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  • Mary Carolla

What do we really know about pain?

Pain is one of those “you know it when you feel it” kind of sensations. It’s also a strange phenomenon, when you think about it. A snowball is cold, so it feels cold when you touch it. A block of concrete is rough, so it feels rough when you touch it. But a knife isn’t painful on its own. Neither is a pot of boiling water or the leg of a table. We handle these things safely all the time, and experience their mass and temperature and texture. But pain exists only in the body, and even more specifically (as people who’ve experienced anesthesia know firsthand) in our brains. But that doesn’t make it any less real! So what exactly is happening when we feel pain, and how do we stop it from negatively impacting our lives?

How does pain work? There are three primary types of pain, and each of them works a slightly different way.

Nociceptive Pain (Tissue Pain) There are many different kinds of sense receptors in the body. Some are sensitive to heat or cold, some to touch or pressure. Others, called free nerve endings, aren’t specialized for any one type of stimulus. When a significant stimulus triggers these nerve endings, they send a message through the spinal cord and up to the brain indicating that something potentially dangerous has happened. The brain then decides (without consulting the part involved in conscious thought, alas) whether this is something to ignore or brush off or if it seems likely that damage has occurred. This then sends this message back down to the affected part of the body.

If the message is “No biggie, ‘tis but a scratch” (hat tip to the Black Knight of Monty Python fame), then you’ll most likely shake it off and forget the incident even happened. If the message is “WHOA, THIS SEEMS LIKE A PROBLEM,” then you experience this as pain. This is useful! Just ask someone with CIPA, or congenital insensitivity to pain with anhidrosis, a disease that leaves people insensitive to pain. Imagine not noticing a bit of grit in your eye until it damages your cornea, developing stress fractures in your feet because nothing is telling you it’s time to sit down, or ending up with burns in your mouth and throat because you don’t realize your coffee is scalding hot. Pain stops us from trying to walk on a sprained ankle or go for a run when we have a fever. Tissue damage, high temperatures, low pH, and capsaicin (the component in hot peppers that makes them spicy) are all common triggers for this process.

Alas, brains are not always correct when it comes to assessing danger. Lorimer Moseley gives a brilliant example of this in his TEDx talk. What’s the difference between the pain from a scratch on the leg and the pain from a nearly-fatal snake bite? Spoiler: it’s whatever your brain is expecting. That’s why you might feel little pain after a bicycle accident, but be in agony when getting the wound stitched up two hours later. Pain is weird.

Neuropathic Pain (Nerve Pain) This is pain resulting from an issue with the nervous system itself, rather than surrounding tissues. If you’ve ever banged your funny bone, you know this feeling well. Common forms of neuropathic pain include:

  • Sciatica: pain in the sciatic nerve running through the hip and down into the leg and foot

  • Peripheral neuropathy: weakness, loss of sensation, pain resulting from nerve damage (often in the hands and feet)

  • Carpal tunnel syndrome: pain resulting from the compression of the nerves that run through the wrist into the hand

Less common forms of neuropathic pain include phantom limb pain (pain that feels like it originates in an amputated limb) and post-herpetic neuralgia, which occurs as a result of getting shingles. Neuropathic pain can be especially frustrating because the typical things we do to reduce pain are not as useful when it comes to pain originating in the nervous system. Moving or not moving our muscles, applying heat or ice; these can have relatively little impact on nerve pain. What’s more, nerves don’t heal as well as things like muscles and skin do, which makes nerve pain more likely to become chronic pain.

Other Pain This is an incredibly vague category, I know. Pain is messy, and a lot of it doesn’t fall into either of the two categories above. Fibromyalgia is a great example of this. Is it pain resulting from tissue damage? Nope. What about nerve damage? Not as far as we can tell. It’s caused by the nervous system malfunctioning, sometimes in horrible ways, but not from actual nerve damage. The world of medicine is still trying to figure out just why this happens.

So how do we alleviate pain? There are several different options. If the pain is caused by some kind of physical injury or stimulus, you can work on remedying that. If your hand is being burned on a light bulb, you can remove your hand, which will make most of that pain go away. If you’re experiencing a muscle cramp in your foot, you can flex the foot (manually, if necessary) to counteract it. If you’re experiencing pain from sitting in the same position for too long, you can move around and shake out your legs. If the cause of the pain is inflammation, anti-inflammatories and ice can reduce that. This is perhaps the ideal form of pain relief, although it’s not always possible.

You can block the messages that tell your brain you’re in pain. This is how many painkillers work. Ice can also numb nerve endings. This is also how TENS units are purported to work; they interfere with the pain messages going to the spinal cord and brain.

You can convince your brain that you’re not in any real danger. This can be a tough one, because the brain doesn’t just listen when you tell it things. But it’s well documented that fear, stress, and anxiety lead to increased pain perception. And of course, pain leads to stress, which leads to pain … (Sigh)

General relaxation techniques—from meditation to light exercise to getting a massage—can all be helpful in turning the brain’s pain alarms down a notch. Physical therapy (practicing certain motions in a way that isn’t painful) and talk therapy can be useful here, too.

How can massage help with pain? Sometimes the issue is one that massage can help manage on a physical level. Tension headaches and plantar fasciitis are examples of conditions that respond well to massage. But even more often, massage gives the brain a chance to let down its guard and experience something non-painful (even pleasant!) in the body. That is a more-than-welcome break if you've been in pain for a while. So, while there’s no single cure-all for pain, that break can mean a lot for people whose pain has defied more straightforward treatments and whose injuries or illnesses are already healed. Feeling the hurt yourself? There’s a massage with your name on it. Book your next one today.

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