What is pain?

To begin my project on pain management, we first have to understand what pain is. The most basic understanding of pain is that there is some kind of injury or harm to the body that triggers a feedback loop from the inflicted area, to the brain, and then back to the inflicted area. For example, if you pinch your shoulder, nerve signals starting from your shoulder will travel up to your brain, where the nerve signals are analyzed as pain. The brain then sends a new set of signals to the shoulder to react, maybe to jerk away out of harm.  This is a basic and simplistic way to think of one type of pain, but it is not always this strait forward or simple. Pain is quite a monster to try to understand. Someone who’s had chronic back pain for the last thirty years probably has a much deeper problem than a temporary pinch. That being said, we can see that there are different kinds of pain. The pain is either chronic or acute.

Acute Pain

The example of the shoulder being pinched is a perfect example of acute pain. Acute pain is often classified as temporary pain. If the pain lasts less than six months, it is acute pain. Also acute pain usually has a known explanation to its cause, most likely an injury that will heal. Acute pain is generally easier to treat. NSAIDs will often suffice for a while. Chronic pain on the other hand, is very different.

Chronic Pain

To begin, chronic pain lasts longer than six months. Chronic pain often stems from deeper rooted problems in which pain is only a symptom to the underlying problem. A good example of chronic pain stemming from a bigger problem is Rheumatoid arthritis, when the immune system attacks the joins causing inflammation, swelling, and pain. Other causes of chronic pain include nerve damage, injuries that did not heal right, or sometimes pain for no clear reason. Chronic pain is generally much harder to treat. NSAIDs are potentially damaging to the body if you are using them for very long. These definitions between chronic and acute pain are not hard and fast, but rather basic ideas.

Recently I sat with Jay McCallum over coffee, and learned a little about pain. Jay McCallum is the co-owner of a physical therapy practice, Corebalance Therapy, here in Flagstaff. His practice is largely based around back pain, though he treats many other ailments. I found one idea he thought regarding chronic pain particularly interesting. He explained that what once could have been an acute injury could have turned into full blown chronic pain, even if the injury had healed. When the tissue was injured, the pain signals through the nerves were constant. For whatever reason, even as the ailment was healing, the brain continued pain signals just as prominently as before. This can turn into a serious problem. The nerves that are used to the pain signals become over sensitized, and the brain could learn that sending an overwhelming amount of pain signals is the normal thing to do. Meanwhile, the patient suffers. So now, in these types of cases, the goal is to retrain the brain that it does not have to send pain signals because the body is not being harmed.  Later on in my project I will explore a little more of Jay McCallum’s work and also how there is a mind-body connection with pain.