What is pain?


Pain is one of those things that is incredibly difficult to describe but you know it when you feel it.  In the same way that the Inuit people have multiple different words for snow, we have many ways of describing pain – stabbing, shooting, aching and so on. We talk about pain thresholds and notice that people seem to experience pain differently – I’m sure we all know people who react in a far more extreme way to cuts and stings and those who hardly seem to notice them. Then we hear stories of people in emergencies managing to do all sorts of things with significant injuries while feeling no pain at all. So what is pain and why is it so complex and unpredictable?

Putting it simply, pain is an output of the brain in response to certain inputs. The inputs are generally:

  • sensory – for example the impact of something hitting us, the heat of a burn, a scratch when we are cut or a “twang” or “snap” when we sprain our ankle or pull a muscle

  • logical/contextual – “what happened?”, “has this happened before?”, “was it serious?”, “can I still walk?” and so on; or

  • emotional – for example stress levels or self protection mechanisms such as those that mask the pain sensation in a life threatening situation.

The brain processes all those inputs, looking at the whole picture, and creates outputs such as a perception of pain, reflex actions or a stress response.

This means there is a lot more to pain than simply the physical state of your body.  Our logical mind and memory put context to our sensations and this will influence the amount of pain we feel (rightly or wrongly!)

As Lorimer Moseley, one of the world’s leading pain scientists, explains in his “Why things hurt” TEDx talk, his experience of pain when getting scratched by plants or bitten by a snake when out walking depended more on his perception of which had happened than on the reality. I’d highly recommend watching this.

So, while the state of the tissues is one input and our logical mind gives our sensations context, these are not the whole story. Other factors, such as our emotions, tiredness and stress levels can turn up the volume on our pain experience, particularly when the pain becomes chronic or persistent.

In order to reduce our pain experience we need to look at all the factors and address each of them.

Take a look at the cup in the picture – all of those words in the cup are factors in the amount of pain we feel, our “pain contributors” – physical, psychological and emotional. When the combination of those stressors gets too great, the cup overflows and we experience pain.

When this happens we can either:

  • Reduce the contents of our cup (our pain contributors) through lifestyle changes, relaxation techniques, dietary changes and other techniques such as hypnotherapy or CBT; or
  • Increase the size of the cup by building our strength, resilience and tolerance to those stressors or to a particular activity that causes us pain

So whilst, in many situations, there is no specific “fix” for pain you may find that tweaking lots of little things can make a real difference.