Pain

Pain. At some point in our lives we will experience pain. Whether it be physical, emotional, or both. The fact that the experience of pain can be so drastically different from one individual to the next, has created a lot of inquiry in the medical field. 

Since I graduated from physical therapy school (over 20 years ago now ) the definition of pain, how it manifests, and how to treat it, has completely evolved and changed. We once thought pain occurred when an apparently noxious stimulus occurred in our physical body creating a direct response to the output experience of pain. What we now know is that the process of pain development is much more complex. It is still agreed that a noxious or uncomfortable stimulus often occurs to start the process, however the signal is then set to the brain which interprets how to respond to this stimulus.

Therefore the same type of stimulus response can vary dramatically from one person to the next, based on the brain's process. For example, if I've experienced a history of pain in the bottom of my left foot and I then step on a sharp object, my experience of that pain will likely be quite different from a person without this previous foot “trauma.” It is also proven that other factors will directly impact the degree of pain they report, such as the state of one’s nervous system and the amount of stress a person is experiencing.

This newer model of understanding pain is termed the BioPsychosocial Pain Model. It explains that pain is created by the brain directly, and this process is impacted by multiple factors. It confirms that pain is not the direct result of body tissue damage, particularly in chronic pain. Instead, chronic inflammation is often causing or contributing to the chronic pain. Fear, and other negative emotions, can directly increase inflammation contributing to chronic pain. The natural healing “pharmacy” of the body in the calming parasympathetic nervous system state is inhibited when stress, fear, and negative emotions are high. 

So with this new information, how can we modify how we treat pain as physical therapists or rehabilitation practitioners? We can provide techniques to help our patients or clients transition from the sympathetic nervous system's limbic state of stress and fear to the parasympathetic nervous system's calm and healing state. There are many tools to do this such as mediation & mindfulness; see our Stress Management page, energy work such as Reiki or EFT tapping (emotional freedom technique), in addition to the assistance from other practitioners such as acupuncturists and psychologists.
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If you’d like to learn more about pain and the Biopsychosocial pain model, here are a few good resources:

David Butler and Lorimer Moseley's Explain Pain

Adriaan Louw's Why Do I Hurt?

Greg Lehman's Recovery Strategies 

The Back Pain Podcast with Rob Beaven & Dave Elliott