And if you’re feeling a little low on hope, then get yourself a copy of Alison Sim’s Pain Heroes. It is full of everyday people and their stories of hope and recovery. It may just give you back the belief that you can get better – and most people really can!
Pain does not equal tissue damage
2. The next most important thing to know is that pain does not equal tissue damage. We can have damage without pain – think silent heart attacks or cancers that are detected too late to treat, despite destroying lots of tissue. We can also have pain without damage – think back to the last time you stood on a piece of Lego, LOTS of pain – but no real injury. There is definitely no 1:1 relationship between pain and injury.
Yes, pain does often occur with injuries that involve tissue damage. No one is disputing that, but we must acknowledge that pain is just not that straight forward – it is often weird and unwieldy. Even the intensity of our pain has an unpredictable relationship to the severity of our injuries. Think about a pesky little paper cut – tiny, barely a break in the skin and it hurts like all hell. Then magically, within a few minutes, without the injury healing at all, the pain goes away. And we’re back to a damage without pain scenario. So say it with me here (because it’s REALLY important you get this bit) pain does not equal tissue damage.
Why am I telling you this? Because many of my patients have pain, sometimes lots of pain – but there is no significant injury. Nothing to ‘fix’ or ‘heal’.
So, if pain is not a gauge of tissue injury or it’s severity, what is it? And can we make it better?
Pain is protective
3. So despite what I said about knowing thine enemy, pain is not actually your enemy . What you will discover as you learn about your pain, is that it is there to protect you. But, like a misguided friend it can sometimes get a little carried away and do more harm than good.
To most of us pain makes sense as a protector once injury has occurred. With acute pain post injury, your nervous system is obviously encouraging you to rest and recover. To avoid making the injury worse. This is helpful.
But pain is also predictively protective. By that, I mean that pain typically occurs below the threshold of tissue tolerance. Before tissues yield to injury. Pain is felt before a sharp object tears tissue (Lego…). And, pain is felt before heat actually burns (a morning coffee that is too uncomfortably hot to hold). This is also helpful. Pain is essentially a feeling to help us detect an imminent threat and to help change our behaviour before injury (or more injury) occurs. It is there to protect you and, that is a good thing. Except when its not…
You see sometimes our nervous systems can get too protective – too sensitive, like that friend we were talking about. Sometimes our nervous systems can stay hypersensitive and protective for too long after an injury. Sometimes they can be drama queens, getting all sensitive about a minor scrape or scratch. Or, sometimes they can be protecting us from invisible things that we can’t perceive (like blood sugar, blood pressure, physiological and/or emotional stress etc.) and when we fail to modify the potential threat in our (internal or external) environment, our pain can drag on and on. It can escalate and spread, and morph into an unwieldy behemoth. This unwieldy behemoth is chronic pain and chronic pain is not like acute pain. It is a different beast altogether.