What is Pain?
Pain is rather innocuous. We all know it. We all have it at some point. But how many of us truly know what pain is? And further, why do we have it?
Pain gets a bad rap. Most people are quick to assume it is there to make life harder. It is actually there to protect us. Imagine this - you are on the beach, walking barefoot, when you step on a sharp shell. It’s sharp and big enough to cut through the skin and start bleeding. But now imagine what will happen if you ignore your foot after you step on that shell. You keep walking. You put on your Crocs and continue about your day. Maybe you even go to bed that night and the shell just stays there. We all know what is going to happen: it will get infected and turn into a much bigger ordeal than if you had just cleaned the cut in the first place. This is why we have pain. Pain is the body’s way of saying, “Hey, deal with this, this part of your body needs attention”. Pain prevents us from developing said infection. Pain motivates us to seek help when something is wrong.
So if the pain is protection, you may think, then why do I still have pain when doctors say “There is nothing wrong?” This is where pain becomes a little more complicated.
A Brief Anatomy Lesson (bare with me as I nerd out):
Pain is an output of the brain. There are NO receptors in the body that “detect” pain. The ‘nociceptors’ that get talked about as the “pain receptors” do not detect pain. Those receptors detect various physical body sensations: hot, cold, pressure, and vibration. Those cells (they have more specific names like Pacinian Corpuscle as an example) then send a message of pressure (as an example) up the spinal cord and to the brain where the brain decides what to make of it.
Let’s go back to the sea shell example.
You are walking along the beach and you step on a sharp sea shell, causing your foot to start bleeding. You might feel something sharp and some pressure on the bottom of your foot. Pause: this is ALL the receptors do. At this point, that information is sent to your brain and your brain decides what to do next.
In the next nanosecond, your brain visually processes the environment, listens for cues around you, and reviews previous memories of these sensations. Your brain sees other seashells around you and that you are on a beach, hears your friend ask you, “Did you step on a seashell?”, and reviews the other times you have stepped on a small sharp object (i.e. legos). This is all subconscious, all extremely fast - it is so fast it feels immediate.
Your brain pieces together all this information and determines, you have indeed stepped on a seashell. Then something really important happens.
Your brain determines the level of threat this seashell is.
Now, this may sound silly considering the levity of our example, but stay with me.
Your brain’s primary purpose in life is to keep you alive. Everything it does or does not do is an attempt to maintain homeostasis. Your brain takes all the information it previously processed and hypothesizes the level of danger to your survival caused by the situation. Essentially: Does the seashell threaten your life?
Now, unless you have had a terrible experience regarding seashells, the answer is usually no. Therefore, the brain tells the body to stay calm and agrees that it is not pleasant and may hurt a little (3/10 pain) but your brain has decided the shell is not going to kill you. You decide to look at your foot, remove the seashell, clean the wound, and put a bandage on it. And now, you go on with your day to enjoy the beach.
The decision your brain makes about the level of threat is crucial to your experience of pain.
Now imagine, that instead of a seashell, our rather innocent friend, the situation is you mildly rolled your ankle off of a curb. You have a history of ankle injuries and currently are experiencing a lot of stress in your life related to finances, the political climate, and relational strain. You roll your ankle and feel a mild pull of the ligaments and mild heat from the inflammation. Your receptors send that information to your brain where again, your brain processes all the information about the situation, the previous memories of your ankle injuries, and your overall stress level. Based on those factors, your brain hypothesizes the level of danger to your survival. Unlike with the sea shell, where you were relaxed and have no major previous memories, now your brain sees you are stressed, you have a story about your ankle and the body sensations (pull and heat). Now the brain rings the alarm bells, there is a large threat to your survival and your pain experience is more intense and likely lasts longer.
This is the crux of pain: When the brain perceives the combination of an unpleasant story/memories related to the body, heightened emotion/stress, and body sensations, the brain determines there is a threat and therefore, triggers a pain experience.
Put more simply:
Body Sensation + Unpleasant Memory + Heightened Stress → Threat → Pain Experience
I know there is a lot to unpack. Pain neuroscience is a lot. This takes time, be gentle and patient with yourself.
What do we do about it?
