By Greg Mortensen, PT, DPT
You have probably felt pain thousands of times since you were born. Every skinned knee, cut and fall has given you some level of pain to experience. For better or worse, pain is a part of life! You can be sitting around your home, driving a car, playing a sport, or sleeping and it can find you, whether you went looking for it or not. Injuries and accidents occur when you are being foolish or responsible and can be complex or simple, but they can all leave you in pain. Sometimes you get lucky and your pain is fleeting – lasting only a few seconds or minutes, but other times it can last days, weeks, months or even years.
Generally, the level of pain you feel is determined by the severity of the injury. The greater the injury to your body or the more areas that are injured equals greater amounts of pain you feel (Although, this isn’t always true). Most of the time, your body recovers without the need for special treatments. You rest up for a day or two, take over-the-counter medications like ibuprofen and then your body seems to get better on its own.
But sometimes your body needs a little help. If your pain is worse than what was expected and you aren’t getting better as fast as you would like, what do you do next? You may wait a little longer hoping that the pain goes away or perhaps you ask around and get advice from family or friends. If the pain continues, you will likely seek the guidance of a trained medical professional and go to a hospital or doctor’s office. After your evaluation, the doctor or specialists may recommend getting x-rays or an MRI, taking stronger prescription pain medications, wearing a cast or a brace, or even having surgeries. What happens if none of these things help to resolve your pain?
Going this long without relief…you probably feel a bit helpless and hopeless. You could even be getting those same feelings from your doctors, friends, or family. Hopefully you haven’t actually heard anyone doubting you or whether your pain is real, but it isn’t uncommon for people to become unsympathetic the longer things last. It’s frustrating. Why isn’t your pain going away?
This is why pain is complicated. Pain isn’t something that can be shared or objectively measured – only you can feel it. Pain is subjective, personal, and can be different for each person. In order to fully understand why you may still be having pain, you need to have a good understanding of your body and how pain is communicated and interpreted.
The brain is your body’s computer and nerves are the wires that send signals to and from the computer. In a way, a nerve is like a standard light switch, it is either on or off. So how do your nerves get switched on to send the signal? There are many different types of nerves, which means there are a variety of ways that they can get triggered. Each nerve will only send its signal to the brain after the nerve has been stimulated in the correct way. For instance, an ant can crawl halfway up your leg before you feel it. Why? Because the ant wasn’t heavy enough to stimulate the nerves that convey light touch to your brain.
The nerves throughout your body can sense pressure, pain, changes in blood pressure, and many other sensations. One example is thermoreceptors, which are specialized nerves found in the skin to detect temperature changes. This type of nerve helps you distinguish between having your hand on a stove or in a bucket of ice. When the thermoreceptors are stimulated by touching something hot or cold your brain is sent a signal. Then from all your experiences (since birth), your brain is able to quickly tell the difference between hot and cold. The signal from the nerves hasn’t changed, it is still just switched on or off. However, but because of past experiences, your brain is more efficient and accurate when the nerves are stimulated by hot and cold.
Pain nerves aren’t really much different. There are two types: A-delta nerves and C-fibers. When the nerves are sufficiently stimulated, they send their signals to the brain where they can be interpreted. A-delta nerve fibers are insulated by myelin, are generally larger, and travel up to the brain in a different pathway than C-fibers. This means that the signal from the A-delta nerves travel faster than the C-fibers and reach the brain first. From all your experiences with ‘painful’ situations, when the signals from the A-delta fibers are interpreted, you feel them as a sharp pain. Then as the signals from the C-fibers reach the brain and are interpreted you feel them as a dull, aching kind of pain. So when an injury first occurs, you probably feel a sharp, specific pain followed by a lingering dull, aching pain.
Nerves don’t have a choice. When their threshold for stimulation is reached, they send their signals. However, you brain does have a choice. For example, soldiers can ignore their pain and keep on fighting. In life or death situations, mothers have demonstrated extreme strength despite damage to their bodies. You have probably experienced something similar, albeit to a lesser degree. Have you ever been so focused on a task that you didn’t notice a small cut until much later? The nerve sent the signal but somehow you managed to ignore it. Nerves can be stimulated, sending signals to the brain, and yet, your brain can disregard the information.
Let’s get back to how this relates to your pain. Your body generally heals quickly, with most injuries healing within 3 months. However, surgery, a re-injury, or a very severe injury can delay your body from healing in that timeframe and it is possible that you may still need more time to heal. But more likely, something has changed with your nerves or your brain.
Prolonged stimulation to the nerves and the areas of your brain that process those signals can result in changes to both your computer and your wiring. Your nerves become easier to trigger and your brain is more receptive to the signals. The brain’s ability to process information has been modified from the regular stimulation and input from the nerves. These same areas of the brain also process your emotions, particularly the negative ones like anger and stress. This means that it is not only easier to trigger your pain, but your emotions and feelings contribute to your pain.
Treating Chronic Pain
Treating your pain is no longer as simple as addressing your injury. Normally, the pain you feel means that damage has or is being done to your body, but with chronic pain and the probable changes in your nerves and brain, pain no longer equals damage. So, now you need a treatment that addresses both the injured area and the way your body is processing and interpreting the signals blasting your brain. Thankfully there are still a variety of treatments that can help manage your pain.
Treatments can still be performed by a physical therapist but they should have experience and skills for treating patients with chronic pain. Your physical therapist should work closely with your doctor and others involved in your care so that they can help reduce or eliminate your pain. There is almost always something we can do together to help relieve your pain.