Pain is a warning system for our bodies, letting us know that there is a risk of damage happening.
Pain is complex. It might be felt as mild discomfort, severe cramping, constant dull aches or short stabbing sensations.
Pain can be classified as acute pain or chronic pain. Acute pain is short term (less than 3 months) and may include tissue damage from a back injury or ankle sprain. Generally, people with acute pain are encouraged to stay active and gradually get back to doing all everyday things, such as work or physical activity.
Persistent pain lasting three months or more is generally called chronic because in this type of pain tissue damage is not the main issue.
People can experience acute and chronic non-cancer pain in many different parts of their bodies. Some Examples of Chronic pain include:
Low Back Pain
Acute Knee Injuries
The Process of Pain
Pain all starts with the stimulus. It could be a mechanical stimulus, such as a heavy object falling on your legs or face! Or it could be a temperature stimulus such as touching a hot item. Our nociceptors send a signal to the brain via our neurons (nerve cells) that there is danger.
Nociceptors are like transducers in a microphone. A transducer converts sound energy into electrical energy. Likewise, nociceptors convert mechanical energy into an electrical signal in our nerves which we call pain.
However, our brain has a filtration mechanism. Our brains can diminish or amplify coming in signals. This may explain why often, injury is not equal to the amount of pain that is perceived. This is why we often hear people have a different pain threshold. Each person’s brain is trained to amplify or diminish coming in signals!
Pain Threshold is a personal experience.
As mentioned above pain is a warning system for our bodies, and it happens and controlled by the brain. Also, pain signals coming to the brain can be diminished or toned down to produce less pain or no pain or they can be amplified or toned up to cause more pain. For example, Pierre and Mary may both hurt their backs, picking something up from the floor. However, Mary may just rub the area and return to her activity and pain is gone within hours. In contrast, Pierre, on the other hand, may stop moving and rest for several hours and take medicine to relieve the pain, and the pain continues for days or weeks!
The experience of pain is individual for many reasons that are not just physical – for instance, the type of injury or where the damage has happened. But can emotional health, for example, feeling low and depressed or excited and alert, can affect how someone feels pain.
Cultural and social expectations can also influence how a person experiences pain.
One thing we all have in common is that wherever the pain is in our bodies, our brains play an important role. The brain takes all the influences described above and mixes them together. The result is the type of pain each individual feels and also how each person responds to the pain. And that will be unique to each of us.
Even though the brain is essential to the way we feel pain, that doesn’t mean pain is ‘all in your head’.
Pain is very real.
For a lot of people, chronic non-cancer pain has an explainable cause. It could be the result of surgery or an injury or a symptom of a chronic condition like osteoarthritis or migraine.
But sometimes the cause of chronic pain is harder to identify because the brain keeps on producing pain even after the body tissues are restored and out of danger! Some people say it still hurts, and they must have something wrong. But that’s is just it once anything dangerous is ruled out, health professionals can explain that most things in the body are healed as well as they can be by 3 to 6 months. So ongoing pain being produced by the brain is less about structural changes in the body.
So why is the brain producing more pain when clearly the danger is no longer there? The process is complicated, but our brains have a big part to play in diminishing or amplifying these danger signals.
Chronic Pain and the Brain
We are learning that many of the brain regions overlap. The experience of pain overlaps with the same circuits that are involved with your emotions and your cognitions. Stress, anger, tiredness, fighting with your spouse or your boss those same circuits in the brain involved with that negative emotion are directly connected and overlapping with those in pain. That stress, that anger, that frustration all simply amplify your overall experience of pain.
Facts about the Brain and Pain
- 500 areas of the brain are turned on when we were in pain. So this means some of these 500 areas might be responsible for other functions such as hearing or smelling or knowledge etc.… For example, someone with chronic knee pain may feel more pain when he hears a negative comment or may feel less pain when he hears a positive word. If the doctor says “your knee is stuffed mate” it might hurt more or if the doctor says “this is common and many people received treatment and function normally” it may hurt less.
- Some brain parts overlap, this may explain why you may often hear “there’s a fine line between pain and pleasure”. It is because pain and pleasure are produced by the same part of the brain. This may explain why we seek out and enjoy unpleasant experiences, such as fear-inducing rollercoasters or sad movies!
- There is no pain in the joints or muscles. They only send signals to the brain. The brain decides what hurts or what doesn’t. So the way our brains are trained, from our genes, upbringing, life experiences, etc.. will determine how much pain we feel. This is why a papercut hurts so much and hurt even more while we are at work! This may also explain why people who get attacked by sharks may not feel pain because the brain is in survival escape mode, NOT pain mode.
- We are bioplastic. This means your body will change as you experience chronic pain. Your body will adapt. But the good news is our brains are changeable too. Our brains are continually changing and adapting to everything happening in our lives. The longer you have pain, the brain adapts to be better and better at producing pain. However, all hope is not lost. Although the brains of people with chronic pain have changed, bioplastic changes in the brain will continue to happen until the day you die.
- Our brains act as an immune system. Our immune system will attack a foreign body such as infection such as a virus or bacteria. So our brains too once they receive signals we are in danger they send out pain signals to protect us from the threat.
Medicines and Chronic Pain
It’s unlikely that medicines on their own will be able to completely stop chronic pain.
Medical experts recommend them only in combination with treatments such as self-management, physical activity and psychological approaches.
The following medicines can be considered by your doctor when starting to treat chronic pain:
- non-steroidal anti-inflammatory drugs (NSAIDs)
Opioids and Chronic Pain
Opioids can be used to treat acute pain and chronic pain caused by cancer. However, their role in the management of chronic non-cancer pain is limited.
Suppose you have tried the treatments and medicines recommended when starting to treat chronic non-cancer pain but have not had enough improvement. In that case, you may be prescribed an opioid.
Opioids can improve pain and the ability to do day-to-day tasks. But this improvement is small. In fact, it is so tiny that it may not be necessary for people with chronic non-cancer pain.
Harms from taking opioids, such as constipation, nausea and sleepiness, are extremely common.
The longer someone takes opioids, the more likely it is that they will experience side effects and need to increase their dose to achieve the same pain relief (this is called tolerance). Tolerance exposes them to a greater risk of overdose leading to death.
Every day in Australia, there are, on average, 3 deaths, nearly 150 hospitalisations and 14 emergency department admissions because of harm from opioids, with far more deaths and poisoning hospitalisations attributed to pharmaceutical opioids (including codeine and oxycodone) to heroin. While opioids can decrease pain and improve function in a select group of patients, there are still harms from their use.
Compounding and Pain
Compounding pharmacists have been helping patients with chronic pain by dispensing customised transdermal pain medications. While avoiding the use of addictive drugs, these medications may be customised to include different types of drugs, in various dosage strengths, that are delivered simultaneously in one application. Compounded medicines using customised delivery systems help patients get the most medication possible. Transdermal pain cream compounding provides analgesics through the skin, for example, which allows for smooth, continuous drug delivery and pain relief. Transdermal treatments also bypass the digestive tract to speed delivery and reduce stomach upset.
Compounding can also combine multiple medications such as simple analgesics and opioids in one transdermal cream. This will increase the likelihood of treating the pain and decreasing the chance of side effects such as constipation, fatigue and tolerance.
Talk to your health professional.
The aim of the blog to demonstrate pain is complex, and many factors will influence how much pain a person will feel. Discuss with your GP
- Benefits and harms of medicines
- develop a health plan
- discuss treatments that don’t involve drugs and other pain medicines that may help reduce pain and improve your quality of life and ability to do things