Pain: A Sensitive Subject

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As individuals pursuing active lifestyles, we’ve bought into the phrase, “No pain, no gain.” We’ve embraced the idea that pain makes us stronger in our weekly exercise routines, meanwhile other medical professionals will tell us to “listen to our bodies.” I see patients daily who are torn between the two mixed messages. Neuroscience experts suggest that understanding pain is essential for trying to address why we hurt. To do this, we must understand a simple yet painful truth about pain: you can’t live with it, and you can’t live without it. Here’s why.

Pain is a response which occurs when our brain senses that there is danger or potential danger to your body. That response is necessary for us to survive and protect ourselves. However, the long-standing, “chronic” pain experienced long after injury can actually be more debilitating than helpful. Recent estimates indicate chronic pain costs over $600 billion each year(1), and remains the focus of research studies with the intent of answering the question that we’ve been asking for years: Why do we hurt? What can we do about it?

What most people don’t know is that the pain response is actually an output from the brain as opposed to the body tissues that are hurting. These intricate brain pathways send signals to every part of our bodies to let us know that we must take some sort of action to help avoid tissue damage. For example, when we twist our ankles running, the brain is in charge of determining whether or not we should keep running by the amount of pain we experience. Interestingly, though, the amount of pain you experience does not necessarily equal the amount of danger you may be in or the amount of tissue damage that has occurred. There have been numerous studies that have shown tissue compromise in MRIs with people that were not experiencing any pain. One such study showed over half of its subjects with lumbar disc bulging or protrusions that did not have pain and another showed positive shoulder tears in baseball players without symptoms (2,3). On the contrary, there are people in medical clinics everywhere trying to ease their pain without any evidence of tissue damage. Thus, it becomes important to understand other factors that may be involved for proper treatment.

When there is an initial onset of pain following some type of injury, an inflammatory process ensues. Like pain, inflammation is also a necessary response that contains curative factors to promote healing. The expectation is that those tissues will heal, but the timeframe for each person can vary. However, what goes on when those tissues are “healed” and we begin to experience chronic pain?

Perhaps the most prevalent factor of chronic pain is abnormal joint movement with decreased muscle strength and control. Over time, pain will limit our ability for normal movement and can lead to even further dysfunction and thus, more pain. Studies have also shown a strong correlation between anxiety and depression with chronic pain. Pain, depression, and anxiety all share the same nerve pathways and can influence and enhance one another (4)

Consequently, it is important to remember that pain is a response that necessitates a global and thorough approach to treatment. The next time your brain tells you something hurts, take action!

Special thanks to PT student Ross Eason for his help!

1. Gaskin DJ, Richard P. The economic costs of pain in the United States. J Pain. 2012; 13:715-724. 2. Jensen MC, Brant-Zawadzki MN, Obuchowski N, et al. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. 1994;331(2):69–73. 3. Halbrecht JL, Tirman P, Atkin D. Internal impingement of the shoulder: comparison of findings between the throwing and nonthrowing shoulders of college baseball players. Arthroscopy. 1999;15:253-258. 4. The Association of Depression and Anxiety with Pain: A Study from NESDA de Heer EW, Gerrits MMJG, Beekman ATF, Dekker J, van Marwijk HWJ, et al. (2014) The Association of Depression and Anxiety with Pain: A Study from NESDA. PLoS ONE 9(10): e106907. doi: 10.1371/journal.pone.0106907