By Matthew Varca, PT, DPT, PRC
The topic of pain is extremely complex and often riddled in mystery and misconception. Often people don’t get a complete explanation regarding their symptoms, while some may get multiple explanations from different professionals, leading to increased frustration and confusion surrounding pain. Often pain is thought of purely as the result of tissue damage / disease. This to not 100% true. A pain experience is the result of an individual’s beliefs, experiences, knowledge, and perception of danger making no two individual’s pain the same.
The purpose of the following article is not to describe the depth of pain science but to highlight some common misconceptions surrounding a pain experience. Below you will find some statements that will allow you to reflect and test your own knowledge and understanding of what you may know about pain.
Statement: Pain only occurs when you are injured
Answer: FALSE
Many people (and even some therapists and medical doctors) believe that pain and injury are synonymous. Injury and disease states may or may not be experienced as pain. Many studies on asymptomatic (pain free) subjects show the poor relationship between the health of the tissues and a pain experience. Listed below are a few examples that describes the poor relationship between injury/disease and pain:
- It is estimated that 40% of asymptomatic individuals have a bulging disk on MRI (Alyas, Turner et al., 2007)
- There is only a 50% correlation between knee pain and arthritis (Bedson and Croft, 2008)
- Imaging of the asymptomatic general population shows a 35-40% prevalence of rotator cuff tears across all age groups (Reilly, Macleod et al., 2006)
- In 40% of asymptomatic males and females, between 25-50% will demonstrate disc degeneration and signs of injury, endplate changes, foraminal stenosis and facet joint degeneration on spinal imaging (Spielmann, Forster et al., 1999)
- many, many, many more studies . . .
Injury and/or degenerative processes can, therefore be present, yet an individual may experience little to no pain.
Statement: The brain decided when you will experience pain
Answer: TRUE
Pain is a brain construct, based on perception of threat. When bodily tissues detect threat a signal from the nerve is sent to the brain to be interpreted as threatening vs non-threatening. The brain constantly receiving information from the environment as well as the body and determines the most appropriate response (pain vs no pain) based on survival, perceived threat, and previous experience. If the brain ultimately determines that it is threatened it will produce a pain signal, resulting in an avoidance behavior that should aid in survival.
Lets put this into a real world example. If you were to walk at work or at home and sprain your ankle, it would likely cause pain. Nerves pass along a “pain message” to the brain to call upon action, such as walking funny, seeking medical help, and canceling plans to run a local marathon.
Now imagine the same ankle sprain but while crossing a busy street. As you walk across the street, you sprain your ankle, but out of the corner of your eye you notice a speeding bus heading your way. Most people would agree that, in this case, the ankle will not hurt, and you will get out of the way of the speeding bus safely to the sidewalk. Once at the other side, the ankle may actually start to hurt. What happened? In response to the speeding bus, the brain determined that the bus was the larger threat to your survival, therefore, no pain was produced to protect the ankle, allowing you to get out of the way (Louw and Puentedura, 2013). Pain is truly a byproduct of our perception of threat. To fully understand why we are feeling pain we must first understand the context in which the injury occurred. If you don’t believe me take it from Swayze from Roadhouse.
Statement: My environmental surroundings can impact injury recovery
Answer: TRUE
Have you ever wondered why people might experience very similar injuries to their tissues (e.g. ankle sprain, car accident), yet recovery can be so different? While there are many reasons for their different experiences, we need to realize that these injuries occur in various environments. Ankle sprains may occur during times of stress, times of happiness, being employed, being unemployed, spouse happy and even spouse mad, etc. Scientists have now shown that the environment surrounding a tissue injury can to a large degree determine how much pain is experienced.
A good start is to realize that if you hurt yourself in a stressful environment, there are likely to be a lot of stress chemicals floating through your body. It will cause your nerves to wake up, become extra sensitive and take a long time to calm down. It is helpful to reflect upon the time period in which you developed your pain and all the issues going on in your life at the time which have contributed to your pain experience.
The environment surrounding an injury can also yield a positive experience and help you experience less pain. For example, it has been shown that kids who play contact sports early in life tend to have less pain later in life. These kids learn that not all pain is bad. Pain may be felt and injury seen, however, these injuries are seen as part of being on a team and are often worn as a badge of honor (Louw and Puentedura, 2013).
Education is therapy. Knowledge is therapy. One of the first steps you can take towards decreasing pain is to gain a better appreciation and understanding of pain itself. By reading this article and breaking some common pain misconceptions you are reducing perceived threat and bringing some clarity to your pain symptoms. Every individual has their own unique experiences and lifestyle which makes what they feel truly theirs. If you are experiencing pain we can help tailor an individualized approach to fit your goals and get you back to what you love.
References:
Alyas, F., M. Turner and D. Connell (2007). MRI findings in the lumbar spines of asymptomatic, adolescent , elite tennis players. Br J Sports Med, 41(11): 836-841.
Bendson, J. and P.R. Croft (2008). The discordance between clinical and radiographic knee osteoarthritis: a systematic search and summary of the literature. BMC Musculoskeletal Disorders, 9: 116.
Louw, A. & Puentedura, E. J. (2013). Therapeutic Neuroscience Education, Vol. 1. Minneapolis, MN: OPTP.
Reilly, P., I. Macleod, R. Macfarlane, K. Windley and R.J. Emery (2006). Dead man and radiologists dont lie. a review of cadaveric and radiological studies of rotator cuff tear prevalance. Annals of the Royal College of Surgeons of England, 88(2): 116-121.
Spielmann, A.L., B.B. Forster, P. Kokan, R.H. Hawkins and D.L. Janzen (1999). Shoulder after rotator cuff repair: MR imaging findings in asymptomatic individuals — initial experience. Radiology, 213(3): 705-708.