Understanding your pain and other symptoms
We know that if you understand your pain and symptoms it helps you to deal with them more effectively. Therefore pain education is a key part of the treatment process. So, at Specialist Pain Physio we will tell you about the science and more importantly how to apply this knowledge for your benefit.
This page will provide you with information about pain and its influences. The following is based upon the very latest understanding of pain science.
Here is a great article written by Lorimer Moseley in 2007 that helps to explain current understanding:
We understand pain and the underlying mechanisms far better now than ever before. This is a really exciting time as the science of pain is moving forwards quickly and being translated into clinical interventions that are effective in relieving pain and restoring normal movement and function.
There are several excellent models of pain that help us to understand that pain is a conscious experience produced by the brain (this is not saying it is in your mind, it most definitely is not), the Mature Organism Model (Louis Gifford) and the Neuromatrix Theory of Pain (Ron Melzack). The former model discusses the sampling of the internal and external environments, brain scrutiny of the incoming information on a background of genetics, past experience, culture, sex and beliefs and the subsequent production of an appropriate response that promotes survival. The neuromatrix is a ‘widespread networks of neurons’ across the brain that create a characteristic pattern of activity known as a neurosignature. The pain neuromatrix includes regions of the brain that are active when we experience pain as demonstrated by many studies that have used functional MRI (fMRI) scans. The fact that there are many areas of the brain that make up the matrix means that a variety of stimuli can provoke activity and hence the experience of pain.
Pain is part of a protective response to a perceived threat to the body. When we sustain an injury, either as a result of an accident or gradual changes that occur in the tissues through repeated use/posture, the body seeks to re-establish homeostasis (internal regulation). The effect that an injury has upon our regulation system creates physiological stress, a biological system that is activated by any physical or psychological threat. A range of processes are triggered as part of this protective response including changes in the way we move (some obvious, e.g. limping; some subtle, e.g. delayed activation of deep abdominal muscles in back pain), inflammation that is the start of healing, blood flow changes and pain. The pain is our brain’s way of drawing our attention to the affected area(s), allocating a location for us to monitor and address the problem appropriately (e.g. rub the area, seek help, take analgesia). Pain is a ‘need state’, like thirst or hunger, when the experience motivates some necessary action.
PAIN IS AN EXPERIENCE PRODUCED BY THE BRAIN
We know that pain is not an accurate indicator of tissue damage. Lorimer Moseley has gone to great lengths to point this out in his papers and books: Painful Yarns & Explain Pain. Clear examples of this include phantom limb pain when the sensation is experienced in a body region that is no longer present, and the significant discomfort that can occur with a minor incident such as a paper cut. We have learned a great deal from phantom limb pain (pain in a body part that no longer physically exists), a condition that has directed efforts to the brain in deepening our understanding of pain. What we know is that our body is represented within the brain in a number of locations. Our sense of self (interoception) is created in a part of the brain called the insula and our sensory cortex provides the brain with a ‘map’ of where information is coming from and a mode of allocating a sensation for us to experience. These representations are developed genetically and maintained by a constant flow of sensory information. The loss of a limb or an injury alters the inflow of this information thereby changing our experience of the body, our sense of ‘self’. A body part can feel bigger and out of position, often uncomfortably so, despite the fact that this is not an accurate self-analysis.
The key point from the research to date is that we do not need the tissues to experience pain. Danger signals being sent to the brain from actual or potential tissue damage are not sufficient to produce pain. It is the brain’s scrutiny of this information that results in pain if a threat is perceived. Sometimes the brain will consider other factors to be more important than the tissue damage, for example the soldier who escapes the battlefield with significant trauma. The nervous system has very powerful inhibitory mechanisms that can modulate danger signals and therefore allow us to ‘escape’ rather than dwell on the damage.
