Pain is a part of life: a very frustrating, confusing, demoralizing, yet necessary part of life.  

As physical therapists, one of our most important responsibilities is educating our patients about what pain actually is. We’ve noticed that understanding pain offers our patients the peace of mind and hope that empowers them to address their problem. 

What is pain? 

The complexity of the pain experience has challenged the medical community for hundreds of years. We are learning new things about it every day. What we know for sure is that it is as unique as your fingerprint; everyone experiences it differently.  

The brain produces our pain, and everyone’s brain is completely different. The purpose of pain is to draw attention to a part of the body that sense something might be off. This is vital to the human experience because it protects you from doing further harm to that body part. Think about what happens when you put your hand on a hot stove. Your finger senses extreme heat that your body is not designed to tolerate, so your body sends a pain signal to the brain. Your brain tells you to pull your finger away from the hot stove. Pain is protective. We need it to survive. 

However, sometimes that protective pain becomes unhelpful when you continue to feel pain even after your tissues have healed

Different types of pain: acute vs. chronic 

Acute Pain 

The “finger on a hot stove” is an example of acute pain: it’s caused by something specific that is threatening your body to be a warning sign to you to do something about it. This pain will go away once the affected area has been sufficiently healed. Very simple. 

Chronic Pain 

Chronic pain on the other hand is much more complex as there may not be an identifiable cause making it difficult to diagnose, let alone treat. A patient may report they have had low back pain for 10 years after a triggering event like an injury or surgery, and even though their tissues have fully healed, they still experience pain there. This can be extremely frustrating for these patients because more than anything they just want to know why they still have pain there. This is where learning about pain can be so beneficial because it can give them an idea about the different causes of pain aside from just soft tissue damage. Enter in the biopsychosocial model: 

This diagram does a good job showing all of the factors that make up the pain experience and can help people appreciate the complexity and individuality of pain. Everything that you’ve experienced in your life from past injuries, stressful events, language that people have used around you, and so many other unique things about your past create your “pain profile.” The reality is that some people have a high pain tolerance and are less prone to developing chronic pain while others may be the opposite. The good news is that research is showing that learning about pain science is an extremely effective, long-term solution for people suffering from chronic pain. 

So here are some helpful analogies to help you understand chronic pain: 

Pain is an Alarm System

Chronic pain is like an overactive alarm system in your house. Imagine a normal alarm system that goes off when an intruder comes into the house – it did it’s job, it protected the house. But now, that alarm system becomes more sensitive to ANY threat that even comes close to the house. So that alarm system is now going off if someone just walks up to the house. 

Now think about that alarm system as the body’s nervous system. That nervous system produced a normal pain response to a triggering event where part of the body was in true danger like it was supposed. Then it became sensitive to much smaller events that normally do not produce pain. That nervous system has become overactive and just needs to return to a normal level. 

Pain is Your Volume Control

The nervous system can act like the volume on your iPhone. When the nervous system volume is low, your pain experience will be lower. When the nervous system volume is high, you may experience more pain. So what is controlling the volume? The person with the hand on the volume control. There are may personal factors that affect the how “loud” your nervous system is. Refer back to the biospyshcosocial model: how much you think about your pain, how much activity you do, how supported you feel at home and work, your past experiences with injury/pain, and many others. 

Sometimes There’s a Technology Glitch 

Persistent pain is like a software failure. When your computer freezes or crashes, it’s almost always a software error. If you looked inside the computer you wouldn’t find anything wrong with the hardware. You don’t run out to a computer store and replace the hard drive or internal modem. The problem is the software, not the hardware. Chronic pain is a problem with the software. There is nothing wrong with the hardware in the body (e.g. bones, muscles, organs), but the software that sends messages throughout your system has a glitch (N. Schechter). 

Hopefully one of those analogies connected with you and helped you begin understanding how pain works. But I want to reiterate the astounding complexity of pain. We learn more about it every year. It’s okay if it is still confusing and frustrating (it can be for us too!)

Just because you feel pain, that does NOT always mean that there is damage being done to your body. It’s merely a signal that your body feels threatened. Sometimes that threat is real, but other times something else creates a perceived threat. Partnering with a trusted medical provider can help you figure out what is causing your pain and how to address it.