“Of Course it is happening inside your head Harry, but why on earth should that mean that it is not real?” – Harry Potter and the Deathly Hallows, JK Rowling
Pain is something that affects everyone and is nearly always a patient’s main concern. The patient may have stiffness, weakness, or restrictions in their daily life, but often what really concerns, irritates and frustrates them is their pain! Pain is also something that people often misinterpret, purely due to a lack of understanding of what it means, and that can have negative impacts on their own wellbeing. This blog post was inspired by my attendance at the Explain Pain course in April presented by Tim Beames of the Neuro-orthopaedic Institute (NOI). The course gave me a fascinating insight into the most recent research and understanding of pain.
In essence, pain is a completely individual and unique experience created by the brain in response to perceived threat and, contrary to popular belief, is not always linked to damage. One of the most common (and damaging!) misconceptions that physiotherapists face from patients is that pain must be a sign of damage or harm, and further more, that the more pain you have, the more damage you have (and vice versa). In fact, this is simply not the case, as the most recent research shows.
For example, the sheer agony of stubbing a toe! You can’t move, breath or see, and then swear words appear that you didn’t even realise you knew. So much pain for so little damage! Or what about when you’re feeling stressed or tired or just run down and you start to feel aches and pains all over your body? In this instance there is often no damage at all, and yet you still feel sore, stiff and weak. An extreme example is phantom limb pain, where someone will feel pain in a body part that they don’t even have any more!
On the other hand, injuries can occur and you feel no pain at all! This is particularly common when injuries are sustained in sporting or warlike situations. In these instances the brain has decided that actually, it isn’t important for us to feel this pain right now, there are bigger things afoot! The brain then produces its own painkillers (endorphins, encephalins, even derivatives of morphine). Similarly, these painkillers are released during and after exercise, during positive interactions with other people/animals, and during times of happiness.
The release of these natural painkillers will stop or slow when the brain (subconsciously) thinks that there is a danger or threat, and therefore in response to this perception of threat, the brain increases your pain. The brain makes the decision as to whether there is or isn’t a threat by gathering information, not just from your body tissues, but also from your own beliefs, understanding, feelings, memories, and even what other information you are given such as from friends, family or health professionals. In general, the more negative, danger messages your brain receives, the more pain you will have.
So just remember, positivity may not be able to fix everything, but it goes a long way to help speed your recovery and reduce your pain.
If you need any help to manage your pain, physiotherapists are ideally placed to help, not only with any tissue issues that may be contributing to your pain, but also to identify what factors may be increasing or prolonging your pain and how to address these.