What is pain? The answer may be the missing ingredient to a pain-free body - Be My Healer
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What is pain? The answer may be the missing ingredient to a pain-free body

what is pain missing ingridiant

What is pain? And why is this question important to those who suffer from pain?

In 2011, Louw et al conducted a systematic review (a study of studies) on the effect of pain education on pain, disability, anxiety and stress in chronic pain patients. 8 high quality studies involving 401 subjects in the past 10 years were analyzed. They concluded that there is compelling evidence that an education of pain can have a positive effect on pain, disability, catastrophization, and physical performance. Read the abstract here...

That means that knowing about pain is a great place to start to rid yourself of pain and improve your life over all.

What is pain? 

Let's take a quick tour of the neurophysiology of pain creation. 

Just like an alarm system, the pain creation process starts with sensors. There are a countless amount of sensors sitting in your skin, waiting for bad things to happen to you. They are called nociceptors and they are divided into temperature, pressure and chemical sensors.​ These sensors sits tight until one of these three triggers (temperature, pressure or chemical) reach a threshold that our body set, then these sensors will send an alarm signal to our spinal cord.

Do we have pain yet? No. The alarm signal will be evaluated by the experience sorting mechanism in the way, called a synapse. These sorting mechanisms may ignore alarm signals if it does not consider it to be "exciting" enough according to the "recent events" in your body. The alarm signal may also run into traffic jams caused by other alarm signals, and lose its right of passage to more urgent alarm signals. If this particular alarm signal does not get lost on the way, it will get passed up to the control center: the brain.

old pain model

16 Century pain model

According to the older pain model, we would have pain now. However, as new technologies became available, piles of studies on the pain mechanism was done in the past 3 decades and they all indicate that things are much much more complicated than we previously imagined.

The brain is a metropolitan of signals. ​It relies on these signals to make sense of the world and help us survive. As soon as this newbie signal comes to town, it is bounced between hundreds of sensory process centers to be registered and examined for its significance.  We call these sensory process centers "ignition nodes". Here is an example of ignition nodes our brain uses to process pain signals:

brain nerve pathways for chronic pain
  • ​Premotor/motor cortex: organise and prepare movements
  • Cingulate cortex: concentration, focussing
  • Prefrontal cortex: problem solving, memory
  • Amygdala: fear, fear conditioning, addiction
  • Sensory cortex: sensory discrimination
  • Hypothalamus/thalamus: stress responses, autonomic regulation, motivation
  • cerebellum: movement and cognition
  • hippocampus: memory, spacial cognition, fear conditioning
  • Spinal cord: gating from the periphery

After extensive calculation based on the current physical situation, cognitive perspective, past experiences and dozen of other factors, the ignition nodes help the brain to make the million dollar decision: should we tell the big guy, the "conscious awareness".

If the brain's algorithm decides that the alarm signal suggest threat, danger or ​injury, the brain will disrupt your ongoing conscious thought process and alarm you with a painful sensation. AND, WE FINALLY HAVE PAIN!

What is chronic pain?

According to new analyses of data from the 2012 National Health Interview Survey (NHIS), an estimated 25.3 million adults (11.2 percent) experience chronic pain—that is, they had pain every day for the preceding 3 months.

pain does not equal damage

These kind of statistics drive the scientists' interest in the causes of chronic pain. Development in technology revealed to scientists that the presence of pain does not relate to the presence of tissue damage. MRI scans found severe lumbar disc degeneration and nerve compression in pain free individuals. Medical professionals also failed to find tissue damage in those patients who suffer from debilitating pain for months and years.

If no cause of pain can be found in chronic pain patients, there is no treatment to be offered. That does not sit well with medical professionals. Thus, a multitude of efforts have been invested in the study of chronic pain.

The most current model of chronic pain neurophysiology points toward a process called centralization of pain. This process can be better explained with an analogy.

orchestra pain analogy

Our body functions like an skilled orchestra. It is dynamic like tunes, flexible like tempos, and is constantly improvising and adapting to play the most up-to-date masterpieces sensations, emotions, and experiences in our life.

Pain sensation is only one of many many pieces our orchestra know how to play. However, under certain combinations of stress, fear, memory and social influence, our subconsciousness is under the impression that we are constantly under the threat of physical injury, even though it may not be real at all. Our brain could become extensively focused on sensations indicating possible injury. Our conscious awareness becomes overwhelmed by the pain sensation. Our brain becomes hypersensitive to nociceptive signals. Eventually, it will seems that the only sensation we can experience is pain.

It is as if our orchestra is so focused on playing a single piece over and over again, that it is slowly losing the ability to play anything else. The pain masterpiece becomes so familiar that our body continues to play the same tune regardless of the input and output variations, whether it is the caress of the breeze, or the warmth of the sun, or even the touch of a loved one. This process is called the centralization of pain.

Once this happens, our pain is no longer related to physical injury. Chronic pain is caused by faulty adaptation of our body's own neuropathway.

How do we reverse this condition? How do we stop our orchestra from playing the same pain masterpiece all the time and return to its original artistic nature? Treatments should target our cognitive perception through understanding our pain neurophysiology. Numerous studies showed that pain neurophysiology education can help to decrease our perceived fear and threat, improve pain experience, threshold, long term function and activity level in patients suffering from chronic pain.

Why Australians are smart about this

There is a group of physiotherapists in Australia who first started to explain "what is pain" to their patients. In the past 15 years, they ran studies to show the world that pain education can help people recover from chronic pain. They wrote books to show the world the best ways to explain pain to achieve a shift in perspective for chronic pain patients. They raised the awareness of chronic pain education on a national level.

Based on their studies and works, the Australian government funded this national TV campaign to raise understanding of pain. Their government funds courses, events and study materials for chronic pain patients and asks the entire nation to care and help those in pain.

explain pain book

The book "Explain pain" by David Butler and Lorimer Moseley became the "bible of pain education" for all populations. It is my absolute favorite book on the subject of pain. Everything explained in this blog post is presented in the book in more detail and elaboration with large funny artistic graphics and a humorous writing style.

"Explain Pain" helps readers to understand the mechanism of pain and all the different organs and systems it affects. It also suggests ways you can improve your pain and treatment options that may help with the recovery process. It's filled with fascinating facts and interesting analogies to help readers wrapping their mind around some deep and advanced physiology process. It is amazing how this health textbook can attract reader's focus like a sci-fi novel, and everything in the book is evidence-based and cited. No wonder this book has been crowned the "go-to" bible for clinicians and sufferers.

"Explain Pain" by David Butler and Lorimer Moseley

"...this is a great book! It is packed with the right messages for patients and healthcare providers and presented in a visually pleasing format. I highly recommend it for one's patient library and as an introductory summary for those who are entering the field of pain management."

Dr. Loeser is professor of neurological surgery and anesthesiology at the University of Washington in Seattle.

"Painful Yarns" by Lorimer Moseley

This is another book by the same author but is much thinner and more like a short story book. It is filled with funny anecdotes and metaphors to explain our pain experience through things we see everyday, such as cars, snakes and sharks.

“When reading, it is always a good sign when you start to cry from laughing….this is clearly the best book about clinical pain that I have ever read.”

Dr John Keltner, MD (Harvard) Pain Physician, Anesthesiologist and Research fellow, Oxford University.

I hope this blog did a good job to inspire your interest in understanding your pain experience. Pain is one of my most favorite topics to learn and talk about. Please leave me comments if you have any feedback or questions.

Thank you for reading, and I hope you find this post helpful.

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