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Pain scientists are starting to think differently about pain and its causes. The next few questions will help you to understand what we now know about pain. That’s important, because understanding pain will change how much things hurt and how much your body can do.


1.    Why do we get
pain?

Trust us here - pain is not an accurate measure of tissue health.  Pain is a protector. If our brain thinks that we are in danger it makes unpleasant feelings so that we change behaviour to protect ourselves.

So, our brain makes pain whenever it has evidence that our body is in danger and needs protecting, even sometimes when it’s not.


Sometimes we get pain when we injure our tissues and the pain protects us by stopping movement and letting the tissues heal. Sometimes we don’t get pain even when we are in danger because our brain thinks that there is something more important than stopping to protect that tissue – for example if we are about to kick the winning goal and roll our ankle we might not experience pain until later. Do you want to know more? scroll down!


















Sometimes we get pain when we don’t have any tissues to be injured – for example Phantom Limb Pain, which is pain located in a limb that is not there. By investigating how pain might emerge when there are no tissues to injure, scientists have discovered that the brain adapts in many ways to new situations.  

Pain is one adaptation that occurs when the brain has enough reliable information that we are in danger and need to protect ourselves. Sometimes the brain can adapt and be very sensitive to the message of danger, in this case we might get pain for seemingly little or no reason.

The adaptations to danger might include an awareness of movements to avoid (thinking more about how to do things to avoid pain), more connections between neurons and more talking between the networks of neurons in our brain. The extra connections and chatter make the system extra sensitive, like the airport security screens that beep at the buckle on a belt – the buckle is not dangerous but the machine is sensitive. Increased sensitivity can occur immediately, when it serves a really helpful purpose. If it hangs around you end up being over protected.


The good news? You can still train your system over time to be less protective again. Do you want to know more? scroll down! 













 


 
2. Is pain proportional to
injury?

No. It’s not about injury, it’s about detection of danger. A minor back injury often causes a lot of pain. The pain can even last up to six weeks. Meanwhile something that you would imagine hurting a lot might not - how often have you found a bruise and said “oh, when did that happen?”. Pain is a personal thing and context matters. Of course, it is critical that if you get yourself properly checked out by a doctor or physiotherapist - they are highly trained in how to detect unusual nasty things. Usually, their role is to help you plan your recovery.  


We have special nerves in our body that detect harm or danger. When they are activated they send warning signals to our spinal cord and sometimes to our brain. These warning signals are happening all the time, but only sometimes result in pain.


Most of the time, when the warning signals are evaluated, the brain protects us by moving away from the harm and there is no pain. This protection response might involve other systems too, like those involved in increasing our heart rate and releasing energy to our tissues. Do you want to know more? scroll down!




















One amazing thing that scientists have discovered is that we learn pain. That is, the more we have pain the better our brain gets at making pain and this can lead to unnecessary warning signals and pain.  


People who have experienced low back pain sometimes experience back pain when bending forward. Repeating this pattern of bending forward and experiencing back pain can sometimes lead to learning that bending forward is dangerous and may cause us to stop that movement. While this may be an appropriate behaviour in the short term it does not provide a long term benefit. We learnt by association that bending is painful and for recovery this may be one thing we need to unlearn.


How do we know when our nervous system is learning pain? We may notice that stress and irritations make our pain worse. We may notice that the pain is spreading and doesn’t go away even when we avoid things and that old injuries might start to hurt again. It’s easy to think that we’re going mad with the pain and that no one believes us. But we are not going mad and pain scientists do believe us. What’s more, pain experts now know that it is possible to retrain our system to slowly reduce our pain. Do you want to know more? scroll down! 
 

 
















3. How long will I have
pain?

In many cases, pain goes away as the tissues heal, around 6 to 8 weeks. In some cases pain stays around much longer than expected. Often it can take a year to feel like you’re back to normal after an injury or pain.

The more we have pain the better our brain gets at making pain and this means that certain parts of the nervous and immune systems could be overactive. The overactivity means that we may experience longer-lasting and more frequent pain.


We can think of the overactivity as like living with a sensitive car alarm that goes off at any little thing – a puff of wind, or even someone just looking in the window, not even touching the car. Our brain becomes overprotective and pain persists. Do you want to know more? scroll down! 

 





















4. What can I do about
pain?

Scientists and health professionals know a lot more about pain than they did just a decade ago. It is now known that pain is all about protecting us, not about providing a measure of injury. By understanding pain better we will all be able to ask better questions and improve the way we treat it. Pain is personal. Treatment for pain should include strategies to help all of the factors involved in the experience of our pain. Because pain is affected by ANYTHING that gives your brain information about the need to protect, treatment could involve several health professionals with different skills, such as a doctor, a physiotherapist, and a psychologist and it will most likely involve those close to you.

In the early stages of acute pain – a sprained ankle, for example - reducing the inflammation in the tissues using physical methods, such as ice, support via bandaging, strapping and/or crutches, and maybe some anti-inflammatory tablets, and having a good explanation of what is going on might be the most important strategies. Reassurance that your body’s natural responses to injury will protect those tissues while they heal, is really important. Movement will follow as soon as your system makes it possible. Physiotherapists are experts at guiding you through this process. Do you want to know more? scroll down! 





















If the ankle has been sore for 6 months or so, we need to identify what factors are contributing to persistent pain including possibly an overprotective response from our brain, psychological and social factors. It is important to rule out rare medical conditions such as fracture or a disease process. Your doctor is expert at identifying these things. Once you are given the all clear, exercise, movement and getting back to hobbies and work activities will help with recovery. Sometimes medications will be helpful, they may address the overprotectiveness – but they are not the main thing. All medication needs to be taken under the supervision of our treating doctor. Local doctors, clinicians and managers who help with return to work, and movement experts including physiotherapists, exercise physiologists and gym instructors may make useful contributions here.


Because pain is about context and will always be very personal, factors such as stress, feeling anxious or flat can be associated with your pain. Psychologists have huge expertise in helping you identify and deal with these things – their skills in helping you cope with the pain, improve our mood and manage your stress cannot be underestimated. Activities such as mindfulness meditation, increasing social outings and looking after our sleep quantity and quality will help. Do you want to know more? scroll down! 





















Being aware of how unhelpful thoughts can increase pain and limit success is very helpful when we want to challenge pain. A life coach, someone trustworthy, non-judgemental and approachable who knows a lot about pain (this could be any appropriately trained health professional) can help us to discover what life factors are holding us back from challenging pain and what life factors help us. A great resource for achieving this understanding is a workbook called the Protectometer.  Ask us about it if you want to know more.
 
Strategies to treat pain often aim at decreasing overprotectiveness in the system and one of the best ways to achieve this is via movement. Movement and exercise boost the immune system, nourish the synapses in our brain as well as strengthen muscles and improve cardiovascular health. This combination of changes help our brains to become less protective. Physiotherapists, exercise physiologists, trained gym professionals can work with us to tailor an exercise program that meets our needs and achieves our goals. One famous saying that is really accurate is – ‘to overcome persistent pain you need patience, courage and a really good coach.’

Do you want to know more? scroll down! 


















Because understanding pain will change how much things hurt and how much your body can do, it is important to seek a good understanding of pain. There are some helpful books on the topic including “Explain Pain”, some great youtube clips linked to this Pain Revolution website and some informative blog sites that get recent and rigorous research into the public realm fast, such as “
bodyinmind.org ”. We need to engage with the latest information on pain and change our thinking and behaviour in order to join the pain revolution.


THANK YOU FOR YOUR HELP AND SUPPORT AND FOR THE TIME YOU HAVE SPENT GOING THROUGH THIS RESOURCE.