Understanding Pain

As physical therapists we commonly ask patients about pain they are experiencing. We may ask you to quantify your pain on a scale from 0-10. We may also ask you to describe your pain. Is it achy? Is it sharp? Is it shooting? These questions can be hard for some patients due to the variability in their pain levels throughout the day or week. Pain is described by the International Association for the Study of Pain as “an unpleasant sensory or emotional experience associated with actual or potential tissue damage.” Let’s break this definition down to further understand your pain:

It’s an unpleasant sensory experience. This is the easiest concept to understand because most of us have all experienced pain. It can come from a simple paper cut, a muscle strain, or a disc herniation. None of us enjoy it when it occurs. Unlike previously thought we don’t have “pain receptors” but instead have generalized sensory receptors that signal to our brain. Depending on the signals, our brain may interpret the stimulus as pain, just like it might interpret other sensations such as heat or touch. The pathway is similar but the result is ultimately very different based on what our brain tells us. It’s an emotional experience. That’s right, pain is not just sensory it is also emotional. Pain often keeps us from doing things we love and therefore can cause us to feel emotionally drained. However, just as pain can cause emotional disturbances, pain can be affected by emotions. It has been found that psychological factors including anxiety and depression can play a large role in your feeling of pain. Additionally, stressors such as work can intensify pain due to our brain interpreting our situation as “unsafe.” It is due to actual or potential tissue damage. A common misconception is that pain always means that something is wrong in your body. This is not necessarily true. While pain is commonly a sign of injury, pain doesn’t exist until the brain has told the body you have pain. In an acute situation such as a cut or scrape, the pain signals to you that your body is in danger. However, in more chronic pain, there may no longer be damage to the tissues. The easiest way to understand this is through the idea of phantom limb pain. If a person has lost their hand for example, there is no longer tissue that can be damaged. However, these people often feel pain in their missing hand. Pain is an adaptation to tell us to get out of danger, but sometimes other factors can affect what our brain interprets as pain.