Let’s start with three brief stories

…A famous anecdote in the realm of pain perception involves an incident documented in the British Medical Journal back in 1995.

In this particular case, a 29-year-old builder sought urgent medical attention at his local hospital after inadvertently landing on a substantial 15cm nail while working on a construction site. The excruciating pain he endured prompted the emergency department physicians to administer potent pain-relieving medication. Nevertheless, every attempt to dislodge the nail caused him to scream in agony, making it impossible for them to approach the injured area. Eventually, they resorted to sedation, allowing them to extract the nail successfully. To their surprise, upon removing his boot to attend to the supposed wound, they discovered that the nail had lodged itself between his toes, causing no actual injury—no bleeding, no puncture wounds.

 

What makes this story significant?

This story underscores a critical message: pain doesn’t always correlate with physical tissue damage. It highlights the fact that we can experience intense pain even in the absence of actual injury. Instead, our expectations and the context in which pain occurs play a substantial role in shaping our pain experiences. In this case, the individual anticipated that a substantial nail penetrating his boot would inevitably result in harm, triggering his pain alarm system. This experience does not diminish the reality of his pain; pain is always authentic, regardless of its origins.

 

Let’s go with a second story…

…What can you learn from a crease in your sock?

Imagine putting on your shoes and go for a walk and as you take your first few steps, you feel discomfort under your right foot. The discomfort persists when you walk, so I take off your right shoe and find a crease in your sock. Even if you take off your shoes and put them back on, you can continue walking without discomfort. The pain is gone, but there are no signs of  physical damage in your foot.

 

 

What happened with the crease in your sock? 

Pain was born, it motivated you (and others) to do something (remove the nail, fix the crease) and the pain disappeared. No damage, but pain occurred. These two stories area  great examples of how pain is always about protection and not an accurate measure of tissue damage.

…And now, a third story…

…The idea of the virtual body

Let’s have a look to an excerpt from David Butler’s book Explain Pain:

Phantom limb pain is the experience of pain in a body part that does not exist. Seventy percent of people who lose a limb experience a phantom limb. It’s not all legs and arms either. Phantom breasts, penises and tongues have been reported. We believe that all pain sufferers could benefit from knowing more about phantom pain.

The feelings in a phantom limb are completely real. It can itch, tingle and hurt. Like other pains, phantom pain worsens when the person becomes stressed. The symptoms worsen when someone comes close to where the body part would have been, some feel morning stiffness in phantom joints. Others have reported feeling rings on phantom fingers, old surgery sites, and hands still clenched as though on a motorbike handlebar. Some report phantom legs that ‘can’t stop walking’.

 

 

And how about the phantom limb story?

Pain after amputation is usually more severe if there was pain before amputation. This is a type of pain memory. Phantom limb pain tells us about the representation or map of the limb (the ‘virtual limb’) inside the brain. In fact, the brain holds many virtual bodies. Our virtual bodies let us know where our actual body is in space. Try closing your eyes and reaching for a cup. You can still do it because your brain uses the virtual body to know where the real body is. In phantoms, although the leg is missing, the virtual leg and the relationship of the leg to the rest of the body is still represented in the brain.

 

 

What is pain?

According to the International Association for the Study of Pain (IASP), pain is “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”

This definition gives us hope. The most important thing to recognise is that pain does not necessarily mean that there is damage. Injuries can cause pain, great damage can be painless, or minimal damage can cause a lot of pain. The definition above is expanded a bit to show that pain affects much more than just bodily tissues. It affects and impacts other areas of your life. 

Persistent pain involves emotional, sensory, cognitive (belief in pain), and social dimensions (social withdrawal is common). We call this the biopsychosocial model of pain. This means that all areas of life can affect pain. This is great  because it means you have many options for managing pain.

The point of pain is to force you to do something, ideally to protect yourself. It’s an alarm, and an alarm is designed to call to action. Pain alarms can be very helpful if you have a lot of acute injuries. For example, it prevents you from walking with a broken leg. 

However, the problem with many alarms is that they last long after use. Long-term pain alerts are  not useful alerts. That is, it is separated from the original problem. The alarm doesn’t tell you how much smoke there is or if there’s a fire. Smoke detectors can work even when there is no smoke. 

Key messages:

• • Pain does not necessarily mean that there is damage.

• • Injuries can cause pain, great damage can be painless, or minimal damage can cause a lot of pain.

• • Pain affects much more than just bodily tissues. It affects and impacts other areas of your life.

• • Persistent pain involves emotional, sensory, cognitive, and social dimensions.

• • All areas of life can affect pain, according to the biopsychosocial model of pain.

• • Pain is an alarm, designed to call to action.

• • Long-term pain alerts are not useful alerts, as they can be separated from the original problem.

• • Smoke detectors can work even when there is no smoke, similar to how pain can persist even when there is no underlying injury or damage.

 

How does pain actually work?

When you first get hurt, acute pain can help you change your approach to avoid further damage. If there is no acute pain, you can continue to walk over the injured ankle or open the wound that is healing.  

