THE PAIN COMPLEXITY

Hello readers! In this month’s article, I am going to give you a glimpse into the world of complex pain & physiotherapy. In the April edition of High Country News, we talked about the nervous system. It might be helpful to take a quick look back at that edition for a reminder on what the nervous system is.

We will start by exploring the question “what is pain”? Pain is an unpleasant sensory and emotional experience driven by the central nervous system (composed of the brain and spinal cord) that is associated with actual or potential tissue damage (IASP, 2021). It is important to acknowledge that pain is always a personal experience that is influenced by your own biological, psychological, and social factors. There are a multitude of components that can contribute to your experience with pain, including past experiences, culture, beliefs, etc. Generally, pain is a warning signal from your brain that tells you that your body may need protecting. There are many different types of pain including nociceptive, neuropathic, somatic referred, and nociplastic pain (this is the type we will touch on today).

So, does pain always mean damage? Well, let’s explore!

Our nervous system is always evaluating information about stimuli that may be threatening to us. Interestingly, it isn’t until the signals reach our brain that we “code” the stimulus as pain (or otherwise). Different “codes” include touch, movement, temperature, vibration, and pain. When someone has been dealing with persistent pain or complex pain, neuroscience shows there are structural, functional, and chemical changes within the nervous system that can cause these signals to be “turned up”. Sometimes the signals get so responsive that non- painful stimuli can trigger or “code” a pain response. This phenomenon is often referred to as central sensitization. There is a helpful video online that illustrates persistent pain, to access the video search: “Tame The Beast — It’s time to rethink persistent pain”.

Although pain can occur with tissue damage, pain does not always equate to damage! Pain can be caused by irritation to body tissues (i.e., nerves, muscles, connective tissue) but pain that persists for a long period of time, may be a signal of nervous system hypersensitivity. Let’s explore a helpful analogy (Moseley & Butler, 2017). Think of a motion sensor light that you use in front of your house as a first line defense for intruders. You notice that this light keeps flashing on at night, you get concerned and you keep waking up to check. Eventually you decide to keep watch and notice that it is getting activated from your tree branches shaking and the neighbourhood skunk. The issue here is not that there is an intruder, it is that the sensitivity in your motion light is set too high. Sometimes pain is similar, you get the alert signal (i.e., pain) when there isn’t an intruder (i.e., damage). Like we explored above, one culprit may be that your nervous system’s sensitivity is dialed up.

As we come to the end of this article, I want you to know that if you are dealing with chronic pain you deserve to have your lived experience heard and respected by your healthcare provider. No, your pain is not all in your head, it is real. You are the expert in your experience with pain and there are many ways that we can help support you! LivePlanBe is an online resource with topics on complex pain and strategies that may be helpful if you (or someone you know) is looking to learn more.

This article has just scratched the surface and of course there are always nuances (and a lot more complexity). In the next article, I will explore some pain management techniques. If you are interested in further support with the pain you are experiencing, our team is here to help!

Bre Maughan
(MScPT, BScKin)
Bragg Creek Physiotherapy
www.braggcreekphysio.com