It was first thought that pain was the result of a direct sensory link of a noxious stimulus (external or internal physical change that causes a signal in the nervous system) via nociceptors which are sensory receptors detecting changes in pressure, heat, chemical etc e.g. external stimulus like heat from a fire. The purpose of this was to protect us from harm. So when pain was experienced we changed our behaviour, e.g. we moved away from the fire. It was thought that pain was a sensation and the brain just registered pain implying only an ascending mechanism, where a signal goes to the brain that registers it. However, this didn’t explain why some peoples pain was experienced differently to the same noxious and non-noxious stimulus, nor why phantom limb pain occurred in amputees.
The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”. The current knowledge base we have with regards to the mechanisms of pain are that there is both and ascending and descending mechanism which involves the brain 100% of the time. As a result we now understand that pain is a perception and not just a sensation, that pain can be influenced by our thoughts, feelings, previous experiences and the social & environmental context.
We now know that pain isn’t an accurate indicator of tissue damage. The biological, psychological and social interactions of an individual make them unique and its these that are thought to be key in how individuals perceive and experience pain. Pain is a response to an individuals perceived threat, this response can be disproportionate to their actual threat.
The body is very good at adapting and learning. Therefore the body may associate and generate a painful response to a safe movement as it has learnt or believes doing so will do harm. For example in the case of persistent pain, over 3 months, we know in most cases tissue damage isn’t the ongoing cause, although it could have been originally. The pain persists and could be associated with the social context, environment or psychological state from then the initial injury occurred and that these factors remain a contributing factors to pain via association, although physically healed.
Pain is the bodies response to perceived level of threat. If you’ve been injured before then you are more likely to be more sensitive to pain in the area. Imagine our pain response as a house alarm system, if the house is broken into (injury) it triggers the alarm (pain). We may then be more on guard after this 1st break in (injury) and turn up the detector sensitivity, as a learnt response to what’s previously happened. This then goes off when there isn’t someone breaking but wind just rattling the door (normal movement but no injury). Short term pain is helpful to protect the body but in this example it becomes detrimental to health.
Due to the social and psychological factors that can influence our perception of pain we can change the environment and educate ourselves to reduce our sensitivity to miss interpretation of normal stimuli as painful stimuli. Alongside this, tolerance to low level discomfort/pain in the knowledge there’s no damage can help break the ongoing pain cycle. This graded exposure and understanding helps re-educate our bodies response. For example reassuring ourselves its ok to be in and work through a 2-4 out of 10 in pain (if red flags have been cleared). Pain is complex so trying to simplify can help, but not too much. Pain requires an explanation to help us understand it. Pain is the brains opinion of how much danger you are in. Once you accept this you can begin to change that opinion.
Therefore this is where using soft tissue therapy (massage in combination with exercise) or exercise by itself (PT or strength & conditioning) allows for a considered graded exposure to the stimulus when you know you aren’t under threat, reducing perceived pain and helps to break the pain cycle. Soft tissue therapy gives a window of opportunity to break the cycle and see positive benefits in physical rehabilitation whilst building self-efficacy & providing empowerment to the individual that they can regain control again. This is a process that is unique to the individual and sometimes requires some help, guidance & reassurance of a health professional like myself to support you through the ups and downs in your journey to recovery. If you are suffering from an injury or persistent pain and would like to explore alternative ways through exercises, movement, soft tissue therapy to improve your health whilst addressing the wider factors that can influence pain then book in a free consultation with myself.