What is pain?
Pain is a complex sensory and emotional experience typically associated with tissue damage or potential tissue damage. It is often described as an unpleasant sensation that can vary in intensity, duration, and quality. While pain serves as a warning signal to protect the body from harm, it can also have profound physical and emotional effects. Pain perception involves a combination of biological, psychological, and social factors, and it can manifest in various forms, including acute pain (short-term) and chronic pain (long-term).
Types of Pain by Duration
1. Acute pain is typically sudden and short-lived, often resulting from an injury, surgery, or medical condition. It serves as a warning signal to alert the body to potential damage and usually resolves once the underlying cause is treated or healed. Acute pain is generally sharp and intense but diminishes as healing progresses.
2. Subacute pain falls between acute and chronic pain in terms of duration and severity. It usually lasts longer than acute pain but doesn't persist as long as chronic pain. Subacute pain can result from injuries, medical conditions, or surgical procedures and may require medical attention or management.
3. Chronic pain is persistent and can last for weeks, months, or even years. It often persists beyond the normal healing time and may result from conditions such as arthritis, fibromyalgia, nerve damage, or past injuries. Chronic pain can significantly impact daily life and may require long-term management strategies, including medication, physical therapy, and psychological interventions.
Pain, the On/Off Switch
Pain threshold refers to the level of stimulation required to perceive pain. Like a switch that gets turned on. It is the point at which a stimulus, such as pressure, temperature, or tissue damage, becomes intense enough to be perceived as painful by an individual.
Every person has a unique pain threshold, influenced by various factors including genetics, age, sex, psychological state, and past experiences with pain. Some individuals may have a high pain threshold, meaning they require a greater level of stimulation before they perceive pain, while others may have a low pain threshold and experience pain more easily.
Pain threshold is different from pain tolerance, which refers to an individual's ability to endure pain once it is perceived. While pain threshold determines when pain is first detected, pain tolerance influences how long an individual can endure the sensation before seeking relief or experiencing distress.
Types of Pain by Mechanism
1. Nociceptive pain is a type of pain that arises from the activation of nociceptors, which are specialized sensory receptors that detect potential tissue damage or actual tissue damage. These receptors are found throughout the body in the skin, muscles, joints, and internal organs. When tissue is injured or damaged, nociceptors send signals to the brain indicating the presence of harmful stimuli.
Nociceptive pain can be further categorized into two subtypes:
Somatic Nociceptive Pain: This type of pain originates from the stimulation of nociceptors in the skin, muscles, bones, and ligaments. It is typically well-localized and described as a sharp, aching, or throbbing sensation. Examples of conditions that cause somatic nociceptive pain include cuts, bruises, fractures, and sprains.
Visceral Nociceptive Pain: Visceral nociceptive pain arises from the activation of nociceptors in the internal organs, such as the intestines, bladder, or reproductive organs. It is often described as a deep, dull, or cramping sensation and may be accompanied by autonomic responses like nausea, sweating, or changes in blood pressure. Conditions such as appendicitis, kidney stones, or gastrointestinal disorders can cause visceral nociceptive pain.
Nociceptive pain serves as a protective mechanism to alert the body to potential or actual tissue damage, prompting behaviors to avoid further harm and facilitating the healing process. Treatment for nociceptive pain often involves addressing the underlying cause of tissue injury or damage and may include medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, or other pain management techniques.
2. Neurogenic pain is a type of pain that arises from damage or dysfunction of the nervous system itself, rather than from nociceptor activation in response to tissue damage. It occurs when there is abnormal processing or transmission of pain signals within the nervous system, leading to the perception of pain in the absence of ongoing tissue damage or injury.
Neurogenic pain can result from various conditions affecting the nervous system, including:
Peripheral Neuropathy: Damage to the peripheral nerves, often caused by conditions such as diabetes, infections, autoimmune disorders, or traumatic injuries, can lead to peripheral neuropathic pain. This type of pain is characterized by symptoms such as tingling, burning, shooting, or electric shock-like sensations in the affected areas.