When you get hurt (e.g. stick your toe), your nerves send a lot of information to your brain, telling it to pay attention. Our bodies have millions of nerves that are constantly interacting with each other. It is not a one-way street. The signal goes up and down all the time. There is real  chatter in every direction.  Then there’s  the brain. This is the largest collection of nerve cells in the body. 

The brain is very important for understanding pain. You may be surprised to learn that all pain is generated by the brain, no matter where or how you feel it. When you are injured, all your body’s nerves can do is tell your brain that something happened. It’s your brain (not your toes) that interprets this and says “Ouch!”

Before the brain can say, “Here’s the pain,” it must first  try to put together a lot of information and interpret it rationally. Your nerves are just telling your brain, “It’s dangerous, something’s going on with your toes.” Your brain then weighs  many aspects of your immediate environment against other life factors such as: 

• • What you do for a living

• • Your personal or cultural beliefs

• • Whether you’ve injured your toe in the past

• • What you plan to do in the future! 

This happens incredibly quickly and quickly, long before we realise it. 

Key messages:

• • Acute pain serves as a warning signal to protect the injured area from further damage.

• • Nerves in our body constantly communicate with the brain, generating real-time chatter and feedback.

• • All pain is generated by the brain, even if it’s felt in a specific part of the body.

• • The brain interprets information from nerves and weighs various factors to determine whether or not to signal pain.

• • Factors such as past injuries, personal beliefs, and future plans can influence the brain’s decision to generate pain signals.

• • The brain processes information and generates pain signals very quickly, often before we are aware of it.

 

Pain is an alert!

Our pain alarm works like a fire alarm. Even if the fire is extinguished, the alarm may continue to sound. And if we suffer for so long, we can. It also increases the sensitivity of the alarm. We all experience pain, but there are many types of pain. A fall that cuts your knee or twists your ankle can cause sudden pain. Pain can be unpredictable. For example, even though you have lifted an object hundreds of times without any problem, you can lift it once without warning and the pain will start. Pain may begin without any obvious injury. Sprains, cuts and postural pain are everyday pains. Your brain decides that the tissue is at risk, so you can change your position or rest your sprained ankle to relieve the pain. Remember the  ground you tripped on or the position that caused the pain So you can avoid making the same mistake twice. Pain can also be a more complex experience. It can be surprisingly confusing!

Any information that convinces you and your brain that you may need protection or reinforces warnings of danger  can increase your pain. It is said that Yes, certainly injury can be a factor in pain, but it is not the only factor and you don’t need injury to have persistent pain. You and your nervous system can be sensitive. Depression, anxiety, rumination, fear of moving, decreased sense of control, loss of meaningful activity, or inadequate coping skills are factors that can affect your sensitivity and ongoing pain. 

Key messages:

• • Pain can be unpredictable and can start without any obvious injury.

• • Your brain decides if tissue is at risk and can increase pain sensitivity to protect you.

• • Injury is not the only factor in pain; other factors such as depression, anxiety, fear, and coping skills can affect pain sensitivity.

• • Memories and associations with pain can also affect pain levels.

• • Persistent pain can be complex and difficult to manage.

• • Understanding the causes and factors that contribute to pain can help with managing it.

 

Acute pain vs persistent (or chronic) pain

Even though “acute pain” and “persistent pain” feel the same, there is a big difference. Acute pain occurs over a short period of time and is associated with injury or potential injury to the body. For example, if you sprain your ankle, you may experience pain along with bruising and swelling. This is acute pain. As the body heals, it usually calms down because it no longer needs protection. Even fairly severe injuries usually take less than three months to heal. It’s common knowledge that some injuries, like broken bones, take  longer to heal, but that doesn’t mean the pain should last that long.

Persistent or chronic pain lasts longer than acute pain, and even when it feels like it, it often does not indicate ongoing damage. But we now know that for most people this is not the case. Instead, pain has less to do with injuries to our bodies and more to do with our central nervous system. 

Persistent pain can take over a person’s life.  It’s very important to understand that you can turn the volume of the pain down, but it often takes effort and time.It doesn’t come naturally and you have to be patient.

A good therapist can guide you through this process, but ultimately you must be responsible for yourself. 

Key messages:

• • Acute pain is associated with injury or potential injury to the body, while persistent or chronic pain lasts longer and often does not indicate ongoing damage.

• • Even severe injuries usually take less than three months to heal, but some injuries like broken bones may take longer.

• • Pain has less to do with injuries to our bodies and more to do with our central nervous system.

• • Persistent pain can take over a person’s life and it often takes effort and time to turn the volume of the pain down.

• • It’s important to understand that you can manage your pain, but you must be patient and take responsibility for yourself.

• • A good therapist can guide you through the process of managing persistent pain.

 

Why am I still in pain?

When a person is first injured, it’s normal to feel pain both near the injured area and in other areas around the injury site. For example, after a toe stab, you may feel pain that extends well beyond the injured area to the rest of your foot and even  your calf.I n this scenario, the volume around this area temporarily increases. This is perfectly normal and helpful at first. This increased pain can remind us to slow down and avoid further injury while we heal. will subside. In some situations, the pain may last longer. Remember that we call this persistent pain and it is often associated with hypersensitivity. 

