Factors Affecting Pain
Chiropractors often see patients who have no immediately obvious reason for the onset of their pain. They might not have lifted anything heavy, moved awkwardly or done anything particularly out of the ordinary – so why are they in pain?
We hope that the analogy and explanation below help you to understand why pain can occur in the absence of injury, how pain can become self-sustaining and what factors influence this.
What is Pain?
Pain is defined by the International Association for the Study of Pain as “An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage”.
It can be taken from this definition that the pain does not necessarily occur in the presence of damage. Anybody with chronic pain is likely to have long understood this fact.
Pain is far more complex than just a proportional result of injury. Pain is affected by your emotions, beliefs, thoughts and the social aspects of your life.
Pain is also influenced by chemical changes in your body related to physical stresses, nutritional changes, sleep habits – a whole host of factors.
A Warning Signal
Of course, when there is tissue damage or injury, usually (but not always), there is pain associated with it.
But the intensity of pain doesn’t often correlate to the severity of an injury. If it did, why would trivial injuries such as nettle stings, paper cuts and a bang on the shin be so painful?
It can be helpful to think of pain more like a warning signal that your brain subsequently interprets – a bit like the smoke alarm in your kitchen.
The alarm goes off and warns you if there is a house fire. But it also sounds the alarm if you burn your toast.
Broadly speaking, the events going on in our bodies when we stub our toe and break our leg are very similar. The real action takes place in our brain; that is where the interpretation is carried out.
Sometimes, a bit like the smoke alarm reacting to you burning your toast, our can brain produce too big or too sustained a reaction to a painful stimulus.
This disproportionate response is known as sensitisation and can be a consequence of a number of factors that we will come to shortly. But for the most part sensitisation is a result of regular or long term painful events.
Back pain can be a good example of this process:
A small tweak to your back can be very painful, preventing you from continuing loading your spine in the same way.
Initially this is a good thing, and the intensity of this pain should gradually improve.
But with repeated episodes, sometimes your back will stay painful much longer than might be expected.
So why is this?
To put it simply, your brain has become more sensitive to pain signals – it has ‘learnt’ to be good at pain.
What can contribute to sensitisation?
Imagine pain being a bit like an overflowing cup. Repeated painful episodes can keep the cup topped up, making it continuously overflow.
But there are multiple things that can fill up your cup – injury, emotional stress, lack of or poor-quality sleep, depression, the list goes on.
All these factors are normal – we cannot go through life avoiding stress, and short periods of anxiety and depression are part of day to day life.
However, sometimes too many of these stresses occur at once, or they continue for long periods of time.
Pain results when we fail to tolerate these stresses and they become unmanageable – your cup overflows.
Sometimes it is possible to significantly reduce one or two of the stresses filling your cup, but often this isn’t that easy.
Fortunately, there is another solution. Build a bigger cup!
In other words, over time, you can build up resilience and tolerance to stressors.
You wouldn’t expect someone to be able to run a marathon with no training. But over time, they can absolutely build up the tolerance to the stresses of running to be able to achieve their goal.
We can all adapt to other stressors in a similar way.
There are numerous strategies to build this resilience and what works for your friend might not work for you – it is incredibly individual.
There are numerous resources to help you develop strategies that can prevent your cup from overflowing, and it may be that you need to combine strategies for best effect
There also exists a host of professionals that can suggest strategies and guide you to which might suit you best. The Royal College of Chiropractors Pain Faculty, for example, occupy a unique position as musculoskeletal experts with further training and clinical interest in pain physiology.
What Can Chiropractors Do?
Chiropractors are particularly well placed to help patients with sensitisation issues. In addition to provided expert diagnostics and manual therapy, all chiropractors undertake an element of training in methods for dealing with sensitisation.
By firstly providing a detailed examination, chiropractors can ascertain what mechanical problems are contributing to your pain, as well as which other factors are involved.
With this knowledge a chiropractor can provide specific treatment, addressing mechanical factors. They can also provide advice and self-management strategies.
If these approaches are not effective, your chiropractor can refer you to another medical professional with concise and actionable recommendations.