Understanding Pain: A Journey Through Your Body's Warning System
- Dr. David Didlake, DPT
- Jun 3, 2024
- 7 min read
Updated: Apr 5
Introduction
These are voyages for anyone but the faint of heart! While our mission is to discover the source and cause of our client's pain, it can be a strange world, especially to those unfamiliar with how their body perceives and responds to pain. So if pain is something that is confusing to you, or you'd like to learn more about how the human body perceives and responds to pain, join me as we boldly go where no one has gone before!
Pain Defined
Pain has been defined as a "complex constellation of unpleasant sensory, emotional and cognitive experiences provoked by real or perceived tissue damage and manifested by certain autonomic, psychological, and behavioral reactions" (Terman et al. 2003). That's quite a complex definition, but if there's anything the medical field knows about pain, it is that pain is very complex! This complexity stems from pain being a highly personal experience influenced by psychological, biological, and social components.
"...if there's anything the medical field knows about pain, it is that pain is very complex!"
And while I think all of us would rather not experience pain, there is at least one benefit to pain perception - pain tells us that something is wrong.
If our friend Bob stepped on a nail unknowingly and then walked with that nail in his foot for several days, the wound created by the nail would turn septic, potentially resulting in his early demise.
So while pain isn't something we wish for, it serves a crucial purpose that should be respected. Unfortunately, problems arise when pain is treated only with medication(s), or continues longer, or increases more, than it should.
Pain 101: How Your Body Perceives Pain
Pain is perceived by specialized nerve sensors called nociceptors. These sensors are triggered when either pressure, temperature, and/or certain chemicals in our body exceed a specific threshold. When this threshold has been exceeded, our pain receptors relay pain signals to the brain where we perceive and then respond accordingly. If pain signals become more frequent, or if they are sent from a greater number of nociceptors, we usually perceive the pain to be worse.
So what exactly does pain feel like?
For some people, pain can be described as lancinating, stabbing, or pricking. Pain can also be felt as a burning, throbbing, cramping, or aching sensation. And while pain is felt differently among individuals, it can provide general guidance on which underlying tissues might be damaged or affected.
The Three Types of Musculoskeletal Pain
To help organize and simplify pain, the International Association for the Study of Pain (IASP) has classified musculoskeletal pain into three types: nociceptive, peripheral neuropathic, and central sensitization. Since most of what I deal with involves these three types, let's take a closer look at each.
Nociceptive Pain
This type of pain is usually intermittent and sharp with movement. Nociceptive pain may also present as a constant dull ache at rest. Usually, nociceptive pain is localized to the area of injury, and has a clear, proportionate response to aggravating and easing factors (i.e., when your hip moves it hurts in the groin, and when it isn't moved your hip doesn't hurt anymore).
As a Physical Therapist, I can test for this type of pain by stressing or tensioning specific musculoskeletal tissues. I also treat this type of pain very effectively by finding both the source and cause of pain (see my article on Physical Therapy here for more information).
Peripheral Neuropathic Pain
This type of pain presents with burning, shooting, or electric/shock-like symptoms, and is usually associated with a history of nerve injury. Because nerves are typically involved, pain may follow a nerve root or dermatomal pattern.
As a Physical Therapist, I can test for this type of pain by stressing or compressing specific neural tissues. I also treat this type of pain very effectively by finding both the neural source and the cause of pain (see my article on Physical Therapy here for more information).
Central Sensitization
This type of pain is not proportionate to the extent of injury and is usually associated with physiological changes in the brain and spinal cord. Central sensitization has an unpredictable pain pattern in response to multiple types of aggravating and easing factors, such as experiencing diffuse neck, arm, and shoulder pain when the thumb is touched but experiencing relief with bending the wrist.
Central sensitization is hard to localize and is usually associated with negative emotions, poor self-efficacy, maladaptive beliefs, and a negative family/work/social life.
TABLE 1. COMPARISONS OF DIFFERENT PAIN TYPES
Nociceptive | Peripheral Neuropathic | Central Sensitization | |
Symptoms | Sharp w/ movement | Electrical | Vague w/ no consistent pattern |
Example | Joint sprain or muscle strain | Nerve | Chronic pain, CRPS |
Treatments | EDN, Manual Therapy, IASTM, Taping, BFR training, NIR therapy | EDN, Neural mobilization, Movement retraining, Spinal traction | EDN, Desensitization, Manipulation, NIR therapy, Pain management coaching |
As a Physical Therapist, I may need to refer to other medical professionals to help rule out non-musculoskeletal causes before a central sensitization diagnosis has been established. While I can treat this type of pain, it requires more time and more frequent visits due to both its complexity and the physiological changes that have occurred in the brain and spinal cord.