Neural Compression Syndromes: Compression or irritation of nerves due to conditions like herniated discs, spinal stenosis, or entrapment neuropathies (e.g., carpal tunnel syndrome) can lead to neurogenic pain characterized by radiating pain, numbness, or weakness in the distribution of the affected nerve.
Post-herpetic Neuralgia: This type of neurogenic pain occurs as a complication of herpes zoster (shingles) infection, where nerve damage caused by the virus leads to persistent pain even after the rash has healed.
3. Neuroplastic pain refers to the brain's ability to reorganize its structure and function in response to changes in sensory input, learning, and experience. In the context of chronic pain, neuroplastic changes can occur in the central nervous system, leading to alterations in pain processing and perception.
Chronic pain conditions, particularly those involving persistent nociceptive input or nerve damage, can induce maladaptive neuroplastic changes in the brain and spinal cord. These changes may include sensitization of pain pathways, altered neurotransmitter function, and changes in the structure and function of brain regions involved in pain processing.
For example, central sensitization is a neuroplastic phenomenon in which neurons in the central nervous system become hyperexcitable, amplifying pain signals and contributing to the persistence and severity of chronic pain. Additionally, changes in brain connectivity and function can lead to cognitive and emotional aspects of pain, such as anxiety, depression, and impaired pain modulation.
Physical Activity
Physical activity refers to any bodily movement produced by skeletal muscles that requires energy expenditure. This includes activities of daily living such as bathing or showering, dressing, getting in and out of bed or a chair, walking, working, shopping, gardening, chores, etc... Physical activity is essential for maintaining overall health and well-being, as it helps improve cardiovascular health, muscle strength, flexibility, and mental health. It also plays a crucial role in weight management and reducing the risk of chronic diseases like heart disease, diabetes, and certain types of cancer.
Exercise
Exercise is a specific subset of physical activity that is planned, structured, repetitive, and aims to improve or maintain physical fitness and health. Unlike physical activity, which encompasses any movement produced by skeletal muscles, exercise is purposeful and intentional. It typically involves activities such as jogging, cycling, weightlifting, yoga, or participating in sports with the primary goal of enhancing physical fitness, strength, flexibility, or endurance.
Exercise can be categorized into various types, including aerobic (cardiovascular) exercise, strength training (resistance training), flexibility exercises (stretching), and balance exercises. Each type of exercise targets different aspects of physical fitness and contributes to overall health and well-being. Regular exercise is essential for maintaining optimal health, preventing chronic diseases, managing weight, improving mood, and enhancing overall quality of life.
How does physical activity/exercise decrease pain?
Outside-In
The gate control theory of pain, proposed by Ronald Melzack and Patrick Wall in 1965, suggests that the experience of pain is modulated by a complex interplay of neural signals within the spinal cord and brain. According to this theory, pain perception is not solely determined by the activation of pain receptors (nociceptors) but is also influenced by neural mechanisms that can either enhance or inhibit the transmission of pain signals.
The key concept of the gate control theory is the existence of a "gate" in the spinal cord that can either facilitate or inhibit the transmission of pain signals to the brain. This gate is controlled by a balance of activity between different types of nerve fibers:
Afferent Nerve Fibers: These nerve fibers carry sensory signals from the periphery (such as the skin, muscles, and organs) to the spinal cord. There are two main types of afferent fibers involved in pain transmission:
A-delta fibers: Fast-conducting, myelinated fibers that transmit sharp, well-localized pain signals.
C fibers: Slow-conducting, unmyelinated fibers that transmit dull, diffuse, and longer-lasting pain signals.
2. Inhibitory Interneurons: Within the spinal cord, there are interneurons that can either inhibit or modify the transmission of pain signals. Activation of these inhibitory interneurons can close the gate and inhibit the transmission of pain signals from smaller-diameter A-delta and C fibers. As a result, the perception of pain is reduced or modulated.
