Hurt vs harm - when should you be worried?
- Pain is not an accurate indicator of tissue damage or injury.
- Pain is an output of the brain that is heavily influenced by cognitive, emotional and contextual factors.
- The primary purpose of pain is to protect us from danger and serve as a warning system to potential threats. In chronic pain that protective benefit has been lost.
It is common to think of pain as a direct indication of the body being harmed or injured. However, the presence of pain doesn’t always mean bodily harm. What surprises most people is that pain can occur without significant tissue damage or injury, and keep occuring long after an original injury has healed. And, if there is tissue damage, it doesn’t always seem to correlate with the amount of pain someone is feeling.
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For example, everyone knows how much a paper cut can hurt – that’s a lot of pain for minimum damage! Similarly, when it comes to chronic pain, you can have significant pain even in the absence of any identifiable injuries or evidence of tissue damage. And then there is phantom pain, where someone feels excruciating pain in a body part they no longer have. Or consider the opposite situation, where there is serious injury with only a low level of pain, like when someone escapes a fire only to realize how badly they have been burned once they’re safe.
This doesn’t mean that the musculoskeletal system has no influence on pain or that the pain is all in your head. It’s important to remember that even when no tests have shown its cause or there is no clear tissue injury, all pain is real. However, according to modern pain science, what’s more important than the state of our tissues, is the way we interpret pain.
It all starts to make a lot more sense when we understand how pain works, so let’s dive in and take a closer look.
Why we hurt
The primary purpose of pain is to protect us from danger and warn us when we’re under threat. Pain works as an alert system by drawing our attention to the pain, causing us to assess the situation and initiates precautionary measures to prevent any further damage. By creating the sensation of pain, we can take action to stay safe and give the body time to heal.
In most circumstances, acute pain usually correlates well with tissue damage. Think of touching a hot stove or spraining your ankle for example. In this type of acute pain, your body sends danger messages to the brain that you’re supposed to notice! Typically in these cases, the more you hurt, the more your body is in fact being harmed.
Chronic pain, on the other hand, plays by its own set of rules. We know that chronic pain can occur in the absence of tissue damage and/or persist long after the body has healed from one (3). In fact, there is rarely a clear relationship between an injury and the amount of pain someone is experiencing. In addition, the longer pain persists, the more complex it becomes and the more it loses its protective benefit.
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How the mind determines what the body feels
Pain is not merely a ‘tissue issue’ to be accepted at face value, but a complex experience that is constructed by the brain and influenced by multiple factors).
The brain generates pain experiences based on the perceived level of threat. When danger signals are sent to the brain, the brain then has to decide how much danger there is and whether or not the signals are worth paying attention to. Cognitive, emotional and contextual factors are critical in determining whether the pain volume is cranked up or turned on mute.
To estimate whether the body requires protection, the brain weighs up all the information it receives from your physical body as well as your external and internal environment. This means that your thoughts, emotions, beliefs, expectations, stored memories and past experiences all have a powerful influence on your experience of pain. Things like fear, sleep deprivation or being in a stressful environment can all amplify your perception of pain, while excitement, distraction and pleasure can do the opposite.
Simply put, pain comes down to your brain’s assessment of safety. This is good news, because it means that you have more control over your pain than you may have realized! By changing the way you think and feel about your pain and by practicing behaviors associated with safety, you can change the level of pain you feel.
Moving forward with confidence
Truly understanding that as fearsome as it feels, all pain isn’t a sign of physical harm is a vital step in learning to manage your pain and regaining trust in your body. You may find that with understanding comes a renewed confidence to move and resume meaningful activities you might have previously avoided.
It can also be reassuring to know that many activities, when performed for reasonable lengths of time and at reasonable intensities, may lead to manageable pain. But, with this knowledge you are better able to consider whether an activity simply hurts, or whether it actually has the potential to harm or injure you.
Once you recognize how this overly protective mechanism is driving your sensitivity and preventing you from doing things that aren’t actually damaging, you can begin gently expanding your current limitations and remind yourself that you are in fact safe, capable, and wildly adaptable.
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