This is a question that doesn’t have a simple answer, which often can make managing pain very complex. In society and the health care industry, pain is often over-simplified or over-complex in its explanations, expectations and treatment approaches. What we know is that pain is multifactorial, and there is no one solution, method or approach to treating pain. It needs to be individualized to each person. There is a theory that pain is influenced by at least three factors, the biological, the social and the psychological. This means that we need to address these factors in our pursuit of managing pain. We also need to understand that pain is a natural occurrence in life, it has a place, it has value and it is unavoidable. It's the avoidance of pain that led to the opioid crisis we currently see in society.
Image source: Cholewicki J, et al. Can biomechanics research lead to more effective treatment of low back pain? A point-counterpoint debate. J Orthopedist Sports Phys Ther. 2019; 49 (6): 425-436.
Let's start with biological aspects of pain, and let's be clear: all pain is biological. If pain nerves aren’t sending pain signals, then there is no pain. The question of why they are sending signals is where the grey area comes in, but we will touch on that later. Most people think the nervous system is a set of wires that send signals through the body like a light switch connects a signal to a light. But actually, our nerves are more like glands lined up in a linear fashion, each one secreting a charged chemical that signals the next one to do the same. This process continues until the signal to contract a muscle reaches the muscle or the signal indicating pain reaches the brain. From this process we sometimes can have pain signals being sent long after an injury has healed because somewhere the chemicals have not been fully reabsorbed and the signal keeps firing. It’s also due to the nature of nerves that other chemical issues in the body can affect sensitivity of the nervous system on a whole.
This leads us in the psychological aspect of pain, which in itself could be a full post. Chronic pain can have a huge drain on mental health but mental health can have a huge impact on pain. We often see changes in someone’s serotonin, dopamine and other hormone levels when people are suffering from issue related to mental health. These chemical can be closely tied to sensitivity of the nervous system. Adequate levels can have a positive effect by reducing nerve sensitivity and low levels can have a negative affect by increasing nerve sensitivity. As a result, someone who is happy go lucky, in a good mood can stub their toe and forget about it seconds later, where someone who is suffering from a mental health condition could have the same incident but may experience a heightened pain response, and think their toe is broken. This is just the tip of the iceberg as far as how our psychological state can affect pain, but is an extremely important factor to consider when treating pain.
Finally, there is the social aspect of pain. If we are raised to believe that pain is bad and to be avoided, our beliefs will lead us to avoid pain at all costs. People often believe that pain is an indication that we are doing damage and thus need to avoid pain. As demonstrated above, we can have pain without any damage at all or long after injuries have healed. What we are learning is that we will often experience pain post-injury, long before we reach ranges of movement, loads or stresses that are dangerous. Avoiding pain can lead to avoiding movements, which often reduces tissue tolerance. We see examples of the social aspects of pain all the time: hockey often demonstrates a disregard for pain in pursuit of success, where other sports see athletes pulling themselves from competition with the simplest of injuries.
Our jobs as therapists are not to eliminate pain but to teach you the difference between good and bad pain, hurt verses harm and all other aspects of pain. We will make sure you have the tools and knowledge of how to manage pain, and when it’s safe to play through pain and when you need to sit out.
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