Pain can be quite a pain – pun intended – but it serves a crucial purpose. Pain is our body’s alarm system, alerting us to potential harm and prompting us to change our behaviour to protect ourselves. Without pain, we might not have the motivation to avoid dangerous situations, or address injuries.
However, it’s essential to recognise that pain does not always equate to actual tissue damage. Let’s explore the complex interplay of biomechanics and biochemistry that influences our experience of pain.
The mechanics of pain: Nociception
When you injure yourself, like stepping on a nail, your body activates a danger detection system called nociception, pronounced “noh-sih-SEP-shuhn”. This process begins when specialised nerve endings in the affected area send signals through your peripheral nerves to the spinal cord and up to the brain.
In the brain, these signals are evaluated against a backdrop of various factors: the severity of the potential tissue damage, your past experiences with pain, and even your beliefs about what pain means. This multifaceted processing helps the brain determine whether the incoming signal warrants a pain response.
If the brain decides that the danger signal is significant enough, it triggers a pain response, sending signals back down the spinal cord to the affected area. This response is designed to elicit a specific action, like pulling your foot away from the sharp object, thereby preventing further injury.
Pain and tissue damage
Consider a common scenario: spraining your ankle. When you twist it awkwardly, the ligaments can become torn, leading to tissue damage and pain. Your body immediately activates a protective response. As part of this response, inflammatory mediators are released at the injury site. These chemicals, such as prostaglandins and histamines, play a pivotal role in initiating healing. They increase blood flow to the area, bring in immune cells, and promote tissue repair, but they also contribute to the sensation of pain and swelling.
This inflammatory response is a critical part of the healing process. It helps to offload stress from the injured area, causing you to limp or avoid putting weight on your ankle. This altered movement is your body’s way of preventing further damage while healing occurs.
Context matters: The role of the brain
The brain’s evaluation of pain is highly contextual. Imagine you’re being chased by a predator and accidentally step on a nail. In this life-threatening scenario, your brain might decide that feeling pain in your toe is less important than your immediate survival. As a result, the pain signal may be dulled or entirely ignored. This ability to prioritise certain signals over others highlights the brain’s role in how we perceive pain.
Even in everyday situations, the context can significantly affect how we experience pain. For example, if you’re stressed, sleep-deprived, or anxious about an upcoming meeting, a minor ache in your shoulder might feel much worse than it normally would. When your body is already on high alert, the danger detection system can become hyperactive, amplifying the perception of pain.
The biochemical landscape of pain
At a biochemical level, pain is influenced by various neurotransmitters and hormones. When tissue is injured, chemicals like substance P and glutamate are released, which enhance pain signals. Stress hormones like cortisol can also play a role, heightening sensitivity to pain.
Interestingly, actual tissue damage, like a torn muscle, can indeed cause pain, but many people go about their lives unaware of minor injuries. It’s often the combination of physical injury with psychological factors like stress or poor sleep that brings these underlying issues to the forefront of our awareness.
Below is an example of where biochemical factors were prevalent as the cause of pain as opposed to an injury:
Case study: Hannah
Hannah* presented to us with a 4-month history of low back pain, accompanied by intermittent pins and needles radiating into the leg. There was no specific mechanism of injury. She had come to us after an MRI, which showed no structural changes. She worked full-time in retail, spending long hours on her feet, and in her spare time, she enjoyed bouldering and going to the gym most days. Her symptoms would progressively worsen towards the end of her work day and additionally her workweek, with rest being the most relieving factor.
Upon orthopaedic testing, nothing concerning was identified; she was mobile, had a good range of motion and there were no consistent movement patterns that appeared painful. Nutrition-wise, she was consuming only 600 mL of water per day and eating just two meals and a snack. Her lifestyle was highly stressful, with a toxic work culture, and she was getting only 6 hours of sleep per night. Additionally, she was undereating for her activity levels.
The pattern of her symptoms correlated with her activity: the more she did, the more her symptoms were amplified. Conversely, as she was able to rest more, increase her food intake, and improve her hydration, we saw a gradual improvement in her symptoms throughout the week. We started by introducing small behavioural changes to support better recovery, which led to a noticeable reduction in her symptoms over time.
For this patient, the primary cause of her symptoms appeared to be an overall decreased ability to cope with the physical demands placed on her body throughout the week, emphasising the idea that pain does not always originate from a physical injury.
*Hannah is a real patient but we’ve changed her name to protect her privacy.
Pain as a complex experience
Pain is not merely a direct response to tissue damage; it’s a complex experience shaped by biomechanics and biochemistry, influenced by psychological and contextual factors. Understanding this complexity can help you better manage pain and respond to your body’s signals in a more informed way. By recognising that pain is a protective mechanism rather than just a sign of damage, you can approach your health and well-being with greater insight and care.
At MOSIC, we ensure that we gather a comprehensive understanding of the complete picture of health with all our clients, and consider all elements that may be contributing to their pain. This understanding allows for specificity in our management towards resolution. If there are nutritional or other areas that need to be addressed, we have a network of passionate health practitioners, including Melbourne Functional Medicine. We collaborate with them to help facilitate this process, ensuring we achieve resolution and address the root cause of your complaint.
For more information on how we can help please visit: https://www.melbourneosteopathycentre.com.au/
If you’re an existing patient of Melbourne Functional Medicine and wish to be referred from your practitioner to MOSIC, please get in touch with your health coach or practitioner.
