Pain does not necessarily mean that there is an injury. It is possible to feel severe pain without any visible injury. Conversely, other people may have serious injuries and feel no pain at all. All of this is unique to each individual and influenced by many factors: past experiences, beliefs, culture, social and professional environment, current mood, stress levels, sleep patterns, etc. All of these factors can act alone or in combination to induce pain. Pain is not in your head, even though your brain plays a major role in triggering it! [1]
The alarm system
Pain is not just a symptom; it is above all a very important alarm system for our survival. To put it simply, we can easily compare it to a smoke detector. When a little cigarette smoke is released, the detector does not go off, but if the smoke thickens significantly and a fire breaks out, the alarm is triggered. And just like a call to the fire department to put out the fire, our sensors located in the painful area (called nociceptors) activate and send the information to our brain via cables (the nerves). The brain then regulates this information based on various factors (context, emotion, experience, etc.) to decide how to respond: whether to trigger the pain response (the alarm) or not. Nociception is therefore a mechanism that protects the body from pain. [2]
Pain is not in your head!
The brain, an amazing machine
When pain is first felt during a movement, the brain records the link between that movement and the pain. For example, if you hurt yourself by bending forward, the brain may associate this bending movement with pain. It will therefore trigger a fear response and avoidance of this movement to prevent further pain. This is especially true since we know that fear of pain tends to increase the pain we feel. Sometimes this pain persists over time even though it no longer serves a “protective” purpose. There is no longer any fire, but the alarm continues to sound, and so the pain continues. The person initiates the movement and the brain triggers the pain too easily. [5]
But none of this is in your head! Just as an athlete is able to learn new technical movements that may have seemed impossible, we can make our brain realize that some of the limits it imposes on the body through pain are unnecessary!
The alarm system is not always foolproof
When pain becomes chronic, the sensor can be activated at a lower threshold: a simple wisp of cigarette smoke will trigger the alarm. And so something that shouldn't be painful can become painful. In this case, the alarm needs to be reset rather than calling the fire department.
In summary:
- Pain is not a symptom but an alarm system.
- Just because I feel intense pain does not necessarily mean that I have something serious.
- Conversely, significant trauma can be made less painful by the brain through certain behaviors.
- Understanding your pain allows you to adopt the right behaviors.
- And above all... pain is not in your head!
Sources
[1] Sullivan, M. D., Cahana, A., Derbyshire, S., & Loeser, J. D. (2013). What does it mean to call chronic pain a brain disease? The Journal of Pain: Official Journal of the American Pain Society, 14(4), 317‑322. https://www.jpain.org/article/S1526-5900(12)00560-3/fulltext
[2] https://www.cell.com/neuron/fulltext/S0896-6273(15)00518-8?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0896627315005188%3Fshowall%3Dtrue#
[3] Scholz, J., Finnerup, N. B., Attal, N., Aziz, Q., Baron, R., Bennett, M. I., Benoliel, R., Cohen, M., Cruccu, G., Davis, K. D., Evers, S., First, M., Giamberardino, M. A., Hansson, P., Kaasa, S., Korwisi, B., Kosek, E., Lavand’homme, P., Nicholas, M., … Group (NeuPSIG), C. C. of the N. P. S. I. (2019). The IASP classification of chronic pain for ICD-11: chronic neuropathic pain. PAIN, 160(1), 53–59.
https://journals.lww.com/pain/Abstract/2019/01000/The_IASP_classification_of_chronic_pain_for.7.aspx
[4]Treede, R.-D., Rief, W., Barke, A., Aziz, Q., Bennett, M. I., Benoliel, R., Cohen, M., Evers, S., Finnerup, N. B., First, M. B., Giamberardino, M. A., Kaasa, S., Korwisi, B., Kosek, E., Lavand’homme, P., Nicholas, M., Perrot, S., Scholz, J., Schug, S., … Wang, S.-J. (2019). Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). PAIN, 160(1), 19–27. https://journals.lww.com/pain/Abstract/2019/01000/Chronic_pain_as_a_symptom_or_a_disease__the_IASP.3.aspx
[5]http://www.greglehman.ca/blog/2013/06/10/your-cranky-nerves-a-primer-for-patients-to-understand-pain