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The Pain Experience: What We Know

Updated: Apr 30, 2020

IMPORTANT INFORMATION ALERT: Pain is not (always) a good predictor of injury or tissue damage.

Pain is our most important survival mechanism. It is obviously unpleasant but can let us know if we are in danger. Without pain, we would probably live substantially shorter (though arguably more care-free) lives. However, when pain starts to last longer than we’d like and without a seemingly reasonable explanation, it can dramatically interfere with our lives; for some, it can mean permanent disability.

First, we need to clarify another important point about pain. Pain isn’t as simple as we once thought. It is a complex experience, a learned behaviour and does not always mean something is wrong at a tissue level. The term, ‘it’s all in your head’ can be a taboo and apathetic phrase when used for those with unexplainable pain however there is actually some truth to it.

The brain controls everything about your pain experience.

It takes into account past experiences with pain (Let's say you were in a specific place in the past and hurt yourself leading to a very unpleasant pain experience; the brain doesn't forget that situation/experience.), your subconscious perception on how this current perceived threat may impact your life (If you're a piano player and hurt your hand, the pain experience you have may be very different compared with someone else.), along with many other variables to determine if you are in danger. If your brain believes you are in danger, it will relentlessly create the experience of pain.

One clue to help us understand that pain does not necessarily rely on tissue damage or injury stems from amputees who experience phantom limb pain. These people feel pain in a place that no longer exists on their body. How else can we explain this except by understanding the brain’s role in interpreting and creating the experience of pain.

In those suffering from chronic pain, we see changes in the regions of the brain that represent the area of the body experiencing pain. The area of the brain actually becomes ‘smudged’, explaining how over time, it gets harder and harder to localize where the pain is coming from.

The pain cycle perpetuates as we continually believe we are in danger. As we start to worry about the pain and avoid movements that create the pain and start to avoid activities that bring on the pain, we essentially reactivate the alarm system that tells us we're in danger.

So what’s the take-home from all this? Pain is not simply a matter of, ‘I am hurt thus I feel pain.’

Pain is a complex experience that the brain orchestrates based on many factors and can be present with or without any actual harm.

And just as a pain experience can be learned, it can be unlearned over time. Start to question your pain. Ask yourself, ‘am I in danger?’ One of the best ways to help answer that is to talk with a relevant health professional whom you trust.

To understand this further, 'Explain Pain' by Butler & Mosley is probably one of the most up-to-date and easy to understand explanations on this topic.

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