The number 1 indicator why people go seek help from a medical professional is pain. Whether it’s from injury and trauma or unknown cause, pain can become daunting and instill fear in movement or activity. Understanding Your Pain 101 aims to describe what pain is and help build confidence in being able to take control of your painful experience. Let’s begin with defining what pain is…
What is pain?
Pain is extremely complex and constantly being defined and redefined. Despite popular belief, pain does not only occur due to tissue damage. Here’s a collective definition of pain:
“An unpleasant sensory experience associated with actual or potential tissue damage with sensory, emotional, cognitive and social components”⠀
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In other words, pain really is a multidimensional experience. It is an experience that is influenced by the interaction of one’s social environment, subjective perception, and learned responses including beliefs and expectations. In addition, pain is often more about potential harm rather than actual damage. It is a mechanism that has evolved to become more of a protective behavioural strategy rather than a direct response and indicator of harm. Therefore, pain is meant to protect you, caution you, and does not always represent damage.
So how does it work?
The most widely accepted explanation of pain in today’s society is that pain is an “alarm system” – it is meant to caution you and alert the body of potential harm.
Potential threats are picked up by specific receptors in our body, called nociceptors, which then sends signals to our brain to bring attention to the unpleasant stimulus. The brain will then respond with an action that matches the expectation of this threat while also taking into account other information such as memories and beliefs.
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Let’s look at an example from cooking in the kitchen:
You reach for a plate on the stovetop to realize upon touching it that it is extremely hot. You start to experience a sharp/hot pain in your and rapidly remove your hand
- In this scenario, the potential threat was the heat and temperature of the plate which created a painful experience and the action decided by the brain was rapidly removing your hand
But what if you knew beforehand that the plate was hot and it didn’t surprise you? You likely wouldn’t have had such a painful response and jerk reaction after coming into contact with it since you had already anticipated the potential threat. By simply changing your expectation and knowledge of the plate, the brain is able to create a different output which in this case, would be a reduction in pain experience and altered hand movement.
Let’s add another change in context to the scenario – say you were a chef that handles hot plates numerous times throughout the day. Your response to touching a hot plate or ability to sense harm in a hot plate is likely decreased because you are accustomed to the feeling. In this case, past experiences plays a role in changing your brain’s response, ultimately altering your pain experience.
The moral of the story is that a painful experience relies on our brain’s ability to interpret the alarm and can be influenced by several different factors such as expectations, beliefs, psychological state, social and physical stressors and many more.
Now let’s go back to looking at pain in the context of physical activity and exercise.
The overflowing cup model
The overflowing cup model of pain looks at the relationship between total load or stress applied to the body and the body’s ability to respond to that amount of load. In simpler terms, this model defines pain by the cumulative amount of stress on the body, both physical and non-physical.
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The cup represents the body’s ability to tolerate and handle stressors of daily life and everything we do throughout the day adds/pours water into it. This includes:⠀
– Daily habits such as walking, standing, eating, sleep⠀
– Meaningful activities ⠀
– Coping strategies ⠀
– Emotions and beliefs⠀
– Lifestyle/health/social factors ⠀
– Tissue injury⠀
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Most days, we have a little room left in the cup to manage all the day to day stressors of life. But when the content in the cup starts to build up and overflow, that’s when we can start to experience pain.
Let’s look at a real life scenario:
This past month has been very stressful – you have numerous deadlines to meet at work, you’re in a fight with your significant other and because of this, you’ve been anxious and are finding it difficult to fall asleep. Your typical escape is physical activity and weightlifting, but lately you have been experiencing back pain following heavier lifting sessions. You are feeling really depleted.
Pain management strategies and application
Now using the overflowing cup model, there are two ways to help address your pain:
- Reduce what is inside the cup
- Make the cup bigger
Some ways to reduce what is inside the cup in this scenario include:
- Stress relief strategies
- Focus on sleep, nutrition
- Connecting with family and friends
- Understand what influences your pain
- Decrease frequency of exercise
- Decrease the amount of weight/resistance you are using
- Change the exercises you are performing
Some ways to make the cup bigger include:
- Meditation
- Develop sleep hygiene strategies
- Organize your days and create a routine and schedule
- Gradually increase your exercise load/weight
- Gradually increase the frequency at which your exercise
Pain may limit what you might do for a short period of time, but we can choose to be resilient and welcome the challenge. These strategies are by no means exhaustive, but are meant to show you how there are many ways, both physical and non-physical, that can influence your pain experience. It is extremely important to develop strategies that address these multitudes of factors rather than focusing on the physical stressor alone. There is usually a way to keep you active!
Key Takeaway Points
- In absence of trauma, pain is more of a protective behavioural mechanism rather than representing any physical damage
- Pain is multifactorial, which means if there is more than one thing causing your pain, then there is more than one solution
The worst thing to do is nothing – if you are unsure about what to do, seek help as soon as possible. Find a health care practitioner that can help you address all aspects of your pain experience and get you back to what you love to do.
Nikki Garcia, MPT, BScKin Registered Physiotherapist
Grey Method Physiotherapy & Massage Therapy
