Why am I in pain?

I recently watched a series of lectures about Pain Education on Embodia that were presented by Carolyn Vandyken from Pelvic Health Solutions. If you're a physio looking for some continuing education, I can't recommend Embodia enough! They've got an endless amount of high quality content that you can dive into from the comfort of your home. If you're looking to learn more about pelvic health and pelvic health physiotherapy, your best bet is to start with Pelvic Health Solutions. They're an invaluable resource.

In this post I'll share what I learned about pain science from Carolyn. Pain education is one of the most important tools for a physiotherapist to use to help their patients. The better we understand our pain, the better we are able to treat it!

Pain is an interpretation of signals that are sent by your nervous system to your brain. In this regard, your nervous system acts like an alarm system, sending alerts when certain sensors fire. This mechanism serves to protect us, however, sometimes the nervous system can become part of the problem, sending danger signals that do not necessarily align with the actual threat.

Let’s imagine an injury as someone breaking into your house. What is the logical thing to do after your house is broken into? Turn up the sensitivity on your alarm system. The same logic applies to the body. Your brain becomes hyper-vigilant of an injured area to protect itself from further injury. This is part of the reason why we walk with a limp after rolling an ankle. In the case of an acute injury like an ankle sprain, this mechanism protects us. We reduce the amount of weight we put on that foot as it heals and slowly increase our weight bearing until we can return to normal walking.

But what happens when our alarm system’s calibration is out of whack? This is often the

case with what it is often referred to as persistent pain. I try to use the word persistent rather than chronic when describing pain as chronic implies that it will last for life. Persistent pain is typically described as pain that lasts greater than three months. It can have drastic effects on the nervous system, changing the way we live our every day lives. With persistent pain, the initial injury has long since recovered, yet the pain continues.

This scenario can be described as well with our alarm system metaphor—picture that your house is broken into every day. Your alarm system becomes so reactive that the sirens go off as leaves blow by your house, increasing your fear of a break in rather than protecting you from one. This happens in the body as well. Our nervous system can start to label all movement as dangerous, causing significant pain.

Pain is our brain’s way of alerting us to tissue damage or potential danger to protect itself. In many cases, there is no correlation between pain response and the extent of damage to the tissues. Pain is much more complex than that. There are many factors that can turn up or turn down the brain’s response to perceived threats such as experience, mood, stress, and preconceived beliefs. To put it simply; if you’re expecting it to hurt, it likely will.

I’m not trying to say that anyone’s pain is not real. It absolutely is. What I’m saying is that if we equate pain with structural damage, we miss a huge part of the picture. By explaining the many complexities of the pain experience, we can desensitize the nervous system, taking a monumental step towards a pain free lifestyle.

#painscience