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Pain Explained

Updated: May 4, 2023


Female back neck shoulder pain

There are many different types and qualities to pain. Broadly, pain is divided in to two categories; neuropathic (pain caused by a lesion or disease of the somatosensory nervous system (Murnion, 2018) and nociceptive (pain caused by an external stimulus that activates nociceptors (sensory receptor). This can be due to mechanical or physical injury, thermal or chemical injury such as with a burn. Inflammation is included here (Franks, 2018)).

Pain can also be described according to how long it has been present for. Acute pain is sudden, of short duration and is associated with a cause. Chronic pain lasts or recurs, for longer than three months. Chronic pain can be further subdivided into Chronic primary pain (examples, pain from a specific cause, or chronic pain syndromes such as fibromyalgia, complex regional pain syndrome, non-specific low back pain, chronic migraine and irritable bowel syndrome) and chronic secondary pain syndromes (cancer-related, post-traumatic or post operative pain, neuropathic pain, secondary headache/orofacial pain, secondary visceral pain and secondary musculoskeletal pain) (Rolf-Detlef, et al., 2019).

The body's reaction to an acute painful stimulus, like stubbing your toe, is to send an electronic signal via a reflex loop, to move foot away from the painful stimulus. This happens very quickly and without any immediate brain involvement. However, a signal letting the brain know what is going on, is sent up the spinal cord to the pain centres in the brain, so that you become aware that it has happened. This is when we recognise that something painful has occurred and there are many behaviours we display in response to it. We often hold or guard or rub the affected painful area which protects it from further damage and distracts the brain from the painful signals. Surrounding musculature tenses up or goes into spasm to prevent further movements that might do more damage. Inflammation and tissue damage continues to cause pain and discomfort until the injury heals. Healing time depends on the severity and the type of tissue that has been damaged.


Pain reflex arc

Chronic pain is different from acute pain in that the initial injury has already healed, but the pain signal keeps arriving. This can be constant or recur periodically, mild to severe, but is generally pain that is present for 3 to 6 months or more. There are complications to chronic pain; it can make you feel tired, lethargic, frustrated, angry and depressed. Depression can then affect how we feel and interpret pain, compounding the problem.




Treatment for acute pain tends to involve aiding and supporting healing, through rest, ice, compression and elevation to help reduce swelling and inflammation. Painkillers and NSAIDs can help reduce pain and inflammation. Managing the underlying cause can help prevent further injury or inflammation or it progressing to chronic pain. In the case of musculoskeletal conditions, gently stretching, massaging and mobilising surrounding muscles and joints helps increase blood supply to the area, which increases the delivery of oxygen and nutrients required for damaged muscle fibres and other structures, to heal. It helps reduce spasm and tension, and reduces perceived pain (Daneau, et al. 2019). Exercise (stretching, strengthening and aerobic exercise) combined with education as to how to prevent further episodes, can prevent the recurrence of back pain (Shiri et al., 2018). Therapies that enable patients to feel a better sense of control over their pain and outcomes (a greater locus of control) result in better pain resolution and subsequent functional abilities (Musich et al., 2019). Pain and how it is interpreted, can be a complex and individual experience, with multifactorial influences affecting recovery and therefore, interventions required to aid in recovery. Acute episodes, if managed correctly, can be brief and result in a full return of function with the resolution of pain. Chronic pain often needs careful management and benefits from a multidisciplinary approach which focusses on giving the patient greater control over their own progress whilst integrating functional rehabilitation, a good social support system, compassion and understanding.






References:

Daneau, C., Cantin, V., Descarreaux, M. (2019). Effect of massage on clinical and physiological variables during muscle fatigue task in participants with chronic low back pain: A cross-over study. Journal of manipulative and physiological therapeutics 42(1), pp. 55-65. [Online] Available at: Effect of Massage on Clinical and Physiological Variables During Muscle Fatigue Task in Participants With Chronic Low Back Pain: A Crossover Study - ScienceDirect (Accessed 21.12.22).


Franks,I. (2018). Nociceptive pain. [Online] Available at: Nociceptive Pain: Types, Phases, and Treatments (healthline.com) (Accessed 18.11.22).


Murnion, BP. (2018). Neuropathic pain: Current definition and review of drug treatment. Australian Prescriber 41(3), pp. 60-63. [Online] Available at: Neuropathic pain: current definition and review of drug treatment - PMC (nih.gov) (Accessed 18.11.22).


Musich, S., Wang, S.S., Slindee, L., Kraemer, S, Yeh, C.S. (2019). The association of pain locus of control with pain outcomes among older adults. Geriatric Nursing 41(5), pp. 521-529. [Online] Available at: The association of pain locus of control with pain outcomes among older adults - ScienceDirect (Accessed 17.01.23)


Rolf-Detlef, T., Rief, W., Barke, A., Aziz, Q., Bennett, M., Benoliel, R., Cohen, M., Evers, S., Finnerup, N., First, M., Giamberardino, MA., Kaasa, S., Korwisi, B., Kosek, E., Lavand'homme, P., Nicholas, M., Perrot, S., Scholz, J., Schug, S., Smith, B., Svensson, P., Vlaeyen, JWS., Wang, SJ. (2019). Chronic pain as a symptom or a disease: the IASP classification of chronic pain for the International Classification of Diseases (ICD-11). Pain: The Journal of the International Association for the Study of Pain 160(1), pp. 19-27 [Online] Available at: Chronic pain as a symptom or a disease: the IASP Classificat... : PAIN (lww.com) (Accessed 21.11.22).


Shiri, R., Coggon, D., and Falah-Hassani, K. (2018). Exercise for the prevention of low back pain: Systematic review and meta-analysis of controlled trials. American Journal of Epidemiology 187(5), pp. 1093-1101. [Online] Available at: Exercise for the Prevention of Low Back Pain: Systematic Review and Meta-Analysis of Controlled Trials | American Journal of Epidemiology | Oxford Academic (oup.com) (Accessed 15.01.23).

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