Learning about pain
Pain is a fascinating area, as I am discovering from my current (at times scary) journey of post-graduate study in the area of Pain and Pain Management through the University of Otago.
As many of my clients know, I've become increasingly interested in chronic pain, what it is, what (we think) we know about it, and how it affects people. This interest is something that has evolved over the past few years as I began to see more clients with chronic pain referred to me by their GP, physiotherapist or other health professional and I wanted to be able to better understand this area, so I could be more informed when working with people with chronic or persisting pain. My approach has therefore evolved, and continues to do so as I learn more so I can be more effective in combining my knowledge about pain with how I treat with massage therapy.
Pain really is a very strange thing. The International Association for the Study of Pain (IASP) defines pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage." This definition is good because it acknowledges that pain is unwelcome, yukky and unpleasant. It's an experience on a number of levels including not just what is felt physically - "my hand is sore there", but also on an emotional level, it's distressing, concerning, upsetting for the person in pain - there is a psychological component to pain that can cause suffering. The definition also acknowledges that pain can be associated with actual damage - the fracture, wound, disease process, that can be visibly seen and/or diagnosed, AND also that it can be associated with potential tissue damage, meaning that there may not in fact be tissue damage.
The most important thing to know about pain is that it is NOT in your head. Many of us may have been told this when we end up in the "too hard" basket as medication, treatment, surgery etc fails to resolve what is causing the pain. Or perhaps what initially caused the pain has long healed, but still pain persists. Whatever the case, the pain you may have, IS real, it's not imagined. I also like this
different definition of pain, which comes from Margot McCaffery, a Nurse, lecturer, author and visionary in the field of pain management - “pain is whatever the experiencing person says it is, existing whenever the experiencing person says it does”. This definition acknowledges that it is an individual person's experience, no one else can say what someone in pain feels or doesn't feel. It is a subjective, conscious, lived experience. Understanding this can be quite important for people with persisting pain.
There is another part to pain that not everyone knows. While pain is the experience - what we feel and perceive, an experience that happens as a result of a lot of "stuff" going on in the brain - there is also a thing called nociception, which is the biological "bits", or as the IASP defines it "the neural process of encoding noxious stimuli". In simple terms it is the process our body uses to detect an unpleasant and potentially dangerous event and then communicate it, throughout our nervous system - from the receptors in our skin, muscles, joints and organs, to our spinal cord and then on up to our brain and the bits there that then "makes sense" of it all. We can have nociception, but not feel pain - when we are not conscious - either asleep or under general anesthetic, or when our nervous system determines that running way from the tiger is more important than worrying about the sprained ankle we have just sustained. While pain can be and often is associated with nociception, it is always modified and influenced by a range of factors (neurobiological, - what is happening in our nervous system; environmental - what is going on inside and outside our body; and cognitive - our thinking), which add to the complexity of the experience.
So, pain is created in our nervous system as a way to protect us. In this sense, it is both an output of the nervous system AND something that is experienced by the person. But it is never imagined and just "in your head".
International Association for the Study of Pain. (2018). IASP Terminology. Retrieved from: https://www.iasp-pain.org/terminology?navItemNumber=576#Pain
King, C. D., Keil, A., & Sibille, K. T. (2016). Chronic pain and perceived stress. In Stress: Concepts, Cognition, Emotion, and Behavior (pp. 413-421). Academic Press.
McCaffery, M. (1968). Nursing practice theories related to cognition, bodily pain, and man- environment interactions. Los Angeles: University of California at Los Angeles Students’ Store.
Moseley, G. L., & Vlaeyen, J. W. (2015). Beyond nociception: the imprecision hypothesis of chronic pain. Pain, 156(1), 35-38.