If you want to learn more about chronic pain and how you can better manage it, I highly recommend my book on Amazon titled "5 Easy Strategies to Help Manage Pain". (DISCLAIMER: I receive compensation with your purchase!)
Is Physical Therapy Painful?
Described above were three simple examples to help illustrate different types of pain in a more meaningful and relatable way. However, it is important to recognize that more than one pain type can be experienced at the same time. So unless you are someone who is pain intolerant, or don't have pain receptors (i.e., you have Prader-Willi syndrome), I'm pretty confident you've experienced at least one of these types of pain! As a Physical Therapist, I treat individuals with each of these types of pain every day.
Now this may seem counter-intuitive, but pain can be part of a treatment session.
Let me explain. If a client has scar tissue that has compressed or tensioned a nerve or muscle, the scar tissue will need to be released to allow the nerve or muscle to move freely. I might use instrument-assisted soft tissue massage, electric dry needling, neural flossing, or manipulation of the surrounding tissues with my hands to improve the mobility of the nerve/muscle-tissue interface.
This type of treatment usually elicits temporary pain from nociceptors that were formed as the client's body underwent its normal healing process to repair the injured tissue with new blood vessels, nerves, and scar tissue. However, pain experienced during the treatment session will subside anywhere from a few seconds to a few hours following the session and is dependent on the severity and the complexity of the situation.
Soreness may persist following aggressive soft tissue manipulation, which some individuals perceive as pain, but soreness and discomfort following a treatment session is not unusual!
While it may seem unusual to elicit pain in someone seeking pain relief, the pain brought about via specialized care is temporary and is a byproduct of the treatment process necessary to bring about optimal function.
TRUE STORY: I had a client who suffered a grade 2 strain of the calf muscle (i.e., a moderate tear involving approximately 50% of the muscle tissue). In order to break up scar tissue that had formed following his injury, I performed instrument-assisted soft tissue massage, cupping, and dry needling of the adhered scar tissue. Although the client reported pain during the procedure, he left without feeling any pain in his calf. So there is a method to the madness! (To learn more about tissue healing, be sure to read my article here).
However, what is not normal is when pain continues longer or increases more than it should. This usually indicates one of two things - either medical care is needed immediately because of a serious underlying medical condition, or changes have occurred in the brain and/or spinal cord that have resulted in central sensitization. When the latter happens, different strategies for treating and educating the client become paramount. Trying to treat someone who has central sensitization with a nociceptive approach will simply not work. And while the process of chronic pain development is beyond the scope of this article, know that there is hope for those who suffer from chronic pain!
Summary
Pain is a signal from our body telling us that something is wrong. However, taking handfuls of over-the-counter pain medication every day does not solve the problem! Pain medication usually masks the problem, and unfortunately, if the root of the problem is not correctly diagnosed and treated, the problem will only get worse.
Change Your Mindset and Invest in Yourself!
We are experts at understanding the musculoskeletal system, and are proud to take a holistic approach when it comes to reducing and eliminating musculoskeletal pain. We take the time to find the source and cause of our clients' pain so that they can find true relief.
So as the Captain of this crew, I invite you to "engage" in your health as you and I boldly go where no one has gone before!
SCHEDULE YOUR SESSION TODAY!
Here's to your health!
Dr. David Didlake, DPT
PT, Cert. SMT/DN, CSCS, Cert. TPI Medical Level 3, Dip. Osteopractic, FAAOMPT
Owner, Integrative Therapeutics "Home of the Saint Louis Golf Doc"
Follow me @theintegrativeclinic @thestlgolfdoc
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References For those interested in the scientific evidence behind pain mechanisms, we've included some key research citations:
Terman GW, Bonica JJ. Spinal mechanisms and their modulation. In: Loeser JD, Butler SH, Chapman CR, Turk DC, eds.Bonica’s Management of Pain . 3rd ed. Philadelphia, Pennsylvania, USA: Lippincott Williams and Wilkins; 2003:73.
Raja S.N., Carr D.B., Cohen M., Finnerup N.B., Flor H., Gibson S., Keefe F.J., Mogil J.S., Ringkamp M., Sluka K.A., et al. The revised International Association for the Study of Pain definition of pain: Concepts, challenges, and compromises. Pain. 2020;161:1976–1982. doi: 10.1097/j.pain.0000000000001939.
This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider before beginning any new treatment.
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