The Top Ten Things You Don't Know About Pain

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1. Pain is 100% of the time, an output from the brain. In 1996, Ronald Malzack developed the concept of the neuromatrix. The neuromatrix, in simplistic terms, is all of the mechanisms within the brain, that when activated, produce pain. So when your ankle hurts, the pain is generated by information gathered by the brain. Pain is simply a defense mechanism developed to protect the body.
2. The degree of injury does not always equal the degree of pain. Research has told us that very major injuries may not hurt at all and very minor injuries may hurt alot. The degree of pain you experience is more related to past experiences. For example, if you have sprained your ankle in the past and then you sprained it again, the second sprain will likely hurt more. This is because the brain has learned to protect that ankle following the prior injury and defends it through pain.
3. Despite what MRIs X-Rays and CT Scans show objectively, this may not be the root cause of your pain. While diagnostic imaging may give us excellent views of your internal anatomy, it gives us little information about 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 over 90% had a degenerated or bulging disc. What shows up on an image may or may not be related to your symptoms.
4. Psychological variables, such as depression and anxiety, can make your pain worse. Pain can be influenced by many different things and psychological components are one of them. A recent study in the Journal of Pain showed that psychological variables pre-total knee replacement was highly related to long-term pain post-total knee replacement. The treatment of these co-morbities may actually be more effective than surgery.
5. Arthritis does not cause pain. Despite the two being related, not all individuals with arthritis experience pain. Pain from arthritis is often correlated to secondary variables such as inactivity, depression, etc.
6. Your social environments can influence a painful experience. Many of our patients will state that their pain will increase when they are at work or when they are in a stressful situation. Pain can be sent from your brain due to an environment that it suspects is unsafe. This is the brains way of protecting you.
7. Education about pain can be more effective than core stabilization in the prevention of low back pain. A study published in BMC Medicine last month showed that education to reduce the fear and threat of low back pain was much more effective in preventing the onset of low back pain than a program to strengthen your core.
8. Our brains can be tricked into developing pain in prosthetic or synthetic limbs. Our brain can be tricked through a mirror-box illusion and a referred sensation can be felt in a limb that is not our own. This is wildly fascinating but like an optical illusion, the brain can be tricked in relation to stimuli. The mirror-box is also used in the reduction of pain in individuals with phantom-limb pain following the loss of a limb.
9. The ability to determine left from right is altered when you have pain. Cortical networks within the brain that assist in determining left from right are affected when you experience severe pain. When you feel like you have difficulty differentiating the two quickly, it is likely affected due to your pain.
10. You likely do not have a high tolerance for pain, despite what medical professionals may tell you. Some clinicians make their patients feel better by saying they “have a high tolerance for pain”. This statement may make you feel better, but is not supported in the research. There is a tool called an algometer which is being investigated clinically to objectively measure pain, but there is currently little data to support what is actually a “high threshold”.

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  • Hello Joseph, how are you? I’m artur from Rio de Janeiro, Brazil. I’m PT and researcher and clinician in chronic pain and sports PT. I enjoyed a lot your comments about pain. I friend sent me your link on facebook. I’d like to know if you don’t mind that i can translate to portuguese your post to put in my blog. I have a blog that i write about pain.

    artur gosling December 16, 2011 1:06 am Reply
  • Great stuff! Thanks.

    Megan Zetter February 1, 2012 8:44 am Reply
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  • Today, I went to the beach front with my kids. I found a sea shell and gave
    it to my 4 year old daughter and said “You can hear the ocean if you put this to your ear.” She put the
    shell to her ear and screamed. There was a hermit crab inside and it
    pinched her ear. She never wants to go back! LoL I know this is totally off topic but I had to tell someone!

    Rachelle July 29, 2013 11:32 pm Reply

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