During physical activity/exercise, several types of mechanoreceptors and proprioceptors play crucial roles in providing feedback to the body about movement, position, and muscle tension. These receptors help coordinate muscle contractions, maintain balance and posture, and adjust movements to various stimuli. Here are some of the key mechanoreceptors and proprioceptors involved in movement:
Group Ia (Aα) fibers: These are large, myelinated fibers responsible for conveying proprioceptive information from muscle spindles, which are sensory receptors embedded within skeletal muscles. Proprioception is the sense of the body's position and movement in space. Group Ia fibers provide information about muscle length and the rate of change in muscle length, helping to regulate muscle tone and coordinate voluntary movements.
Group Ib (Aα) fibers: Also known as Golgi tendon organs, these are sensory receptors located at the junction between muscles and tendons. Group Ib fibers provide feedback about muscle tension or force, helping to prevent excessive force generation during muscle contraction, which could potentially lead to injury.
Group II (Aβ) fibers: These are medium-sized, myelinated fibers that convey proprioceptive information from muscle spindles and other mechanoreceptors in the joint capsules and ligaments. Group II fibers provide information about joint position, movement, and mechanical stress, contributing to the body's sense of limb position and stability.
These mechanoreceptors and proprioceptors work together to provide the central nervous system with continuous feedback about the body's position, movement, and muscle activity during exercise, allowing for precise control and coordination of movements and contributing to overall performance and safety.
According to the pain gate theory, non-painful stimuli, such as those involved in mechanoreception and proprioception, can inhibit the transmission of pain signals in the spinal cord. Essentially, the activation of mechanoreceptors and proprioceptors can close the "gate" in the spinal cord, reducing the transmission of pain signals to the brain. Stated simply, any movement that doesn’t produce pain, will reduce pain.
Inside-Out
Movement can decrease pain from the inside out through several mechanisms:
1. Physical activity triggers the release of endorphins, which are natural pain-relieving chemicals produced by the body. Endorphins act on the brain's opioid receptors, reducing the perception of pain and promoting feelings of well-being. Movement can increase the release of endorphins and enkephalins through various physiological mechanisms.
Movement, especially exercise, activates regions of the central nervous system, including the hypothalamus and pituitary gland, which play key roles in regulating the release of endorphins and enkephalins. Endorphins and enkephalins are synthesized and released from various brain regions in response to physical activity.
The repetitive muscle contractions involved in exercise stimulate the release of endorphins and enkephalins from muscle fibers. These endogenous opioids act locally to reduce pain and discomfort associated with muscle fatigue and exertion.
Exercise is known to improve mood and reduce feelings of stress and anxiety. Endorphins and enkephalins play a role in mediating these mood-enhancing effects by acting on opioid receptors in the brain. The elevation of endorphins and enkephalins during exercise contributes to the "runner's high" phenomenon, characterized by feelings of euphoria and well-being after prolonged or intense physical activity.
2. Movement increases blood flow to the muscles and joints, delivering oxygen and nutrients while removing waste products. Improved circulation helps reduce inflammation and promotes healing, which can alleviate pain.
3. Engaging in regular exercise strengthens muscles around the joints, providing better support and stability. Stronger muscles can help reduce stress on the joints and decrease pain associated with conditions such as arthritis or muscle strains. Stretching and range of motion exercises can help improve flexibility and joint mobility. Enhanced flexibility reduces stiffness and tension in muscles and joints, which can alleviate pain and discomfort.
4. Engaging in physical activity can distract the brain from focusing on pain signals. Focusing on the movement and the task at hand can shift attention away from the sensation of pain, providing temporary relief.
5. Exercise stimulates the production of neurotransmitters like serotonin and dopamine, which are associated with improved mood and reduced perception of pain. A positive mood can help individuals better cope with pain and discomfort.
