The International Association for the Study of Pain (IASP) defines pain as ‘An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage’. But what does this actually mean?
A key point immediately is the mention of ‘actual or potential tissue damage’. So, can we have pain when there is no tissue damage? The answer is yes! Pain is a wonderful protective mechanism biologically inbuilt in most of us as an aggressive means of protection. It is the subconscious brain that creates pain, if it feels the need to look after you in a potentially threatening situation.
We have all experienced or have seen examples of pain without damage in everyday life. Too long in front of the computer and your neck starts to get sore? Well it’s not very likely at that first onset of soreness that you have damaged the tissue in your neck, your brain is just trying to motivate you to move or change activity. The same goes for pressure soreness on your buttocks when sitting on a hard chair for too long, the brain again is just telling you to move. Again, whose knees don’t hurt after squatting too long in the garden? Initially, there is no damage; the pain motivates you to move before potential damage. Our brains are very good at protecting us, and sometimes, a little too good.
Conversely, if you haven’t personally experienced it, you have likely heard of stories where someone may, despite serious injury, not feel pain. It might be the story of somebody with something embedded in body tissue, turning up to hospital with no pain, or it might be the cut on your arm you don’t feel when in the midst of another task. Your brain also has this incredible capacity to switch off its protective mechanism, and it can do so if it sees a greater priority.
Pain is never as simple as damage causing pain. Reflecting on our definition again, it is a ‘sensory and emotional experience’. Sensory because we feel it and because it is affected by so many environmental stimuli. Emotional, because it is rarely pleasant and our emotional state can influence it.
Focusing on the sensory, if we look at pain as a protective mechanism, is it that different to the feeling of the wind on your face? Is it different to the feeling of heat when holding your hand over a heating element? Yes, it is arguably much more unpleasant, but it is an experience created for a reason, mostly to protect us.
Looking at the emotional aspects, would the neck pain at the desk I already spoke about feel worse in an incredibly stressful working environment with an unpleasant supervisor? Possibly yes, or if it didn’t feel different, then maybe it would present earlier in the day. Or have you ever rolled your ankle while rushing to something, like catching a bus? Did the pain kick in immediately? Or only after you stopped? This delay in pain was designed to allow you to achieve your needed task first.
These are all examples of the wonderful variability of pain. The nervous system goes through incredibly complex changes during the experience of pain, changes that can make you more susceptible to pain in the future, or make pain persist beyond what is regarded as a “normal” time frame. This is the beginning of a series of blogs that will hopefully bring greater understanding of pain in all its complexity; from the moment of its first experience, to how it is able to persist even after the potential or actual damage is gone.