Understanding Pain, A Ten Week Ecourse

Part One: The Paradox of Pain and Damage

This is Jonathan Blood Smyth, Founder of The Physiotherapy Site and author of Secrets of Pacing, and welcome to the first instalment of my Ten Week Ecourse, I hope you find it interesting and stimulating.

Part One has a lot to think about in it, perhaps more than you expect. I think you will be pleasantly surprised.

You are welcome to publish this course in your newsletters or on your web site, on condition you do not alter it and that you keep the resource box at the bottom of each instalment.

Pain is an important and challenging problem for anyone trying to work in medical areas. Scientists struggle with the mechanisms thought to be responsible, health professionals search for any useful therapy and sufferers have to live with the pain. Often no therapy can be found.

We all suffer. It’s part of human life. It has fascinated and horrified people through the centuries. For thousands of years we have been slaves to its power, our potions and incantations having little effect.

The struggle to understand and investigate pain has been going on for hundreds of years. I thought I’d take you through the story so far and describe the present state of pain knowledge. It’s a fascinating story (at least to me!), and has real relevance for anyone suffering from or treating pain.

Damage and Pain. The Link Which Sometimes Isn’t. Part One

All of our lives we observe the link between damage and pain. If we have an injury we feel pain and know that an injury is present in our bodily tissues. We understand what we call the acute pain model, the way we all think day to day about pain.

Acute pain is recent. That’s our definition, acute pain is one which has come on recently like a sprained ankle sustained on the football pitch.
What does acute pain mean? What’s the message? Acute pain says “Warning! Tissue Damage!” It’s telling us that if we keep on doing what hurt us, we will suffer greater damage. It’s a protective mechanism, designed to allow us to survive through childhood and into adulthood.
Imagine if your children were unable to feel pain? Wouldn’t that be wonderful? No, it would be awful. None of us want children to feel pain, but it’s vital to protect them. Pain is the messenger that something is wrong, that we need to take action.
There are people who are born unable to feel pain at all. It’s very uncommon and we do not know why it occurs. They are unable to protect themselves and damage their bodies easily and without knowing. They don’t live much into adulthood. No, being without pain is not a bundle of fun, it’s a life sentence.
So, when we get the warning about tissue damage, what do we do then? We change our behaviour, that’s what. That’s what the pain is for, to make us change behaviour. Then we take the necessary steps to prevent further damage, heal the injury and give us the best chance to go back to normal again.
Once we take the right steps the injury starts to heal and the pain recedes, leading us to slowly increase our activity back to what we want.
As our abilities return and the pain goes, we return towards the normal for our injured part.

Let’s look at this process. What do we know about the acute pain story? Actually we know rather a lot.

We know how we got the injury, we know when it occurred, we know what has happened (i.e. what has been injured), we know how we can treat it, we know roughly how long it will last and we know we will get back to normal in the end.

In the acute pain model, hurt equals harm. This means that if you have a pain, it is due to injury or damage to your body tissues. This is a USEFUL PAIN, it guides and protects us over our lives.

This is ideally how the pain process goes through when things go well. However, often the process doesn’t go so well and then the pain process can get stuck, leading to a chronic pain problem. And chronic pain problems are a very common and disabling group of conditions.

The heading of this last discussion is “Damage and injury, the link which sometimes isn’t”. In the acute pain model, it’s the link which most definitely is. That much is clear. However, pain has a more complex and subtle story to tell us.

Well, that’s the end of the first instalment of the ten week pain ecourse. I hope you found it interesting. There’s a long way to go yet, so stick with me!

Check out the second instalment of the Pain Ecourse.

To your health and comfort,

Jonathan.

Jonathan Blood Smyth

Understanding Pain, A Ten+ Week Ecourse by Jonathan Blood Smyth.

The Physiotherapy Site is your resource for orthopaedics, joint replacement, physiotherapy and pain.

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