By Susie Reiner, PhD, CSCS, EP-C
At least two in five Americans live with some kind of chronic pain, according to a 2019 report by the National Center for Health Statistics. Pain is a sophisticated and complex chain of reactions that serves one specific purpose: to protect you.
Whether it’s a sharp pain after an ankle sprain or the unrelenting dull ache of low back pain, it is an innate defense mechanism created by your nervous system to stop you from continuing the activity that caused you harm.
Despite being a natural and healthy reaction, pain can often interrupt your everyday life. Here’s a breakdown of pain science and practical strategies to keep doing the activities you love pain-free.
The Science Behind Pain
When you experience an injury, your body automatically responds by stimulating pain receptors called nociceptors. These nociceptors release chemicals that allow the message to travel through your neurons to your spinal cord and, ultimately, your brain. It is interpreted as pain or discomfort and immediately creates a biological and psychological cascade of reactions to stop the action and begin the healing process.
While there is still much to understand about pain, the theories linking physical injury and emotional pain are nothing new. Dating back to 360 BC, Plato defined pain as an emotion as a result of the intensity of a stimulus. In 1644, Descartes described the brain, or the “soul,” in his words, as the moderator of pain.
Modern pain science takes a multi-disciplinary approach, proposing that the way your brain interprets pain is unique to each individual based on prior experiences, genetics, and mental health. Complex interactions between biological, psychological, and sociological factors can all affect your physical and mental well-being, changing how you experience pain.
Different Types of Pain
You can break down pain into three major types based on your symptoms and possible underlying conditions:
- Nociceptive pain: These pain receptors are most active in acute injuries. Comprised of specialized nerves located within skin, muscles, joints, bones, and major internal organs, they can detect potentially harmful movements, heat or cold, and chemicals.
- Neuropathic pain: Commonly a result of a nerve injury or impairment, chronic or episodic neuropathic pain isn’t connected to the body’s defense system but is more likely linked to trauma (like a car accident), metabolic conditions, or neurological diseases.
- Inflammatory pain: When faced with a harmful stimulus, the body produces an immediate inflammatory response characterized by increased blood flow and immune cells to the injured area, along with a pain response to reduce further movement. Arthritis is a common form of inflammatory joint pain.
An easy way to assess what type of pain you’re experiencing is to consider the timing. Acute pain usually starts suddenly and reacts to a specific event like an injury or surgery. While it might be uncomfortable for a short period, acute pain typically subsides as the tissue heals. If pain persists beyond three months, it is considered chronic pain. There are various causes of chronic pain, including disease, medical treatment, chronic inflammation, or even an unknown reason–where your nociceptors continue to fire after the tissue has already healed.
Regardless of the type of pain you’re experiencing, there are solutions to reduce your pain and make daily tasks easier.
Effective Strategies for Pain Management
The first line of defense in treating pain from an acute soft tissue injury is to promote healing through early protected movement, elevation and compression. In conjunction with your healthcare provider's recommendations, the PEACE and LOVE method of rehabilitation speeds up your recovery time, reducing the time you are in pain.
Chronic pain, however, may require a multi-disciplinary approach to treatment. Research shows physical activity, such as cardiovascular exercise and muscle strengthening, can significantly improve chronic pain, physical and cognitive function, sleep, and chronic disease risk.
Mental health may play an important role, with one review finding 75 percent of patients with depression showed exclusively one symptom–some kind of chronic pain. A study with fibromyalgia patients found that tailored cognitive behavioral therapy combined with an exercise program significantly improved short- and long-term experience of pain symptoms. Chronic pain and stress can also go hand-in-hand with how your brain perceives these signals. Effectively coping with stress in your everyday life through physical activity, mindfulness and meditation, spending time outdoors, or connecting with others, offers a distraction from discomfort and can physiologically improve chronic pain symptoms.
The good news is you’ve already taken the first step in managing pain–understanding it. Studies show that education helps shift your conceptualization of pain from a marker of tissue damage to an indication of your body’s perceived need to protect itself. Increasing your knowledge of the science underpinning pain can help motivate you to adjust your everyday behaviors. In turn, research shows these minor tweaks of behavior change can help decrease your sensations of pain, disability, and movement restrictions in the long run.
The bottom line: Pain is a complex and highly individual experience. Pain resulting from acute injuries will usually subside throughout your rehabilitation. Work with your healthcare provider in a chronic pain management plan that addresses physical and mental health and education.