Our nervous system’s “chatting” begins to build a self-reinforcing “feedback loop.” Nerves do more than just send messages throughout the body. All the nerves in our body, including the spinal cord and brain, change in response to what we are doing and the world around us. We constantly change our “sensitivity” according to  the situation. But you can turn the radio volume up or down. This can lead to significant changes in pain levels for no immediate apparent reason.

An oversensitive nervous system often causes pain during daily activities such as walking, bending over, and turning. In some cases, just thinking about certain movements or activities can cause pain. Why is this happening and what is driving these changes? 

Pain is felt not only in the injury site, but also in other areas around the actual injury site. For example, after a toe stab, pain may radiate well beyond the injured area to the rest of the foot and even the calf. In this scenario, the volume temporarily increases around this area . This is perfectly normal and helpful at first. This increased pain can remind us to slow down and avoid further injury while we heal. This pain usually subsides quickly when you return to your normal habits and activities. In some cases, the pain may last longer. Remember, we call this persistent pain and it is often associated with hypersensitivity.

The “chatting topic” of our nervous system begins to build a self-reinforcing “feedback loop”. Nerves don’t just send messages throughout the body. All the nerves in our body, including the spinal cord and brain, change in response to what we are doing and the world around us. Importantly, nerves are constantly changing their “sensitivity” to what is happening around them. Again, you can turn the radio volume up or down. This can lead to significant changes in pain levels for no immediate apparent reason.

An oversensitive nervous system often causes pain during daily activities such as walking, bending over, and turning. In some cases just thinking about certain movements or activities can trigger pain. Why is this happening and what is driving these changes? 

Key messages:

• • When a person is first injured, it’s normal to feel pain both near the injured area and in other areas around the injury site.

• • In this scenario, the volume around this area temporarily increases. This is perfectly normal and helpful at first.

• • An oversensitive nervous system often causes pain during daily activities such as walking, bending over, and turning.

• • Nerves don’t just send messages throughout the body. All the nerves in our body, including the spinal cord and brain, change in response to what we are doing and the world around us.

• • Pain is felt not only in the injury site, but also in other areas around the actual injury site.

• • The “chatting topic” of our nervous system begins to build a self-reinforcing “feedback loop”.

• • In some cases just thinking about certain movements or activities can trigger pain.

 

Nerves may become sensitive

The brain is made up of different parts, each with different main functions. The parts are amazingly connected and work as a team. We can form connections in seemingly unrelated areas, such as  smell, movement, and emotion. For example, many people know about the power of smells and music to evoke memories. If you listen to music regularly and pass by your local bakery, your favourite tune may remind you of the smell of freshly baked bread.  

Similarly, when a person repeats certain movements or activities regularly, the brain creates patterns of neural connections. When the movement lasts for a  long time, the brain strengthens the relationship between movement and pain. It’s as if your brain connects the dots between the normal sensations coming from your back, the bending movements, the memory of the injury, and the experience of pain. may come to the surface.

Once you’re sensitive, just prepare for this move, you can move the pattern  and  feel the pain. The body has healed as much as it can, but the move still hurts. Often we avoid or fear these movements because these connections form. This creates credible evidence  in the brain that these movements are dangerous, thus further strengthening the connection. 

Key messages:

• • The brain is composed of different parts with distinct functions, and they work as a team to ensure optimal brain functioning.

• • The brain can create connections between seemingly unrelated areas such as smell, movement, and emotion.

• • Music and smells have a powerful effect on the brain’s ability to evoke memories.

• • Repeating certain movements or activities can create patterns of neural connections in the brain.

• • The brain strengthens the relationship between movement and pain, and this can result in pain even when the body has healed.

• • Fear and avoidance of certain movements can further strengthen the connection between movement and pain.

• • The brain’s ability to create connections can be both beneficial and harmful depending on the situation.

• • Understanding the brain’s ability to create connections can help individuals manage pain and overcome fear or avoidance of certain movements.

 

Can you imagine life without pain?

As someone reading this, if you live with ongoing pain, this may sound like the best thing you can live without being able to feel pain. Some people have a rare genetic disorder called CIP (congenital insensitivity to pain). People with this condition can put their hands in hot water or undergo surgery without anaesthesia because their bodies do not produce pain signals. As superhuman as it may sound, this genetic disorder carries significant risks. Pain is your body’s greatest protective mechanism and should motivate us to do something. 

At HEALPATH, we believe in providing personalised care and support to each individual. Our team of dedicated Pain Relief Practitioners is committed to understanding your unique pain concerns and creating a customised treatment plan. Whether you’re a young athlete, a working professional, or someone seeking relief later in life, our services cater to all age groups between ten and ninety years.

Experience the following benefits with HEALPATH:

• • Comprehensive pain management without medications

• • Enhanced mobility, flexibility, and range of motion

• • Reduction in muscle tension and improved muscle function

• • Increased circulation and tissue healing

• • Targeted relief for specific pain conditions

• • Personalised treatment plans based on your goals and needs

• • Dedicated and experienced Pain Relief Practitioners who prioritise your well-being

Remember, your pain doesn’t have to define you. Discover the power of medication-free pain relief with HEALPATH.