Welcome to my brief guide to pain. Pain is an enormous topic, drawing upon many disciplines and fields, similar to the study of consciousness. Whilst putting together my thoughts to answer the question ‘what is pain?’ I soon realised that it was going to be a lengthy piece, and only for those who had the time and inclination to bear with me. Regular readers of my blog at Specialist Pain Physio will be familiar with the importance of understanding pain (hence UP!! and @upandsing) as the start of changing and overcoming pain, particularly persistent pain. Now it is obvious why we called our campaign UP | understand pain — because when you do, you’ll realise that it can change when you take action, and that is what Pain Coach is all about.

So here’s my brief guide to pain in bullet points:

What is pain?

Here are some facts but not all (we will always discover new facts, and I will update accordingly):

• This is my recent thinking on pain: “Pain is the conscious experience of a need state, others being hunger and thirst, felt by a person in a particular area of the body in respect of a perceived threat (that may be conscious or subconscious, or both), not separate from the context of the moment, the environment, prior experience, predicted experience, the social circumstance, current biological state, health, thoughts, feelings & emotions”.
• Pain is a vital survival device, without it we do not live as long or as healthily.
• Pain is part of the way we protect ourselves alongside changes in movement, body sense, thinking, emotions, perceptions of the environment, planning, anticipation, attention.
• Pain is how we protect ourselves in the face of a perceived threat. When our body systems detect danger, actual or potential, there is a need to protect and this includes pain in the area that is perceived to need such protection — consider that the sum of sampling our body tissues, organs, systems (they sample themselves as well), plus the sum of the environment, plus the results of sampling the brain (what do I know, where am I, what are my beliefs, what have I done here before, what has worked, how am I feeling etc) leads to what we experience in any given moment; and if the sum of all of these inseparable characteristics of being alive represents some kind of threat, then we will change our behaviours and experience pain. For the mathematicians:
  • (what is happening in my body + what is happening in the environment + what I know + what I do not know I know) right now = (my reality in this moment) that is always passing
• It is poorly related to the extent of the injury or tissue damage.
• It hurts and ‘I’ feel it in my body (or where my body used to be or should have been, in the case of phantom limb pain).
• It is ‘I’ who feels pain, not my body; I hurt, much like I am thirsty and not my mouth
• When I feel better, my pain feels better (because I feel pain).
• Pain involves many body systems — always the nervous system, often the immune system, plus the autonomic nervous system, the endocrine system and the sensorimotor system.
• There is no pain system, there are no pain signals. There are systems that detect changes and presume threat that requires attention and action; pain compels us to do something to make it go away, both in how we think and what we do.
• Pain is influenced by how we are feeling, how we think about it, where we are, who we are with, what we have been doing, what we are doing, what we may do, how tired we are, how much attention we put on the pain and our expectations to name but a few.
• We can only feel pain now, in the present moment. Our memory of the pain experience is unreliable, and whilst we may recall that we were in pain several days or weeks ago, we cannot remember that actual feel of the pain with any accuracy. Like any experience, pain happens in the moment but is hugely flavoured by the way we think about it. For example, if we are anticipating that something will hurt, such as getting up from a chair, then it usually does and more due to the expectation priming our systems that protect. If we have pain under certain circumstances, an association can develop so that the next time the context arises, protection kicks in, including pain.

Next time….what sorts of things can we do to overcome pain?

Richmond Stace | Pain Coach & Specialist Pain Physiotherapist