6. Regular physical activity helps reduce stress levels by lowering cortisol, a hormone associated with stress. Lower stress levels can indirectly alleviate pain, as stress often exacerbates pain perception.
7. Pain free movement “re-wires” the brain:
The phrase "neurons that fire together wire together" refers to the concept of synaptic plasticity, which is the ability of the connections between neurons (synapses) to change in strength over time in response to activity. This concept has significant implications for the pain experience, particularly in the context of chronic pain and central sensitization.
When pain signals are repeatedly sent to the brain due to ongoing tissue damage or dysfunction (as in chronic pain conditions), the neurons involved in transmitting these signals can become hypersensitive and more easily activated. This increased activity can lead to a strengthening of the connections between neurons involved in processing pain signals.
Over time, the repeated firing of pain-related neurons can lead to the formation of persistent neural circuits or "pain pathways" in the brain and spinal cord. These circuits can become hyperactive and contribute to the amplification and persistence of pain perception, even in the absence of ongoing tissue damage.
The strengthening of connections between neurons involved in pain processing can result in a phenomenon known as central sensitization. In central sensitization, the central nervous system becomes hypersensitive to pain signals, amplifying the perception of pain and leading to heightened pain sensitivity.
Regular pain-free movement can help normalize neural activity in the central nervous system (CNS), particularly in areas associated with pain processing, such as the spinal cord and brain. This normalization can help reduce hypersensitivity to pain signals.
By engaging in regular movement, individuals can strengthen neural pathways associated with pain-free activities, reverse the maladaptive plasticity by promoting the rewiring of neural circuits, which can help counteract the effects of central sensitization.
It's important to note that the type and intensity of movement may vary depending on the individual's condition and the underlying cause of pain. It's advisable to consult with a healthcare professional before starting any exercise program, especially if you have chronic pain or a medical condition.
Pain Catastrophizing
Pain catastrophizing is a term used in psychology and healthcare to describe an exaggerated negative response to actual or anticipated pain. It involves magnifying the threat value of pain stimuli and feeling helpless to cope with it. Individuals who catastrophize about pain often ruminate excessively about the pain, feel intense distress, and have difficulty shifting their focus away from it. This can lead to increased pain perception, greater disability, and reduced quality of life.
Graded exposure to movement is a therapeutic approach that involves gradually and systematically exposing individuals to physical activities or exercises that they fear or avoid due to concerns about pain or injury.
By gradually exposing individuals to activities or movements that they fear will exacerbate their pain, graded exposure helps desensitize them to those feared stimuli. Over time, this can reduce the perception of threat associated with physical activity. Successive exposure to gradually increasing levels of activity can help individuals build confidence in their ability to engage in physical exercise without experiencing catastrophic outcomes such as severe pain or injury. This process helps to challenge and modify negative beliefs about physical activity.
Engaging in graded exposure exercises can shift the individual's focus away from their pain and onto the specific tasks or movements they are performing. This shift in attention can help disrupt the cycle of rumination and catastrophizing associated with pain.
Graded exposure involves careful pacing of activities based on the individual's abilities and tolerance levels. Learning to self-regulate activity levels and pace oneself effectively can empower individuals to manage their pain more effectively and reduce the sense of helplessness, improve mood, increase physical function, and promote overall well-being, which can contribute to reduced pain catastrophizing.
Fear Avoidance
Fear avoidance in relation to pain refers to a behavioral response in which individuals experiencing pain or discomfort avoid certain movements, activities, or situations due to fear of exacerbating their pain or causing injury.
When individuals fear that certain movements or activities will worsen their pain, they may avoid those activities altogether. This avoidance behavior can range from simple tasks like bending or lifting to more complex activities like exercise or social interactions.
Avoidance behaviors can lead to physical deconditioning, reduced flexibility, and muscle weakness, which can further exacerbate pain and dysfunction. This can contribute to a cycle of disability and functional impairment. As individuals avoid activities they perceive as painful or risky, they become more deconditioned and less able to perform everyday tasks. This can lead to increased dependence on others, decreased participation in meaningful activities, and a decline in overall quality of life.
