The Top 9 Things You Should Know About Pain

1. Pain is output from the brain. While we used to believe that pain originated within the tissues of our body, we now understand that pain does not exist until the brain determines it does. The brain uses a virtual “road map” to direct an output of pain to tissues that it suspects may be in danger. This process acts as a means of communication between the brain and the tissues of the body, to serve as a defense against possible injury or disease.
2. The degree of injury does not always equal the degree of pain. Research has demonstrated that we all experience pain in individual ways. While some of us experience major injuries with little pain, others experience minor injuries with a lot of pain (think of a paper cut).
3. Despite what diagnostic imaging (MRIs, x-rays, CT scans) shows us, the finding may not be the cause of your pain. A study performed on individuals 60 years or older who had no symptoms of low back pain found that 36% had a herniated disc, 21% had spinal stenosis, and more than 90% had a degenerated or bulging disc, upon diagnostic imaging.
4. Psychological factors, such as depression and anxiety, can make your pain worse. Pain can be influenced by many different factors, such as psychological conditions. A recent study in the Journal of Pain showed that psychological variables that existed prior to a total knee replacement were related to a patient’s experience of long-term pain following the operation.
5. Your social environment may influence your perception of pain. Many patients state their pain increases when they are at work or in a stressful situation. Pain messages can be generated when an individual is in an environment or situation that the brain interprets as unsafe. It is a fundamental form of self-protection.
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  • Good post Joe. But, it begs the questions: Will we ever be able to really make a major difference in peoples perceptions and experience of pain? Can we change the person that was raised in a family of hypochondriac complainers and moaners?
    I realize that we can change depression and mood disorders, which in turn could reduce the pain response. And, we can reduce healthcare dollars and unnecessary testing by educating about the lack of correlation between diagnostic abnormalities and pain.
    But the one, perhaps funny and bizarre question that always pops into my mind: If I take the best pain expert out there, and lop off his finger with a tree pruner, will he experience pain?

    John Duffy PT OCS April 14, 2014 9:29 am Reply
    • Hey Duffy,
      Thanks for reading my man. Hope all is well with the family.
      I do think that this revolution of “pain science” will eventually effect the consumers attitude and beliefs towards pain, leading to better overall management. It is obviously going to take some time to undo prior beliefs (which is challenging for our brains—when proposed with two sets of conflicting information, it will often chose the information that it knew first).
      Did you know, the US only makes up 4% of the world population, but consumes 80% of the world supply of prescribed opioids? This is staggering but I think its because of a cultural belief, built upon a perception that 1. we should not experience pain 2. pain is bad. Both of these beliefs could not be further from the truth, and although pain elicits a negative emotional experience, it is necessary for our survival. Mick Thacker, out of Kings College in England has proposed pain to be: ““an embodied element of suffering encapsulated by an experience of the person within the society and culture in which they live”.
      I think we need to do a couple of things in the management of pain:
      1. Dissociate the belief that the degree of pain equates to the degree of injury. This needs to take place at the level of the consumer-physician and consumer-physical therapist, and the belief that you really hurt because x-y-z. I suspect we over “treat” painful conditions on the premise that something is “causing” that pain. Sure, nociception may often be driver for the nervous system to respond, but we have created this concept that: “Arthritis causes pain”. “This is really going to hurt”. etc.
      2. Dissociate the belief that things need “fixed” via medication and/or surgery. Often times, simply moving can modulate symptoms (hence why we all have jobs). There is this belief that unless I fix this, I will always have pain. Unfortunately this belief is likely contributory to the painful experience itself.

      josephbrence April 15, 2014 5:31 pm
    • There might be physical neural substrate underlying some of influence of perception on pain. Was at a presentation recently by Oxford Uni Prof. They’ve managed to fMRI spine there. During placebo pain relief trials they found indications of real descending inhibition in dorsal horn, suggesting endogenous neurochemical analgesia upstream of perception when patient believed themselves to be under analgesia.

      Simon P July 30, 2014 5:35 am
  • Reblogged this on Body Basics – A Physical Therapist's Perspective and commented:
    From Joseph Brence on Forward Thinking PT

    erikpohlman April 14, 2014 10:46 am Reply
  • John,
    I absolutely think we can make a difference in peoples perceptions and experience of pain, mainly through education, like the study Joe mentions regarding the military. Education on all the possible “inputs” would allow the patient to control more of their pain experience, rendering the current situation “less unsafe” and reducing pain output. For these patients who are “complainers and moaners” it’s probably even more important to avoid heavy biomechanical explanations to their pain and imaging findings related to pain, as it will be a “reason” for them to hurt. Clinician will be fighting an uphill battle from the get go.
    As far as the tree pruner/finger question, it’s probably safe to say that they will experience pain. However cut the fingers off 100 “pain experts” there will be a 100 different pain responses as pain is highly individualized. Some will value the threat of losing their finger more or less than others, rendering the situation more or less dangerous, therefore affecting pain output. Do they perform a lot of manual therapy and therefore vision their career ending? (most likely higher threat value). Have they had a serious injury to their hand or arm before and survived it without issue (perhaps lowering threat value). Chop of their finger and there will probably be pain, however it will be different in everyone.

    Mark Powers April 14, 2014 3:33 pm Reply
  • Pingback: The Top 9 Things You Should Know About Pain | PHYSIOTHERAPY

  • Reblogged this on and commented:
    Wanted to share this, This is from, Joseph Brence’s blog. “The Top 9 Things You Should Know About Pain!” Great resource for patient and clinician as well.

    Mark Powers April 15, 2014 1:03 pm Reply
  • Pingback: Pain is Complicated | Physiothoughts

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