The Unique Experience of Pain

27/04/2023

Hello reader. Let’s start with a simple question… have you ever had a physiotherapy appointment? If so, I’m guessing there’s a good chance it was due to pain. Of course, it could also have been a tightness, an ache, a stiffness, a soreness or some other unpleasant feeling that’s affected you. “An unpleasant sensory and emotional experience…” is how pain is defined internationally. This means that an unpleasant tight, stiff, sore or other feeling technically falls under the umbrella term of “pain”. However, we know that the description you use for the experience of your symptom(s) is all that matters. Therefore, the title of this blog might be more apt as “Your Unique Experience of Symptom(s)”. A bit too clunky perhaps.

The symptom(s) people experience can be straightforward. “I have an ache in my lower calf after I run”. Or they can be more complex and even uncertain, “Sometimes it’s sharp there, other times it’s hot in the same place and sharp somewhere else”. Trust the language that you use to describe your symptom(s). It is your experience and you are the expert. A similar situation of uncertainty can arise when we ask a person to rate the severity of their problem. For some it is easy, while others may need more time. We understand that not only should you trust what you know about your symptom(s), you should also feel comfortable exploring your situation at your own pace. That is a boundary that we try to find together. 

In understanding the reasons for pain it is common to focus on the tissues that may be damaged or not working effectively. This of course is vital. However, the experience of pain has been shown in extensive research to be influenced by a multitude of factors. Sleep quality and duration, emotional wellbeing, the immune system, stress, activity levels, diet, general health and the list goes on. For quite a while. The important point here is to recognise that sometimes helping the ligament to heal or the muscle to work more effectively is not enough to fully resolve symptom(s). If it is, that’s great. If it’s not enough then it’s always worthwhile exploring what other factors maybe having an impact on your unique experience of pain. Unfortunately, for some people this may require a longer journey to make sense of it. 

One factor that seems to play a role in developing pain that persists is how we learn in an associative manner. The example I would commonly give to explain this is the Pavlov’s dogs experiment. The experiment involved ringing a bell and then giving the dogs food. After repeating this a few times, the bell could be rung without giving the dogs food and they would still salivate. Their bodies had learned to expect food on hearing the bell. The experience of pain can work in a similar manner for people. The ringing of the bell may be very obvious, such as repeating the movement that was related to the onset of pain. Or it could be more subtle, such as stress levels in the lead up to the first episode of pain. It may also be multiple ringing bells of various sizes and strengths. This can be part of the journey to understanding your unique experience of pain. 

Till the next blog, stay active and stay well!

Lonan Hughes

Chartered Physiotherapist