Written by Pam Showman, PT, DPT

Pain is an elusive concept. While there have been attempts throughout history to define it and apply parameters to the definition, there are still things we don’t understand. Much of medicine has tried to dumb pain down a subjective experience to a number on a scale, but we know that this attempt to apply objective terms to a multi-faceted subject has been meager at best. Even though this may instill uneasiness in even the most stoic of individuals, this is actually an enlightening realization. The gist of this is that everyone’s pain is their own experience and is affected in differing proportions by multiple factors, including structural anatomy, past experience, nervous system sensitivity, emotional connections, and interpretations of sensory input, to name a few. This is encouraging because this means that there are a lot of different ways to go about changing a pain experience, instead of simply trying to change a physical structure or response by the body.

This is especially true in persistent pain, or pain that has lasted for months or years. Pain initially is a good thing because it alerts the body and brain to a threat. However, when pain persists, it can start to protect us from everything, whether it is threatening or not. And get this, the brain can recall previous painful memories and then influence the current interpretation of pain, too. So, again, this is encouraging because it lets us know that pain does not always equal tissue damage, especially with pain that has lasted for a while. If this concept is hard to digest, think of it this way: You’ve most likely had numerous cuts and scrapes throughout your lifetime, correct? And they have probably healed without incident. The cool thing is, we are designed to heal, the body is capable of some pretty cool things when it comes to repairing and restoring function. However, when it comes to more involved injuries that you can’t necessarily visually see healing, there are some things that can come along and hijack the process of restoring normalcy to function that have nothing to do with the actual structure that is painful. There isn’t always a clear answer to the question “What is causing my pain?” Sometimes the processing ability of the nervous system is the thing being hijacked. If that isn’t addressed, no matter how much you try to change your pain with physical modalities, it won’t get to the root of the issue and cause permanent change.  

Regardless of how long you have had pain, there are strategies to address these processing differences by the brain and restore function over time. Part of this includes gradually helping you return to the activities that you love to do. Part of this is also realizing the other factors that are playing a role in your pain experience. Remember, your body is a resilient structure, it just may need some help remembering that fact.