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If you’ve ever grown up with siblings, you would know as well as I do that you tend to develop your own language. In my case, I grew up with a brother and every now and then our conversations would involve more playful punching than actual talking. For us, this was normal. Sometimes, I think it was just easier for us to do that then to verbally communicate how much we cared (at least, that’s what I like to think). People who’ve grown up in this environment might just shrug it off if someone else casually punched them in the arm just to say “hi”. But what happens if you’ve never had a brother like that or if you normally expressed your feelings with words? You might find it surprising, jarring, or even a little traumatic if someone decided to just hit you on the arm out of the blue. No matter how harmless their intentions were,you might be left feeling a little stressed out and sore.
Pain is a much more complicated experience than a lot of people realize. It’s not necessarily the punch itself that causes pain, it’s more about how that punch is perceived. According to more recent research, we know that pain is a combination of our innate physiology, our emotional or mental state, and our life experiences. These systems work together to create an “internal alarm” that helps you protect yourself or repair any damage. When that alarm goes off, your stress levels can start to rise, you might start to sweat, and you get the feeling like you’re ready for something to happen. This internal alarm is generally the same in everyone, but what’s different is how easily it can be set off.
Your genes and physiology work together to determine how your body behaves and what is considered damaging to your cells. But whether something is experienced as painful,depends on how it’s processed in your brain. Your genetics play a big role in laying down your foundation. If your parents were hardy, resilient people, then the chances are pretty good that you’ll be built the same way. But that’s only part of the story, and even the toughest people have their bad days. If you’re stressed, anxious, or depressed, then you’re already in an altered state where you may not be as resilient as usual and as a result, your pain tolerance may be affected.
Your environment also plays an important role in determining what is painful to you. If we look back to the example with my brother, he’s taller, louder and a lot bigger than I am and sometimes he’s not afraid to show it. But having grown up around this kid my whole life, I’m used to hanging around people that look like bears in human clothing.From a survival standpoint, I should probably be nervous when big guys start getting loud and a little rowdy. I’m sure most people would get anxious in that situation, but my brother has trained me well. Thanks to him, my internal alarm takes a little bit more of a push before its set off. But this can also work the other way too. For people that have experienced terrible trauma, especially earlier in life, it’s almost as if their body was put through a series of fire drills. Now, their internal alarm can be ready to respond to a crisis right away, making it potentially easier for them to experience something as painful or distressing. This certainly isn’t always the case, but your environment can definitely influence your reaction.
So, what happens when we experience pain? If we sense a potential threat, our stress hormones are activated, our immune system is engaged, and our body is preparing to either run or fight. These responses are all activated before anything even happens, we just have to anticipate something bad. It’s the reason why a fear of needles can make the vaccination experience so much more intense for certain people. Now, if any physical trauma has occurred, your body goes through the usual steps of damage control: stop the bleeding (if there is any), swell up for a few days to repair the immediate damage, start patching up the holes with new tissue, and then eventually recover strength and function. The body slowly comes down from all the chaos of the initial injury, and your brain, once it knows everything is fine, can go back to its usual business. But what if your brain still believes that you’re in danger and the internal alarm never turns off?
This becomes very important when we start talking about chronic pain.For the 20% of adults who experience chronic pain, their internal alarm is unable to properly turn off and bring the body back to normal.So even though the initial damage might be repaired, their central nervous system has been in that heightened state for so long that the brain starts to behave differently. It slowly “learns” how to be in pain and can now experience it more easily than before.This is why chronic pain management is so challenging.You’re actively trying to reprogram the brain through different rehabilitation strategies like medication, exercise, lifestyle management, counselling, and goal setting. It requires the help of multiple health care providers and a coordinated effort to deal with the ongoing symptoms. This is obviously not an easy task, and it can take years before people are able to manage on a day-to-day basis.
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Hopefully after reading this article you have a better understanding of why pain is not such a simple thing. It is a very complex process that involves all the major systems of the body and is not always visible to the naked eye. There may not be any broken bones, deformed joints, or apparent bleeding to indicate an obvious problem, but this does not mean that there is no pain.Managing chronic pain is a long-term struggle and although you may lose some of the battles, the goal is to the win the war. Thankfully, you don’t have to fight that war alone.
Joshua Lee, PhD, Registered Physiotherapist, is an aspiring clinician scientist that seeks to bridge the gap between biological mechanisms of pain and clinical rehabilitation. Drawing from his previous experiences in graduate biochemistry, science education, and cross-cultural teaching, he brings a more integrative approach to physiotherapy. As a licensed physiotherapist, he deals primarily with under served and marginalized populations In London, Ontario where he gains invaluable experience in delivering interdisciplinary care to those who need it. He can also be found lecturing from time to time on complex pain at Western University or anywhere else that will bother to hear him talk. Currently, he remains optimistic that his PhD in chronic pain will soon end, and allow him to bring the innovations from the bench to the bedside.