What’s the number one reason people seek out physical therapy (PT)? If you said “pain” you are correct. They are in pain and would like physical therapists to help them get out of it. And many times, through education, activity modification, therapeutic exercises, re-training the nervous system and manual therapy, PT can reduce or even eliminate pain. But unfortunately pain is more complicated than “fixing” the physical problem resulting in the resolution of pain. Besides, there are entire medical specialties dedicated to pain and pain science.
First, what is pain? Let’s start with the definition. Pain is “an unpleasant sensory and emotional experience associated with or resembling that association with actual or potential tissue damage.” Did you catch that one? …actual OR potential damage to the tissue…sensory AND emotional experience. Pain is incredibly complex with the influence of many factors including but not limited to quality and quantity of sleep, previous injuries and how you managed those injuries, perception of pain and injuries, physical activity, nutrition and hydration, and even job satisfaction and social support. A systematic review published in Osteoarthritis and Cartilage in 2019 by Ho et. al. included 24 randomized control trials and found sleep interventions (cognitive behavioral therapy and short-term pharmacological interventions), without any other treatment, improved sleep and pain for people with low back pain. Another study published in Injury in 2016 by Briet et. al. examining symptoms and limitations after an ankle sprain found a stronger correlation with psychosocial factors (like self-efficacy) than actual severity of the sprain. When your neck or back or shoulder is hurting, it’s hard to believe that something other than damaged tissue is going on! But, the research is out - pain is more holistic than we even imagined.
This being said, take a bird’s eye view of your current situation. Did you start having pain when you started that big stressful project at work? How’s your sleep been? Did pain start in those knees after eating less than ideal during the holidays and gaining a few extra pounds? These factors, and many more, will affect pain tolerance and perception.
Next, how does pain work? In the absolute most simple sense, pain is a signal from the nervous system which is interpreted in the brain specifically the prefrontal cortex. There are different types of pain with varying approaches to relieve that pain.
Types of pain:
Nociceptive pain - tissue irritation or damage.
Neuropathic pain - nerve irritation or damage.
“Other” pain - neurological dysfunction including fibromyalgia, central sensitization, Complex Regional Pain Syndrome (CRPS), non-specific chronic low back/neck pain for examples. Names under this category can include nocipathic, nociplastic, allopathic, central or maladaptive, primary pain and types of pain that haven’t been categorized yet.
Knowing your pain characteristics will help determine the type of pain and therefore how to address it. Characteristics could include sensation of pain (dull, achy, sharp, etc.), when it feels better and worse (time of day and activity), when the pain started, and how it has progressed. The more accurate information you have, the easier it'll be to take action.
Here’s the take-away:
Pain doesn’t always equate to tissue damage or physical injury.
Pain is very complex and requires a holistic lens reviewing lifestyle factors like sleep quality/quantity and mental health.
Finally, the cause must be identified to address your pain. Physical therapists are the experts for physical impairments like muscle weakness or recovery from an injury for example. PTs can also refer you to another professional to help you navigate other areas which may be contributing to your pain, like insomnia or mental health. Whatever your individual circumstances, we can work together to get you back to feeling your best.
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