Everyone will experience physical pain at some point in their lives, and confronting pain is a completely normal part of being human. In fact, we need pain to have normal function. Pain experiences have tremendous breadth in their impact and feeling. They can be fleeting or long lasting, mild or deeply personal, and a minor nuisance or life defining. Experiences on each end of the pain spectrum can be debilitating. At one end of the pain spectrum, pain can feel inescapable, emotionally compromising, physically draining, and comprehensively limiting. On the other end of the pain spectrum, some individuals do not feel physical pain. This phenomenon may sound ideal, but these individuals typically watch their bodies fall apart through injury and infection without any warning that it is happening. Pain is our body’s alarm system and danger sensor, but experiences surrounding pain can be more complex than this role suggests. The most knowledgeable group to consult for information about the science of pain is the International Association for the Study of Pain (IASP). The IASP defines pain as an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage. This definition is surprisingly complex, so let us unpack it.
The confounding nature of pain:
-The nature of pain is complex.
-Pain is more than a nerve signal.
We have all had injuries like cuts, bruises, strains, sprains, and broken bones that have caused aches, discomfort, and irritation. These experiences lead to beliefs that strongly associate the idea of tissue damage with physical pain. Though, just as often, we can have these same cuts and bruises without immediately noticing them. How often have you found a bruise with no recollection of how or when it appeared? Similarly, imaging studies have frequently shown that individuals can have severe tissue degeneration without experiencing symptoms, and individuals without any significant tissue abnormalities can report significant pain. Further, how can we explain special instances of pain such as an amputee that has pain in a limb that is no longer present? Our intuitive idea of pain is not always a complete observation of the pain experience.
The sensory relay race:
-Nerve signals move from a receptor to a nerve, then to the spine, and finally networks in the brain.
-The brain provides context to our nerve signals.
To understand pain, we need at least a 10,000-foot view of the nervous system. Our nervous system is set up like a relay race rather than an individual sprint. A stimulus like touch, heat, or pressure occurs, and the race begins. A nerve relays this information from the limbs and trunk to the spine. The hand off occurs. The information is received at the spine, and it is relayed to the brain. The race continues to its third leg. The information reaches the brain, and it is relayed to multiple areas within the brain. We are on to the final leg. The information is processed and given significance. Multiple areas of the brain tag team to process the relayed information. The sensory areas of the brain act like color commentators and provide basic information about the location and type of stimulus, but the memory centers, emotional centers, and logic centers in the brain act like end game analysts. They provide context to the relayed information. This relay race allows our sensory perception to be nimble, but it also allows our perception to be nuanced and complex.
Building the experience:
-What we feel is determined by multiple inputs; it is not just a sensation.
-Processing in the brain allows pain to function as an adaptable danger sensor.
The brain provides context for our sensory experiences, and the brain likes teamwork. For example, I once stepped off a curb onto a crosswalk and sprained my ankle. I did not feel physical pain until I was on the opposite side of the street and walking to my destination. In this case, other sensory cues like my past experiences navigating crosswalks, the expectation of oncoming traffic, and the emotional sense of urgency provided additional context to the sensations from my ankle. The cues from my context indicated more immediate danger in crossing the street than in the feedback about my ankle sprain, and the sensory signals from my ankle were temporarily overridden. Conversely, I frequently see others receive injections, and I frequently use dry needling to help ease symptoms like pain. I love the effectiveness of dry needling and injections, but I dislike needles. Occasionally, as I am watching an injection or performing dry needling, I will notice sensitivity and sometimes even an ache in the same limb as the individual that is receiving the injection. In this instance, my brain is providing context to my visual input with emotional cues, memory cues of my own experiences, and sensory cues that I have felt in the past with my own injections. All these cues provide context to information from my vision and contribute to the feeling of discomfort.
-Many of the sensations that we feel are outputs from the brain that are carefully crafted by multiple sensory, memory, and emotional inputs.
-Pain can indicate more than tissue damage.
Pain acts more like an alarm system than a damage sensor. The sensation of pain is a polished product that is a combination of sensory information, learned experience, emotional state, and contextual cues from multiple systems. It does not only reflect raw sensory input from the body. Pain can indicate tissue damage, but it can also indicate danger, unfamiliarity, or heightened emotional and physical stress.
We can help:
The pain experience can be frustrating, confusing, and debilitating. It can be influenced by a variety of sources, and it can be heightened by stress and dysregulation in multiple body systems. Luckily, this experience does not need to be navigated alone. At STAT, our physical therapists can develop a multimodal plan to help you understand and take control of your pain journey. We use hands on approaches such as dry needling, cupping, joint mobilization, and neuromuscular facilitation to address physical roots of pain. We use graded exploration of movement patterns, cues for mindfulness, pain neuroscience education, and stress management techniques to address the learned and contextual elements of pain. In addition, we incorporate strength training, aerobic conditioning, and personalized exercise modifications to help you build resilience and fully return to the activities that you value. Further, just like the brain, at STAT Wellness, we like teamwork. We also offer functional medicine, health coaching, and nutrition counseling to comprehensively address the complexities that pain presents.