Pain is a subjective experience determined by a localized response and a behavioral response. The localized response is driven by the pain receptors (mechanical, heat and chemical receptors) and nerve endings in the tissue of the injury or damaged area. This information is transmitted to the spinal cord via afferent nociceptors. At the spinal cord the message is relayed through a well-defined pathway to the higher centers in the brain. It is at the higher centers that the behavioral response is stimulated to begin behaviors that are directed at relieving or terminating the experience of pain.
If we look more closely at the localized tissue response to injury we see a variety of pain-producing chemicals that activate or sensitize the primary afferent nociceptors. The local pain response is where three different types of cells are activated to produce pain: mechanical (pressure, pinch), heat, and chemical. The signals released into the circulation stimulated by acute tissue damage produce an inflammatory process that not only stimulate pain, but also stimulate healing.
The behavior response as it is related to higher centers is what makes pain so tricky to modulate and even treat, especially in a chronic pain state. The experience of pain is not only a chemical process locally sending a signal to higher centers, but it is also an experience dictated by personality, health status, stress, and even prior experiences. Each person’s pain experience is unique to them, yet it is extremely common to experience pain both acutely following injury or surgery, but also chronically.
One in four Americans suffer from pain per the National Center for Health Statistics. Chronic pain is the most common cause of long-term disability and the primary reason for seeking health care services. In 2010, the annual cost of pain was greater than the annual costs of heart disease, cancer and diabetes combined. The health care costs due to pain ranged from $261 billion to $300 billion.
Pain is not only a prevalent problem, but it is extremely expensive for the health care system and costly due to lost productivity in missed work.
What is most interesting about pain is that in most cases it is a normal response to inflammation from an injury. In this case, it is designed to promote a behavioral response like resting in order to allow healing to take place. In the chronic pain state, this shifts to the same behavioral response yet without an acute injury. In a nutshell, pain is a subjective response experienced by the brain determined by local chemical response traveling from the nerve ending to the spinal cord and then the brain. In the chronic case, it is primarily driven solely by the brain rather than a brain response to a peripheral injury.
The behavioral response (the brain) is what important to understand to distinguish what pain is harmful versus what just hurts. In the case of infection or traumatic injury, the pain is harmful and needs to be addressed medically. However, in most cases pain hurts but doesn't cause harm. For example, the pain of a total knee replacement does in fact hurt. Yet, that is a NORMAL response to surgery and there actually is not need to medicate the pain. The trouble comes from being afraid of the pain based on our expectation or past experience which then tells our brain that we are in harms way. In this particular case, assuming a successful surgery and no infection, it is important to listen to the pain to not over due it but in fact move through the pain.
Attempts at turning off the normal pain response in fact impairs the healing process(NSAIDS) or promotes addiction (Opioids). Non-Steroidal Anti Inflammatory medications are geared to decrease the inflammation in the peripheral tissue which potentially decrease soft tissue and bone healing. Of specific concern with the use of NSAIDs is the decrease in the cellular response of the macrophage which is important for soft-tissue healing, bone healing and the immune system. The Annals of Physical and Rehabilitation Medicine explored the role and impact of NSAIDS on athletes stating, "This (NSAIDs day 3-7 post injury) could allow a more rapid return to the athletic activity. However, in the long term, this rapid return is likely to be the detriment of good-quality healing."
If you target the brain in modulating the pain with medications like opioids, then you create a problem with addiction or even death. The endogenous opioids blocks pain by attaching to the receptors in the brain and synthetic opioid are designed to to the same. The opioid receptor in the brain slows breathing and calms you...it may not actually even decrease the pain, just make you calmer through it. However, the synthetic opioids can cause constipation and worse addiction. In fact the CDC has reported that early opioid prescribing patterns for opioid-naive patients has been strongly associated with long-term use. Specifically, after the third day of opioid use, the risk of chronic opioid use raises dramatically. This addiction to opioids is the the gateway to heroin addiction.
Pain hurts, yes.
Our fear of pain has led to treatments of pain that are in fact, harmful.
We at SOAR are dedicated to providing safer alternatives to alleviating what hurts without causing harm.
The SOAR Into Healing uses nutrition, movement, rest, connection to your brain, and professional supplements that are inherently safe and effective at supporting healing all while reducing pain naturally and reducing the need for potentially harmful pharmaceutical pain medications.
Remove. Replace. Restore.
Remove the fear of pain that hurts.
Replace with techniques that support healing and reduce pain.
Restore optimal recovery without addiction or harmful side effects.
Eat Well. Move Well. Sleep Well. Connect Well. Supplement Well.....To Reduce Pain
Dr Carolyn Dolan DPT, Cert MDT, MSHN
Where physical therapy, nutrition and lifestyle meet, because how you live your life determines whether or not you soar. Inspiring action with information so you can reduce pain, optimize healing and improve function naturally during recovery from injury, surgery or painful condition. This is a website for the open-minded; obstinate need not apply.