Why is treating pain different for everyone? Pain is the common reason individuals seek medical care and I would suggest a primary reason people come to physical therapy. It is often an elusive phenomenon that can be disruptive to the quality of one’s life. *The International Association for the Study of Pain‘s widely used definition states: “Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” There are many classifications of pain including:
- Sensory-Discriminative: sense of the intensity, location, quality and duration of the pain
- Affective-Motivational: unpleasantness and urge to escape the unpleasantness
- Cognitive-Evaluative: cognitions such as appraisal, cultural values, distraction and hypnotic suggestion
It has been theorized that pain intensity (the sensory discriminative dimension) and unpleasantness (the affective-motivational dimension) are not simply determined by the magnitude of the painful stimulus, but “higher” cognitive activities can influence perceived intensity and unpleasantness. Cognitive activities “may affect both sensory and affective experience or they may modify primarily the affective-motivational dimension. In other words, your emotional state has a large impact on “how much pain” you feel. An individual’s framing of the painful experience can dramatically influence the intensity of that experience. As a therapist I work specifically to address physiological, biomechanical and postural factors impacting pain. In this blog I want to address other issues impacting pain.
Melzack and Casey suggest pain should not only be treated by trying to cut down the sensory input by anesthetic block, surgical intervention and physical therapy, but also by influencing the motivational-affective and cognitive factors as well. How does one accomplish this?
The first step is to get a clear picture of the physiological stimulus that is at the root of one’s pain. Different tissues will respond with different patterns of pain. Keep in mind, that though all pain is unpleasant, not all pain is of equal urgency. It has been my observation from thirty years of experience as a physical therapist helping people in pain, that the intensity of one’s pain is most often NOT correlated with the severity of the “problem”. What I mean by that is; many conditions that are in fact life threatening, specifically certain types of cancer and auto immune diseases often offer very little pain. Conversely conditions that are intensely painful will not threaten your life. Examples such conditions are child-birth and sciatica. Understand that this does not mean that one should ignore pain. The mere presence of pain is enough to alter one’s quality of life and negatively impact one’s longevity. But, an individual experiencing pain can be helped by having a clear understanding of the cause and potential threat posed by that pain.
Another important point to consider is that all pain is mediated in the central nervous system. It actually occurs in the brain regardless of what part of you body hurts. Take for example “phantom limb” pain, a condition in which individuals who have had a traumatic or surgical amputation of one of their limbs may continue to feel pain in that limb long after it is gone. The pain is mediated by the brain and is by definition an unpleasant emotional experience. Finally it is important not to judge yourself because you are experiencing pain and do not compare your pain experience to other. In our country we tend to judge pain as “bad”. Though it is unpleasant pain is not morally bad. Additionally, comparing one’s experience to friends and neighbors can often lead to frustration and shame. Consider a positive emotional experience. When my wife and I go to see a comedy, “Nacho Libre” for example, I may belly laugh through the entire movie and she may offer a polite chuckle. Same stimulus but very different responses and neither of us is right or wrong for our response.
So what to do? If you are experience a persistent episode of pain;
- Have your condition evaluated by an objective and qualified specialist. This will help establish a plan to handle the physiological contributors to your pain.
- Understand your condition and its severity (you may not fully understand the pain itself and that is OK)
- Talk to an objective third-party about how you feel. This will assist you in handling the emotional contributors to your condition.
- Do not judge yourself, or allow others to judge you, for experiencing pain
- Eliminate those external stressors factors that might make your experience more unpleasant.
- Do those positive actions that will help reduce the painful stimulus and improve you tolerance to your condition
If you have questions about pain please call me at 480-833-1005.
