Pain, does it need to hurt so much?

Physical pain is an essential part of the human experience; it’s the body’s protective alarm system. Its a subjective experience and one which is challenging to convey to other people. Especially if there are no obvious outward clues, our ability to tolerate pain is as individual as our fingerprints and shaped by many factors: genetics, previous pain experiences and our beliefs. Lifestyle and social environment also have a role to play, the quality of our sleep and our general and psychological health can impact our levels of pain too.

When we get ‘a hurt’ as some of my patients young and older like to call their injuries, a whole cascade of things happen: the ‘sensation’ is sent swiftly from the affected body part to the brain signalling the OUCH! Fortunately, most of these are temporary unpleasant experiences. In most cases, we experienced a lowered pain threshold, which is a normal temporary reaction to injury. For example, you stub your toe and the tissue around the wound will feel tender and sore while it heals. Each of us will respond differently to the same stimuli; some people can brush it off and get on with their day while others react more severely, sometimes seemingly disproportionately. 

Gaining a better understanding of how and why we individually respond to pain is crucial because it [pain] blights people’s lives, affects their relationships and is overwhelming the NHS and allied health care professionals alike. New studies have begun to explain why we react differently to pain. Think of the brain as a simple control centre, making swift predictions on the severity of an injury or trauma, then creating super-speedy estimates of how painful it should be.

Sometimes this process goes haywire, and the brain mistakenly continues to fire out pain signals long after the damaged tissues have mended. Or when there is no threat at all, leading people into persistent or chronic pain states. It isn’t possible to predict who will slip into these states, but studies show it is more likely to occur during periods of high pressure, prolonged stress or sadness. 

We categorise pain into distinct phases which I have described in a previous post (pain, what’s going on). In the UK, persistent or chronic pain affects one in five adults, yikes, this is huge. It can affect any part of the body and all age groups. According to pain medicine experts; chronic pain changes the way the spinal cord, nerves, and brain processes potentially unpleasant stimuli – the perceived or real ‘hurt.’ These tissues become overreactive or hypersensitive for reasons not fully understood. 

However, we still have some control. In that, the brain and our emotions can dial down or turn up our pain experience. This insight is not insignificant, but a challenging concept for those affected, this is what we know:

  • Our pain threshold, also called tolerance of pain, is influenced by previous traumatic experiences.
  • People living with anxiety or depressive conditions appear to be more susceptible to physical pain and report it at higher levels.
  • Smokers report pain more often and at high levels too.
  • Those with a BMI of over 30 also appear to experience more pain.
  • Interestingly, most athletes, apart from professional footballers, have a higher pain tolerance than the rest of the population. 

Our adult response to pain is, in part, determined by our childhood learning encounters to injury and pain. Consider this example:

  1. A toddler has a little tumble in the playground; he picks himself up and carries on playing despite his grazed knee. 
  2. The same child trips in the clear view of his primary caregiver, who rushes yelling to his aid. So he learns to ‘react’ in a way to be rewarded; by displaying distress and experiencing more pain. While this is not a conscious decision, his behaviour ultimately shaped by the caregiver (over) reaction. Further, what studies show that this can become a learnt behavioural response to pain and predispose people to chronic pain as an adult.

While we cannot change our genes, or early socialisation, as adults, we can influence the way our brains perceive pain, don’t believe me? Let’s go back to the time before painkillers became readily available; it was common for people to use a variety of mind-body techniques to regulate their response to pain, distraction being the most familiar. This century mindfulness and self-hypnosis are popular and effective ways to ramp up our pain tolerance and dial down discomfort, and many other unpleasant sensations. Movement practices and exercise are other good options because they help the release of natural painkillers called endorphins. 

Let’s pop back to the tumbling toddler if I had the chance to step in. I would gently encourage his primary caregiver to respond differently. To wait, or quietly and calmly check to see he wasn’t too badly hurt, reassuring him if needed and sending him back to play; the perfect pain distraction. This approach will prime his brain to be more resilient and build healthier injury experiences. 

After decades of studies and PhD level research, why is chronic pain still such a mystery? We know that pain can be complex and complicated, caused by many factors and conditions. The reality is that it’s still an impossible dilemma because up to 50% of all consultations in primary care are folk with medically unexplained symptoms (MUS). A mammoth-sized challenge for any healthcare practice. Mostly, we simply don’t know what we’re looking at, so how do we best treat it? – A rhetorical question.

Is this hopeless? I think not; because this is what we do know. Persistent pain is often associated with subconsciously unhelpful behaviours and habits, things such as breath-holding or rapid shallow breathing, which incidentally also triggers the flight-fight-freeze stress response. These strategies can become a kind of neurological habit which further fuels the fear-avoidance, and guarded movements observed in people with chronic pain.

Movement therapy is a useful and meaningful way to support people to create more beneficial habits. Which with practice reduces muscular tension and lowers stress allowing healthier movement and loading patterns, and in most (but not all cases) results in a significant reduction in pain, or it is resolving completely. 

People often ask me how long will this take. Well, it depends, complex or long-standing problems may take a while, most people should be willing to commit to 3-4 months, with 10-16 sessions over this period. Perhaps starting with weekly sessions, extending to fortnightly, then monthly as things improve. Recovery usually involves some navigating, and reassessment because it’s rarely a straight line:

While this is a challenge the potential gains make the serious negotiation (with oneself), perseverance, courage and outside help, worth every minute and every card swipe spent. Everyone is an individual, with their own pain story, so there simply can’t be a one size fits all prescription and is that why we don’t have a cure, yet.