Pain-free movement plays a crucial role in decreasing fear avoidance.
When individuals engage in pain-free movement, they experience firsthand that certain activities or movements do not necessarily lead to pain or exacerbate their existing pain. This reinforces the perception of safety and reduces the fear associated with those movements. Over time, repeated experiences of pain-free movement can help individuals build confidence in their ability to move without fear of injury or worsening pain.
Through carefully guided and progressively challenging movements, individuals learn to confront their fear of pain in a controlled and safe environment. This exposure helps desensitize them to feared movements and reduces avoidance behaviors over time.
Engaging in pain-free movement facilitates functional restoration by improving mobility, flexibility, strength, and overall physical function. As individuals regain confidence in their ability to move without pain, they are more likely to resume activities of daily living, work-related tasks, recreational activities, and social engagements. This increased participation in meaningful activities enhances quality of life and reduces the impact of pain on daily functioning.
Overall, pain-free movement serves as a powerful therapeutic tool in decreasing fear avoidance and pain catastrophizing by providing opportunities for positive experiences, challenging maladaptive beliefs, facilitating behavioral exposure, restoring function, and enhancing self-efficacy. Integrating pain-free movement into pain management strategies can help individuals break free from the cycle of fear, avoidance, and disability, ultimately improving their quality of life and well-being.
Get a Diagnosis
Getting a diagnosis for your pain is crucial for several reasons. Pain is often a symptom of an underlying issue. A proper diagnosis helps pinpoint the root cause of your pain, whether it's an injury, inflammation, infection, or a chronic condition like arthritis or fibromyalgia. Treating the underlying cause is essential for effective pain management and overall health.
Different types of pain require different treatment approaches. Once you have a diagnosis, your healthcare provider can develop a personalized treatment plan tailored to your specific condition. This might include medications, physical therapy, lifestyle changes, or other interventions aimed at relieving your pain and improving your quality of life.
Ignoring or neglecting pain can lead to complications over time. For example, untreated musculoskeletal pain can result in decreased mobility, muscle weakness, and even long-term disability. By addressing the underlying cause of your pain early on, you can help prevent these complications from occurring.
Knowing the cause of your pain can help manage your expectations regarding recovery and prognosis. Some conditions may require long-term management, while others may be more easily treated or resolved. Understanding what to expect can alleviate anxiety and help you better cope with your pain.
Chronic pain can have a significant impact on your physical, emotional, and social well-being. Without a proper diagnosis, you may endure unnecessary suffering or resort to ineffective self-management strategies. Seeking a diagnosis allows you to access appropriate care and support, potentially reducing your pain and improving your overall quality of life.
Overall, obtaining a diagnosis for your pain is the first step toward effective management and improved well-being. It empowers you to make informed decisions about your health and enables healthcare providers to offer targeted interventions that address the underlying cause of your pain.
How much should I move?
As much as you can, without increasing your pain.
Pain is a highly subjective experience, and what works for one person may not work for another. Tailoring movement and physical activity allows respect for each individual's pain thresholds and limitations. By avoiding activities that exacerbate pain and focusing on those that are tolerable, individuals can engage in physical activity safely and effectively.
Different types of exercise and movement can have varying effects on pain management and overall health. For example, someone with joint pain may benefit from low-impact exercises like swimming or cycling, while someone with back pain may find relief through core-strengthening exercises.
Tailor activity to your preferences, abilities, and pain levels. When people enjoy the activities they're doing and feel comfortable doing them, they're more likely to stick with them long-term, leading to better outcomes.
If you would like more information, feel free to call (304-840-2820) or stop by the office. No appointments are necessary, and consultations are free. You can also email me at DocLeviChiropractic@yahoo.com.
Yours in Health,
Dr. Levi G. Merritt, D.C., CPT, CHC
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