Sorting out the process of pain

Imagine getting a bee sting without feeling the sting, or not feeling pain from a knee scrape or paper cut. Sound appealing?

It might. But the fact is pain protects us. Pain is a warning, it says something may be wrong and we should take note. If you hyper-extend your knee in a yoga class you might feel a twinge of pain. That is your brain alerting you to a potential injury. Back off, your brain is saying, something is not right.

“The brain creates pain in an attempt to determine whether there is a threat to the body,” says Jessica Shelton, physical therapist at Providence Park Sports Care Center in Portland, Oregon. The brain gathers information related to pressure, temperature and movement. If danger is imminent, pain is created to call attention to the affected tissue or body part. But that doesn’t mean there’s tissue damage.

The science of pain

We used to think that pain receptors, located throughout the body, signaled pain that was passively perceived by the brain as a sensation. However, in the past two decades pain research has turned a corner. Now researchers know that pain is created by the brain.

If you get hurt, nerve endings are triggered and send information to your brain, which interprets the information and determines if there is a threat. If your brain decides that pain would benefit you in some way, such as encourage you to protect the painful area to minimize further damage, you’ll feel it. Pain may not be an accurate measure of the extent of damage; but it’s the signal that spurs action.

Processing pain

Say you’ve turned an ankle on the tennis court. Your body’s first response is an alert: your ankle has been compromised and you need to do something to avoid further damage. So you stop the game, ice your ankle and stay off of it as much as possible for a while.

At first, you still feel some pain when you stress the tissue that has injured. “This is the repair phase,” explains Shelton. This phase may last 4-6 weeks, depending on the extent of the injury.

There might be some inflammation, but that’s normal. Your body is working hard to repair and create new tissue.

The next phase is equally important. “In the remodeling phase, the new tissue is untrained and it has to learn everything the prior tissue knew how to do,” says Shelton. During the remodeling phase, an injury, such as a sprained ankle, may continue to smart even with the slightest pressure. Most often that’s because there is an increase in the level of sensitization. When an area becomes sensitized, you will feel pain sooner and perhaps more strongly. This is your brain reminding you that you’re still healing.

Ease back into activity

This critical stage of recovery is also when people become impatient with the process. Some people try to jump back into their previous level of activity; others cut back too much or quit their activity or exercise routine altogether. That’s why Shelton encourages her patients recovering from injury, accident or surgery to return to their normal activities in phases.

“Pain does not always equal harm,” says Shelton. “Every time you feel pain, you may not be damaging your body. But if the pain doesn’t decrease over time then I look at your approach.  I might suggest you back off and start small or more slowly,” she says.

It could mean that the recovery process takes longer than expected. But Shelton finds that patients who have a better understanding of how pain works are more comfortable with it and more likely to return to their previous level of activity.

“Understanding how pain works, what is considered normal pain, and what is sensitized pain is powerful stuff,” she says. “Especially for people who don’t think they’re getting better.”

This is a simplified explanation of the current understanding of pain – the biology of pain is, in fact, extremely complex. However, understanding how and why the brain controls the output of pain changes the way it is managed, especially during recovery from an injury or surgery.

To learn more about pain, consider enrolling in a class. Ask your Providence provider for information about one in your area. Or watch this short video to learn more about pain. Shelton also recommends the following books: “Explain Pain” by David S. Butler and G. Lorimer Moseley, Ph.D., or “Painful Yarns” by G. Lorimer Moseley, Ph.D.

If you’re experiencing persistent pain, talk to your primary care provider, or ask to be referred to a physical therapist. Don’t have a primary care provider? Look for one in your region here.