Pain: How it Works & Management

by Jan 18, 2019Physiotherapy

What causes pain and how does pain work?


Modern pain science focuses on the biopsychosocial model of pain, which posits that our qualitative experience of pain is a holistic combination of biological, psychological, and social factors, which can include:

Biopsychosocial Model of Pain

Biologically speaking, the sensory process of receiving and interpreting pain signals is called nociception (coming from the Latin “to hurt” + “to perceive”) and uses nociceptors, special pain-oriented nerves. When stimulus that could harm us, usually in the chemical, thermal, or mechanical forms, comes in contact with our nociceptors, it sends a signal to our brain that we experience as pain, and urges us to do what we need to do to stop experiencing the dangerous stimulus.

Psychologically and socially speaking, our experience and sensitivity of pain can be altered (increased or decreased) by a number of different factors from self-esteem and coping skills to cultural beliefs about pain.

How does Chronic Pain Work?

Pain can either be acute (less than three months, usually sudden onset and can be caused by soft tissue damage) or chronic (sustained for greater than three months).

Chronic Pain strikes like lightning
Lightning Strike Gif

Often, once pain begins to become chronic, pain experience can be changed both physically and psycho-socially, and even if the initial cause of the pain is gone (ie a soft tissue trauma, which generally heals in the 3-6 month trauma), pain can still be experienced. If you’ve experienced a soft tissue injury and are still experiencing high pain levels after 3 months, chances are you have developed an over-protective nervous system. The nociceptive system acts like an alarm, and when activated, it sends messages to the brain for action, and once the action is taken, the alarm is designed to calm back down. If you’re still struggling with pain, the alarm system has not fully calmed down yet, and remains extra sensitive. Understanding this, and working towards retraining the mind and body (ie the nervous system), can over time calm the alarm system.

How do I know if my system is being over protective?

You will know your pain system is becoming overprotective when:

  • Your body starts to feel more sensitive than it did.

  • Activities that used to cause a little pain now cause a lot of pain.

  • Activities that were usually not painful, start to become painful

  • Other signs your pain system is becoming over-protective include:

    – Your pain might spread, or it might move from one side of your body to the other, or from one location to another, or new spots become sore.

    – Your movement system starts to get in on the act. Remember that movement is another great way to protect. You might find some movements become more difficult. You might feel stiff.

All these things show that your system is ‘on alert’. Pain can actually be turned up and down by your thoughts, feelings and other things going on in your life – things that actually have nothing to do with the painful body part!

Pain Management

Pain management is as complex as pain itself, and usually involves a holistic approach that targets biological, psychological, and social factors. It can often include approaches such as CBT (Cognitive Behavioural Therapy), adjusting diet, gradually introducing physical activity, building your support network, physiotherapy, etc.

Book an appointment with your physiotherapist to understand your situation and to plan your chronic pain management.

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