What Pain Means-and When it Doesn’t Signal Injury
Why do we hurt and what does it mean?
If you’ve been living with pain for months, or even years, you may be wondering what’s going on in your body and whether something is still damaged. When we experience pain, from a cut on the hand to stubbing our toe on the coffee table, we associate it with injury or, more specifically, tissue damage. And it often is, to some greater or lesser degree. But what is happening when pain persists long after the injury should be healed? Is the tissue still damaged? Do we risk further injury?
As humans we have an amazing capacity to heal. We are not machines and, in the vast majority of cases, we don’t need to be “repaired.” Most common injuries heal in a matter of weeks, but the pain may last for months or years. In these situations, tissue healing has occurred, yet pain persists.
Why?
Pain is complex. Research over the last two decades has significantly expanded our understanding that the EXPERIENCE of pain is more than just damage to tissue. While many healthcare providers focus on the biomedical model, equating tissue damage to pain, there are other aspects that contribute to how each of us actually perceives pain. Having a broader understanding of pain helps providers better guide treatment and helps patients better understand what is happening in their bodies.
Let’s discuss types of pain as we know them today. There are three: Nociceptive, Neuropathic, and Nociplastic.
Nociceptive pain is the most common type of pain, caused by actual or threatened damage to non-neural tissue (skin, muscles, organs) which activates specialized nerve endings called nociceptors. This is the kind of pain that occurs when we stub our toe and can last several days to weeks due to ongoing inflammation after an injury, but resolves with time and healing.
Neuropathic pain, most commonly peripheral neuropathic pain, is simply pain that comes from a damaged nerve. Common symptoms are a burning, shooting, or electric-like quality to pain, a crawling/tingling sensation, increased sensitivity to painful stimuli, or pain in response to typically non-painful stimuli. Pain is often spontaneous and intense but brief. This would be like shooting pain down the back of the leg, associated with a low back injury. Neuropathic pain does not always mean worsening injury. In some cases, the nerve has healed, but the nervous system remains sensitive.
Nociplastic pain is defined as “pain that arises from altered nociception” not fully explained by nociceptive or neuropathic pain mechanisms. This is the kind of pain that most often may be described as “chronic” pain. What does this mean? Basically, this type of pain comes from altered nervous system processing. There isn’t necessarily underlying tissue or nerve damage that can be found to cause the pain. Common examples include persistent back pain, neck pain, or widespread pain without clear injury. Does this mean that the pain isn’t real? No, you may experience what feels like real pain, but it may not be a signal of harm or injury.
So what does all this mean?
There are different types of pain that can occur for different reasons and sometimes without an ongoing injury or clear tissue-related cause. Understanding this helps us know when to protect an injury and when it is safe to push through the pain. In many types of chronic pain, the pain is not giving us any helpful information and may prevent us from progressing due to fear of aggravating the symptoms. This fear limits movement and activity.
It is actually through challenging the body with movement or load that will help the nervous system to calm down and stop interpreting non-painful signals as painful and threatening. The body has an amazing ability to adapt to any demands imposed on it. Finding the right starting point is key to minimizing flare-ups and allowing for gradual return to activity.
How can physical therapy help?
Your physical therapist can help to determine what kind of pain you’re dealing with and the best way to approach it. This can be anything from exercises appropriate to the stages of healing, hands on therapy to improve movement and pain, or even education to help you understand what you are dealing with and how to manage it.
If you have pain related to tissue damage, your therapist can educate you in protection and management strategies, while prescribing the appropriate exercises to begin recovery. If pain is related to altered neural processing, education is a key component to helping to reduce the fear and avoidance of movement, followed by gentle movement and gradually progressing exercise at the appropriate level.
