal damage. Additionally
there are countless stories of people having significant injury yet feeling no pain at the
time. The basis for this apparent variability is that the brain will determine whether there
is a genuine threat to the body tissues and then respond appropriately. Even if there is
significant damage, if something else is more important then the brain can prioritise and
'block off' the danger cues to enable escape or other actions. For example, if you were
crossing the road and trod on a nail you would expect this to hurt (nail into foot, tissue
damage, brain receives danger signals from foot via spinal cord and responds with pain to
motivate a limp, shout etc). However, if you were to tread on the nail and a bus was
careering towards you, the foot would be the least of your worries!

So what is happening? With an acute injury such as an ankle sprain or a wound, the
damaged tissue releases various chemicals that sensitise the nerves. These nerves are
usually quiet and only respond when excited by certain chemicals; i.e. their threshold for
firing signals is lowered. These nerves send 'danger' signals when excited to the spinal
cord where they communicate with further nerves called secondary neurons. The
bombardment of signals causes sensitivity to develop within the spinal cord meaning that
subsequent signals are amplified. To us that will mean that in this sensitised state a
painful stimulus applied to the affected area will be more painful and a non-painful
stimulus (light touch, pressure) would be painful. Think of a hot shower with sunburn or
pressing a bruise.

The signal is then sent from the spinal cord up to the brain where it is scrutinised in the
light of past experience, genetics, gender, beliefs, expectations, understanding, emotions
and other factors. The brain then creates an appropriate response to the perceived
situation and if indeed there is the conclusion that the tissues are in danger, then the
'output' from the brain will be pain. It is important to understand that pain is one response
of many with others including the healing process, reflex changes, blood flow changes,
hormone activity and immune system processes. All of these and others are part of an
overall protective response that serves us well in terms of survival. This is all normal and
expected despite the unpleasantness of pain. But that is the whole point of pain, to grab
our attention so that we do something about it.

As the healing process continues so there is less need to protect the area and the pain
often settles. It is useful to know that ligaments take around 42 weeks to heal and
therefore the body is entitles to protect the region for the duration although in many cases
the pain does reduce significantly after a month or two if managed in the right way.
Unfortunately there are commonly situations when the sensitivity develops and then
persists beyond a useful time. This is deemed a chronic pain as it outlives the healing
process and is seen as maladaptive, i.e. there is no useful purpose behind the pain which
can be of a severe intensity. There are numerous factors as to why this can occur
including the initial sensitivity that develops through changes occurring in the spinal cord
as a result of the initial bombardment by danger signals, early management, beliefs about
pain and injury that determine self-management and other psychological factors.

Pain is a multi-system output which means that the experience is the end result of activity
in a number of body systems including the nervous system, the endocrine system,
immune system and autonomic system to name but a few. We have established that pain
is produced by the brain according to a perceived threat and this is underpinned by a
neural network that when activated creates the pain experience.

The network is known as a neuromatrix which consists of interlinked areas of the brain
that have varying functions but when activated will produce pain. We have a neuromatrix
for all experiences and activities such as talking, writing and walking but also certain
types of activity will be seen when we are experiencing fear or other emotions. The point
to make is that any part of the matrix can be activated and subsequently ignite the whole
system and create pain. The range of brain regions involved include those that deal with
movement, sensation, concentration, memory, vision, fear, planning, emotions,
understanding and more. Essentially this means that on occasion any of these activates
could provoke pain. For example seeing someone bend forwards may cause your back to
hurt or a strong emotion could aggravate the pain. Understanding this neurobiology helps
us to create more effective treatment programmes that target different levels of function
and helps the sufferer to understand their pain to allow for improved self-management. It
is clear that pain is a brain experience so we must focus at this level. More on this later.

Our perception of pain is modulated by many factors. For example, expecting something
to hurt can increase the level of pain, believing that there is damage or that there is
something seriously wrong can influence the pain most likely though fear and worry,
stress, fatigue and immune system function can all affect the pain. Naturally this is
important to understand because it is not only physical actions that can hurt or hurt more
but emotions, thoughts, feelings, past experiences, culture, gender and genetics all play a
role. When the danger signal reached the brain having already been potentially modulated
in the spinal cord both locally and by messages coming down from the brain and brain
stem, they are further molded by the aforementioned factors. If at the end of this brain
activity and analysis there is deemed to be a threat to the tissues then pain will be
experienced.

As stated earlier, all of this information regarding the influences upon pain allows us to
understand in greater depth the processing that leads to the final experience. So often
individuals become inactive and continue to adapt the way in which they move for fear of
further damaging tissue. In fact what the tissues really need is movement to improve their
health, but usually in a gradual way so as to allow the sensitivity to reduce through
moderation of the threat value. The brain becomes very good at producing pain and in
fact shows actual changes in structure. This has been demonstrated as being reversible in
line with reductions of pain and improved control of movement. However, this takes
'brain training' and there are some exciting new treatments that are based on neuroscience
that can 're-wire' the system to reduce pain.

Movement is vital for healthy tissue as demonstrated by studies of immobilisation.


Sensitivity, stiffness, altered perception, altered sensation, skin and hair changes all
develop rapidly when normal tissue is immobilized. Clearly there is need to reduce
movement in certain situations (e.g. fractures) to allow healing but it is important to
mobilise the area as quickly as possible to reverse these changes. Movement sends
messages to the brain about the body, keeping the higher centres aware of the body and
maintaining the brain's perception of the body (the virtual body) which is important for
movement control and sense of self. An exercise programme aims to restore normal
movement and control of movement so as to ensure the map is well delineated to
optimize our functional abilities. This includes proprioceptive work and visual feedback
to enhance the learning process. Persisting altered movement and perception of
movement is one cause of on-going symptoms as the brain deems the area to be
problematic and therefore will protect, i.e. make it hurt.

The local tissue environment is sampled by the nervous system in order to adjust blood
flow and other health maintaining factors. If the tissue is less mobile or less healthy in
addition to the sensitivity that has been initiated, the brain is likely to protect further with
pain and increased levels of tension or muscle activity (spasm). Therefore there is the
pain from the inciting event plus the pain and discomfort of the on-going responses to
protect. Both of these can be managed through a range of techniques that target the
tissues and the nervous system.

In summary, pain is a conscious experience produced by the brain in response to a


perceived threat. In an acute situation there is a clear threat and tissue damage.
Sometimes tissue breakdown over time and the process goes undetected until a 'threshold'
is reached and pain develops, for example repetitive strain or posture related problems.
As time proceeds and the tissues heal often the pain eases, however there are many
people who suffer persisting symptoms because they have not restored normal tissue and
nervous system health, movement and control of movement. There are now methods of
treating these factors at different levels including exciting brain training techniques.

This information is brought to you by Eazol Pain Relief:


www.eazol.com