Pain is the most the most burdensome health condition worldwide. To have pain is normal. Without it humans would not be able to survive.
Pain is a subjective experience markedly influenced and modulated both positively and negatively by cognitive and emotional states. Recent research is validating what we’ve known all along: anxiety may be the single greatest contributor to chronic pain.
What is pain?
Although pain is almost always described by individuals as a thing eg “I have pain”, it is really the experience of unpleasant feelings. Without a conscious brain, we cannot experience pain. When we have a general anaesthetic for an operation the drugs work in the brain so we do not feel pain.
The distressing feeling that we experience and call pain is due to the brain’s subconscious “interpretation” of nerve signals from the body. If the brain “registers” these nerve impulses as a threat then there is an experience of pain which is a warning signal designed to alert the body to avoid danger, similar experiences in the future and to facilitate healing. Humans need a pain system to survive.
Pain is not only a response to danger signals from the musculoskeletal and nervous systems, it is a whole-body response. Although below the level of consciousness, danger signals are received when there is general ill-health. Examples include elevated blood pressure, chronic inflammation from any cause, immune system dysregulation, chronic elevation of blood sugar, abnormal hormone levels, and imbalances in bowel function which can trigger the well-known gut-brain interactions. Managing and dealing with pain requires a whole person plan. To understand what this might mean take a look at the Pathways to Wellbeing approach.
In acute pain, the experience of pain resolves once the damaging or potentially damaging stimuli are removed and the body is healing. This is the normal body response to damaged, inflamed, or stressed body tissues. This pain, depending on the nerve pathways involved is called nociceptive pain, neuropathic pain, or mixed pain.
Persistent pain can become chronic pain and this is an abnormal and unpredictable body response often associated with low-grade chronic inflammation, called metainflammation. Research is progressing rapidly but we still do not know why chronic pain develops in some people and not in others. A relatively new concept, metainflammation defines a state of low-level, chronic inflammation that significantly and detrimentally affects your overall health. It is strongly linked to metabolic dysregulation, increased risk of developing heart disease and obesity, along with impaired immune function.
Chronic pain is not simply acute pain that lasts for a long time. Chronic pain can be considered a response involving the brain and nerves. It is not a measure of persisting injury. It is a conscious experience that can be associated with nociception( the signals sent by nerves to the central nervous system) but is modulated and influenced by a myriad of neurobiological, cognitive, and social factors. Recent research is validating what we’ve known all along: anxiety may be the single greatest contributor to chronic pain.
The pain system, like all systems of the body ( eg cardiovascular system, respiratory system, endocrine system et cetera ) can malfunction and over signal in a variety of different ways and send incorrect and unneeded warning signals to the brain. This is often called central sensitisation which is a neuroinflammatory response.
In chronic pain, there is an experience of pain in the absence of any detectable stimulus, damage or disease. This pain is called nociplastic pain. Noci means nerve, and plastic refers to the changeable nature of the brain cells and connections leading to altered function in response to changing and persisting stimuli. The experience of pain compels us to take action but this experience is a poor representation of injury, or pathology. There are, for example, individuals with terrible-looking knee xrays who have no knee pain, whereas others have minimal xray changes and yet have pain that is experienced as severe.
There are many conditions, such as fibromyalgia, chronic fatigue, osteoarthritis and post-surgical pain that are due in part to a pain system that has gone awry or which has been sensitised to (cause an amplified experience of pain.
Below is our Library of articles about many aspects of pain and management. The articles are updated regularly as new information is received.
These 5 websites, among the 1000’s of websites devoted to understanding and treating pain are all you need to look at.