Explaining pain is like climbing a great mountain.
Lorimer and David started building their house of pain decades ago and their journey of a thousand miles started with just one step – just like yours. Today they have a mother lode of ways to explain pain and simplify the science of pain.
It’s useful to craft your very own skillful ways to explain pain and keep them tucked in your back pocket for when you need them most.
If a patient asks you “why am I having pain?”, how do you respond?
At first you may be consumed by a waterfall of thoughts as to the hundreds of different ways to respond. As a trained healthcare professional probably could get super specific into things like ion channel expression and depolarization… but let’s be real patient’s… few care to hear all of the bells and whistles of the nervous system.
Just like each patient’s plan of care should be individualized, so should their education about pain science. Similar to prescribing exercise, education about pain should be paced as to not overwhelm patients and allow them to take in the information and ask questions as needed.
Some may benefit from a one sentence answer and some may want to drive deeper into the topic and learn all there is to know.
Here are examples of how to break down the incredibly complex topic of pain science into five descriptions, five phrases, and five simple one-liners to help your patients understand pain and how their body works.
5 WAYS TO EXPLAIN PAIN
#1: INPUTS TO THE BRAIN
Our body is made up of hundreds of nerves that are connected like a highway and communicate with our brain. This communication between nerves and the brain goes both ways, but to begin to understand pain it is best start with learning how our nerves “talk” to our brain. Our nerves contain sensors that send messages to the brain about things like temperature, touch, movement, and many more. In places like our skin, muscles, joints, tendons, and ligaments these sensors are specifically referred to as nociceptors. It is helpful to think of nerves like an alarm system that send potential “danger” messages to our brain. These “danger” messages sent to the brain are completely normal and meant to protect us.
#2: THE BRAIN DECIDES WHAT IS IMPORTANT
In addition to receiving messages specifically sent from nerves we just talked about, our brain receives information about what we are seeing, hearing, smelling, thinking, and our emotions. That’s a lot of information to consider and our brain is able to take it all in and process it in an instant, which is pretty amazing! Our brain evaluates all the information it is receiving and decides what is the most important information, what information may not be as big of a deal, and what the overall conclusion is. This overall conclusion is basically what information our brain chooses to send back to our nerves, i.e. how our brain “talks” to the nerves. When our brain receives the potential “danger” messages from our nerves (who are acting as an alarm system) it takes this message into account along with all the other information it is getting.
#3: THE BRAIN TALKS BACK TO THE NERVES AND BODY
Let’s say the brain receives some of these potential “danger” messages from our nerves (who are acting as an alarm system) and after compiling it with all the other information decides it seems pretty important, the brain will send a pain message back to our nerves. As mentioned earlier, this is completely normal, and it is meant to protect us. For example, if you stepped on a nail you would want your brain to get your attention by sending a pain message back to your nerves so you could take care of the problem.
Conversely, if the brain receives some of these potential “danger” messages from nerves and decides it is probably not that big of a deal, no pain message will be sent back to our nerves. Have you ever realized you had a bruise and you have no clue how it got there? This is a perfect example of the brain receiving potential “danger” messages from the nerves, deciding it’s not a threat and no pain message is sent back to the nerves. It is also important to note that the sensors in our body are changing all the time based on what our brain decides is most important at that time.
#4: THE TWO TYPES OF PAIN
Pain is generally classified into two types: acute and chronic. What separates these two types of pain is dependent on what your alarm system does after it sends a danger message to the brain. Typically, pain is classified as acute if it lasts less than three months, which is the normal healing time. Initially when our brain does perceive a threat such as pain, it recruits systems that deal with muscles, sleep, breathing, arousal, digestion, heart rate, and more to deal with the current situation. This is sometimes referred to as the “fight or flight” response. Once the perceived threat has been dealt with, your alarm system eventually calms back down.
Sometimes, the pain lasts longer than three months and this means your alarm system didn’t calm down all the way after a painful experience. This leaves your nerves extra-sensitive, which means it does not take as much to set off the alarm system again in the future and send the danger messages to the brain. Just because the normal healing time is over does not mean pain lasting longer than three months isn’t real. It’s also to remember that just because you are experiencing pain, it does not mean you are harming your body.
#5: NUMEROUS FACTORS INFLUENCE PAIN
Pain is complex and numerous factors influence each person’s unique pain experience. As we mentioned earlier, the brain is amazing and constantly changing based on what is occurring inside our bodies and around us. When pain lasts beyond normal healing time and becomes chronic, it begins to preoccupy other areas of the brain that deal with things like thoughts, emotions, focus, memory, and concentration. This does not mean there is anything wrong with the brain or that it will stay like that forever. Remember all those body systems that were initially recruited to help deal with the initial threat? Well if they have not calmed and returned to a resting state, they can also have an impact on pain. The good news is that we know exercise and learning about how pain works are two ways we can calm our alarm system back down.
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FIVE PHRASES TO EXPLAIN PAIN SCIENCE
Here are five short sentences that summarize the five longer paragraphs described above.
- Our nerves send messages to our brain, including potential danger messages, working like our body’s alarm system
- Our brain compiles this information with all the other input it is receiving from our body and our environment, prioritizes it, and comes up with an overall conclusion
- Our brain sends a message back to our nerves to produce pain if there is a perceived threat to get our attention, this is a protection mechanism
- Normally following our alarm system going off, it calms back down but sometimes it does not calm back down all the way and stays extra sensitive, which is separate from tissue healing.
- Many factors influence pain, especially emotion and anxiety, and can prevent our nerves from fully calming back down
5 SHORT AND SWEET SENTENCES TO EXPLAIN PAIN
Here are five short sentences that summarize pain. You can use any of these in a pinch
- The brain creates pain when it feels threatened.
- Pain is produced by the brain as a way to protect us.
- Danger messages are sent to the brain– the brain decides pain or no pain.
- Pain is produced by the brain after receiving danger messages from our nerves.
- Pain is produced by the brain after receiving danger messages from our nerves, despite actual or perceived tissue damage.
Explaining pain decreases fear-avoidance and pain-related anxiety. It also improves physical outcomes and activity.
How do you explain pain?
What have you found works best for you and your practice patients?
Shelby McClure is a third year Doctorate of Physical Therapy student at Augusta University in Augusta, Georgia and will be graduating in May of 2020. She completed her undergraduate education at Auburn University in Alabama where she earned a B.S. in Fitness, Conditioning, and Performance in addition to a B.S. in Nutrition and Wellness.
Shelby began dancing at a young age which helped to shape her initial interest in health. During college, she worked as a dance instructor as well as a group fitness instructor, which eventually led her to pursue a career in physical therapy.
Throughout her time at Augusta University and subsequent clinical rotations, Shelby realized her passion for pain science and psychologically informed physical therapy. Shelby is currently completing a 4-week elective with the Integrative Pain Science Institute prior to her graduation.
Shelby is from the Atlanta, Georgia area where she currently resides with her husband of 2 years.
To learn more about Shelby, visit her LinkedIn.
