The topic of pain is obviously a huge one, but we wanted to lay out some basic concepts we discuss with all of our pain clients. Acute pain is pretty easy for people to understand, right? You break your arm, or get a cut on your shin, or burn your arm on the stove… it hurts, but as the tissue heals, the pain lessens over time. Chronic pain is what confounds most folks, because the pain in your knee, back, neck, shoulder, etc. persists for weeks, months, or even years! So, let’s look at three big concepts that can help you better understand your pain:

Concept #1: Pain is 100% a brain construct. That’s right, pain is actually an action signal from your brain, it is not a signal from the area you feel it to your brain. We do not have “pain receptors”, we actually have special types of nerves that are threat When these threat receptors sense something noxious or threatening to the system (i.e. you) they send a signal to the brain, which then interprets the signals and decides how dangerous the threat is to the system (i.e. you). If the brain thinks the threat is great enough, it will send pain to that are, and possibly other areas. It is basically the brain’s way of getting your attention so you can do something about the threat.

Concept #2: Injury does not equal pain, and pain does not equal injury. Yes, you can have an injury that does not hurt. In fact, most people have something “broken” on the inside that they don’t even know about. The medical literature is full of studies showing things like 80% of people are walking around with tears in the meniscus of the knee but have no pain, or that 40% of folks who have no back pain actually have bulging discs when scanned in an MRI. On the flip side, many people experience pain with no obvious injury as seen through X-rays or MRIs. This concept relates right back to Concept #1 – the brain sends pain only when it thinks a situation is threatening enough.

Concept #3: Chronic pain is due to an overactive nervous system. Tissue heals in weeks to months. So, if you have had pain for a long time, whether after an acute injury or it crept up over time, your nervous system has become hypersensitized to threat and your brain is sending pain signals inappropriately. Think of it this way: in a normal nervous system, any threat signals have to reach a certain level before the brain sends a signal of pain. But with an overactive nervous system, very small threat signals can cause the brain to send pain. We don’t really have a “pain threshold”, we have a “threat threshold”. And if you have chronic pain, your threat threshold has gotten lowered significantly.

We hope this was informative and let us know if you have any questions. We’ll explore pain more deeply in future blogs!