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Does “Hurt” Mean “Harm”?

Virtually every patient who comes to see us has pain. We have been dealing with pain problems for more years than we care to count and the more experience we have with people in pain, the more we have come to realise that pain is a complicated thing. Far more complicated than most people realise.

Of course, everyone (apart from a very small number of unfortunate individuals, who due to genetic issues can’t feel pain) experiences pain from time to time. In most cases it is a very effective way of steering clear of physical danger and damage to the body. The way that pain works also seems to be pretty straightforward to most of us. For instance, the amount of pain we feel, seems to relate directly to the amount of potential danger that we encounter. An example is a nail sticking through the sole of a shoe. The more pressure we apply through our foot, the more pain we feel. This simple link between the intensity of the threat that is detected by our nervous system and the amount of pain we perceive, has up until recent times been taken for granted by medical professionals. But the reality is quite different and there is incontrovertible scientific evidence to support the fact that pain is not simply an input. It is in reality the opposite as there are no such things as pain receptors in the body. Instead, the brain and central nervous system receive information from many types of receptor cells and then the brain decides whether or not to produce pain and how much pain to create.

This scenario doesn't mean much as regards the above example of stepping on a nail. After all, in this situation, the pain does an effective job of stopping us from stepping onto the nail for a second time and causing more tissue damage. The pain felt after treading on the nail isn’t as bad as it was initially, but it's still enough to give us a protective limp for a day or so, thereby giving the damaged tissues time to heal. The pain then goes away and we get back to walking normally. However, what is happening to the person with pain that won't go away, even weeks, months or years after sustaining an injury? Long after the initial injury and after enough time has passed for the body to heal. For these people with persistent pain, there is a much more complex set of events in play, unlike with the nail in the shoe scenario. In cases of persistent pain, the central nervous system produces pain for no good protective purpose. The pain sufferer then gets trapped within vicious cycles of pain, movement problems, reduced exercise and activity levels, sleep disturbance, stress, anxiety and depression.

The key to resolving such cases of persistent pain depend upon three key interventions. The first is to rule out any significant physical cause for the pain. The second is to identify those factors that are triggering and perpetuating the pain. The third is to devise strategies to deal with these pain drivers.

Pain can be a scary thing. But then it is meant to be scary. The experience and fear of pain is used by the brain to change our behaviour. It affects the way, that we move and our mood and emotions. In most cases these changes are relatively short lived and helpful, as they make us adapt our usual activities while the body heals the damage that caused the pain in the first place. But pain is a complex thing, as are human beings and complex systems can malfunction. When, in the case of pain production, they do go wrong, it can be extremely difficult for an individual to find their way out of the pain maze without some help and assistance. Every person with persistent & recurrent pain is unique. As such, the help required to manage their pain should be tailored to their needs. It is this basic philosophy that underpins our approach to helping people for whom hurt doesn't mean harm but does mean discomfort, distress and disability.

References

Explain Pain 2nd Edition Noigroup Publications 2013. ISBN: 978-0-9873426-6-9

Vibe Fersum K, O’Sullivan P, Skouen JS, Smith A, & Kvåle A (2012). Efficacy of Classification-Based Cognitive Functional Therapy in Patients with Non-Specific Chronic Low Back Pain: A Randomized Controlled Trial. Eur J Pain 2013 Jul;17(6):916-28. doi: 10.1002/j.1532-2149.2012.00252.x. Epub 2012 Dec 4.

Resources

noijam.com
pain-ed.com

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