Pain is an unpleasant sensation that we usually associate with injury or tissue damage, but can actually be present in the absence of tissue damage. Pain can be acute or chronic.
Acute pain lasts for a short time – up to 12 weeks. It is a warning that tissue damage has occurred or may occur, or to help us prevent injury or disease. For instance, if we touch a hot stove, the body sends a danger message to the brain that there is a threat to tissues in order to prevent further injury. A sore foot can signal a need to change your footwear. In some cases, the danger messages may be due to some disease process, and your brain may interpret those messages as pain. This can cause you to seek medical attention – diagnosis and treatment – for what may be a serious condition. Signaling pain in this manner is the body’s way of protecting us and is a good thing.
Chronic pain is any discomfort or unpleasant sensation that lasts for more than 3 months – or beyond an expected normal healing time. Often, those who have chronic pain believe they have an ongoing disease or that their body has not healed, when this may not be the case. Chronic pain is likely not warning you of possible injury or danger; instead, the pain centers in the brain may be causing you to hurt even though there are no new causes of pain occurring in the body. Anyone can develop chronic pain, at any age. The brain changes in chronic pain: When you are injured or develop a painful disease, nerves send information from the problem area to the brain. The brain analyzes this information to determine if there is a threat to the body and whether action needs to be taken to prevent harm.
When pain is constant or chronic, the brain and nervous system go on “high alert,” becoming more sensitive.
Cells that conduct sensation in the nervous system can also become more sensitive when on high alert, making it easier for the brain to interpret these sensations as a threat and thus cause you to have more pain. These changes in the brain and central nervous system induce and maintain chronic pain symptoms.
When pain is chronic: Pain sensations are activated in the brain. The brain continues to interpret all sensations from the problem areas as danger, even when there is no more tissue damage occurring. This makes it easier for the pain centers in the brain to activate. Pain messages come from many different areas of the brain – areas that may control fight or fear reactions, movement, emotions, problem-solving, and learning. In fact, almost any system of the body can be affected by chronic pain.
The brain and nervous system continue reacting by causing you to continue to be in pain. This process increases sensations, emotions, or thoughts about the problem area. At this point, any sensory input can activate the pain centers. Even thinking about it, or reading the word pain can trigger pain sensations. The pain is in the brain: In order to protect you, the brain is making the decision to increase the alert level for sensations you feel.
The American Physical Therapy Association launched a national campaign to raise awareness about the risks of opioids and the safe alternative of physical therapy for long-term pain management. For more information go to moveforwardpt.com, or call North Country Hospital Rehabilitation Services at 334-3260
Katesel Strimbeck PT, MS is the Director of Rehabilitation Services at North Country Hospital. Katesel has been a practicing PT for 20 years. She is a member of the American Physical Therapy Association (APTA).