The beauty of understanding pain is that we can start to work with it. Notice I said, the brain hypothesizes the threat? That is because the brain constantly makes predictions that may or may not be correct. We can challenge the brain and help it change its predictions, thus, changing the pain experience.
We can look at each part of the “formula” and change one aspect of it. If one aspect changes, the pain experience will change. There are a myriad of ways we can change each part of the formula.
Changing the Body Sensations:
In the ankle example, heat and pull were the primary body sensations. We can put ice on the ankle to change the heat sensation and reduce inflammation. In the seashell example, sharpness and pressure were the primary body sensations. We can remove the seashell to reduce the pressure and massage the foot to dull the sharpness.
There are so many different body sensations. The process of changing them takes creativity, curiosity, and openness. A lot of people struggle to even identify the type of body sensation. Looking at a list of body sensations can help you identify what it is you are feeling at a certain moment.
I recommend this resource compiled by traumainformednvc.com to help identify your body sensations and then find the opposite of the sensation. Body Sensations PDF
[As an aside, a lot of creams, ointments, heat/ice, massage, etc., work on this level as well. In addition to reducing inflammation or relaxing muscles, they also provide a different body sensation that your brain registers as positive and then reduces the pain experience.]
Changing the Heightened Stress or Emotional Response:
Yeah - I know. This is the million-dollar question: how do we manage our stress in our current world? If it were easy, we would already be doing it, right?
This is a much bigger topic than can be addressed here but there are ways to help manage stress. Emily and Amelia Nagoski talk about many different techniques brilliantly in their book Burnout. Some suggestions they have and others I have tried myself include:
Hugging someone/being hugged by someone
Spending time with animals
Getting your heart rate up with movement, whether that is running, swimming, kayaking, yoga, Zumba, or running up and down your stairs a few times. It does not have to be “going to the gym” if that is not your thing.
Screaming into a pillow or in your car
Self-Compassion Guided Meditations (Kristin Neff)
Crafting or making art
Writing or journaling
Having someone hold non-judgemental space for you to listen
Crying
Breathing techniques, like box breathing, diaphragmatic breathing, or yoga breathing
This takes trial and error. Be patient with yourself. There is no way to fail, there is only data to be collected.
Changing the Unpleasant Story or Memory:
I’m not going to lie - this is probably the hardest of the three to challenge, especially the longer and more complex the story is. To make real progress with processing unpleasant memories, one would benefit from working with a psychotherapist.
From my own work re-processing unpleasant memories, I have found challenging my negative thoughts with logic or reality-checking can help disrupt the story. For instance, let’s say I did have a terrible experience with seashells. When I stepped on the seashell, I’m sure my pain experience would be more intense than someone without that experience. I may start catastrophizing, “Oh my god, what if my leg needs to be amputated? Or what if I get sepsis and die?” It may sound silly but this is what brains do. I can challenge those thoughts with a reality check, saying “It is highly unlikely any of those things will occur. What is happening is I just cut my foot. As of now, there is no evidence of needing an amputation and if it becomes infected, I will go to the doctor before it becomes septic”. Consciously choosing more helpful thoughts about the story can help lessen the brain’s sense of threat.
One game I like to play with myself is “trying it on”. I take a situation, like the seashell, and say to myself, “This is the worst thing that has ever happened, it is such a terrible experience, it will definitely kill me”, etc. I see how my foot feels (even writing that my foot felt achy). Then I say to myself, “Oh, this is nothing, it will heal easily and go away without issue” and see how it feels (usually it feels better). The point of trying it on is to see a new thought before fully committing to it: See how it feels, if it fits well, maybe you need a different color, or maybe it’s just not for you. That’s the beauty of the game.
To Summarize:
Understanding pain is a process and a journey. As soon as I think I understand it, something happens and makes me rethink the whole thing. Flow with the journey - it is much easier than fighting against it.
A lot of this information is best understood and applied by working with a professional who understands it. That professional can be a psychotherapist, physical therapist, or health coach. I would recommend confirming they understand pain neuroscience - a lot of health professionals do not understand it yet.
I would be happy to chat with you in a free 15-minute introductory call to see if I would be a good fit to help you navigate your journey. Please visit my page to schedule a time. I look forward to meeting you!
Further Readings/Resources:
