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Understanding Pain, A Ten+ Week Ecourse

Week 10. The Pain Story So Far

Hi, this is Jonathan Blood Smyth again, Founder of The Physio Site and author of Secrets of Pacing.

I hope you have found the journey through the understanding of pain interesting so far.


It’s a fascinating subject, and so important as pain is still a severe and unrelieved problem for many people both in and outside a hospital.


We’ve come to a natural break now, having covered the technical and anatomical aspects of pain production and transmission.


There are many lessons from understanding how pain is produced and carried up the nervous system to the brain. It helps us with explaining and managing the many different types of pain problem which patients bring to us.


So what are the lessons? Well I have a few thoughts.


When people get injured we concentrate on the tissue damage and pay less attention to the central nervous system consequences.


Tissue damage sensitizes the local peripheral nerves and brings so-called silent nociceptors into action. This up-rates the pain transmission of the local area and gives the primary and the spreading secondary hyperalgesia typical of injured parts.


Strong, incoming pain transmissions hit the nerves in the central nervous system and quickly start a process of change. The spinal cord nerves begin to change very soon, responding more and more strongly to the incoming barrage of pain.


This is the up-regulation of the nervous system which typically occurs in every acute pain episode. However, this may have very serious consequences when the up-regulation does not settle.


We will see later how some pain conditions may be entirely or mostly due to changes in the central processing of pain. If we concentrate on a peripheral tissue diagnosis in these cases we will be missing the point.


Finally, the integration of inputs in the nervous system gives us an explanation for why emotional changes, depression, our understanding of what’s going on and our activities and exercise can all affect pain transmission and how much pain we feel.


Did you miss any of the instalments? Here’s list of them and what each one was about.

1. The Paradox of Injury and Pain

2. The Paradox of Pain, Part 2, The Link which sometimes isn’t

3. The Mind and the Body - separate?

4. The Structure of the Pain System

5. The Structure of the Pain System, Part 2

6. Plasticity, Up-regulation & Peripheral Sensitization

7. Central Sensitization

8. Pain and Movement Control

9. Integration of Pain in the Nervous System

Have I finished yet? Apparently, not by a long way. There is so much more to say, from psychological aspects right through exercise and on finally to Pain Management.


I hope you want to stick with me!


Until the next instalment, my best wishes for your health and comfort,



Jonathan Blood Smyth


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