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Pain Science is the study of pain and its relationship to the brain and the body. The feeling of pain that you experience is the neurological process of the brain receiving information from nociceptors (danger detectors) from the body and coordinating a response. The brain sends this response as a signal back to the body's spinal cord and nerves based on the severity of the injury.1, 2 Essentially, when you are injured, your brain will tell you that you are hurt by causing the sensation of pain. This is one way that we can experience pain in the body. It is the most common alarm system response.
There are also several instances when your brain might not send you these pain signals, even if you are injured. For example, if you are very afraid, your brain might prioritize resolving your fear before it actually processes that you are injured. There are also cases where you may not have any external injuries, but you still feel the sensation of pain. For example, you might feel a "phantom" pain or ache upon looking at a stove that had burned you months prior.2 All of these cases are studied in the field of pain science, and the findings are utilized by health professionals, especially physical therapists.
Understanding the brain's relationship to the physical body is essential when it comes to patient treatment. By studying how the brain works in relation to pain, a health professional can help pinpoint the cause of a patient's pain, as well as formulate an effective treatment plan. It also helps the patient understand the source of their pain and learn how they can take control of their pain.
In the early 17th century, René Descartes published his book Principles of Philosophy, in which he discussed phantom pain.3 He theorized that pain was produced by the brain, not by the phantom limb. Descartes' research prompted a new type of thinking about pain. His contributions to the world of medicine are still evident in Western medical practices today.
It wasn't until the early 1800s that medical texts began to focus on the links between physical and mental aspects of pain. This time also saw the development of medical clinics. Pain research around this time still followed the work of "specificity theory" advanced by researchers Johannes Müller and later Maximilian von Frey.4 This theory saw pain as a separate sensation with its own sensory framework.
During the mid-18th century, debate over whether pain was predetermined by fate was sparked. This subject became especially popular while discussing the role of war, which further prompted progress in the understanding of pain. As a result of lessons taken directly from the battlefield, many new treatment options were introduced in England, France, and the U.S.5
At the start of the 1900s, pain research went two ways. The first was the temporal aspect of pain mechanisms. This research included the connection between physical pain and its connection to mental processes, both on an intellectual and emotional level. The second way followed the introduction of Darwin's theory of evolution to the concept of pain. It introduced the idea of adaptation to surroundings and viewed the nervous system as a defense against aggression.5
In the mid-1900s, American neurologist William K. Livingston became Chairman of the Department of Surgery at the University of Oregon Medical School. His team there decided "as our basic assumption the concept that nothing can properly be called pain unless it is consciously perceived as such."5 He considered pain to be a perception, not just a sensory event. By the 1950s, he began to consider the brain's function in relation to the perception of pain. He noted that the brain will "prioritize" based on the needs of the individual, which could interfere with how and when the body would receive the sensory signals of pain. Livingston wrote in his book Pain and Suffering, in which he described his difficult search for a satisfactory definition of pain. He wrote that any consideration of pain by either physiological or psychological approach alone would be incomplete.5
In terms of newer studies, the treatment of chronic pain wasn't wholeheartedly addressed until around the 1980s. Physical medicine (also known as physiatry) is one of the only specialties that tackle chronic aches and pains head-on, but it is still one of the younger medical specialties.6
Up until about 25 years ago, pain in the musculoskeletal system was primarily thought of being due to tissue-based causes. With advances in pain science, there is a stronger understanding as to why we experience any pain in our body (it is an alarm system response that protects the body) and there is better understanding how to treat pain with lots of research looking at how the brain is part of the whole alarm system response.
In 2012 Keith Smart and his colleagues published a series of articles that started to help PTs figure out a better way of diagnosing what type of pain someone is experiencing. We now are able to figure out if pain is tissue based (nociception), due to nerve irritation and possible injury (peripheral neuropathic) or caused by central nervous system dysfunction (nociplastic pain).
On July 16, 2020 the International Association for the Study of Pain updated their definition of pain (which was from 1979) to the following.
An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage," and is expanded upon by the addition of six key Notes and the etymology of the word pain for further valuable context.
Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors.
https://www.iasp-pain.org/publications/iasp-news/iasp-announces-revised-definition-of-pain/
Pain and nociception are different phenomena. Pain cannot be inferred solely from activity in sensory neurons.
Through their life experiences, individuals learn the concept of pain.
A person's report of an experience as pain should be respected.
Although pain usually serves an adaptive role, it may have adverse effects on function and social and psychological well-being.
Verbal description is only one of several behaviors to express pain; inability to communicate does not negate the possibility that a human or a nonhuman animal experiences pain.
What makes this updated definition so groundbreaking is that after 2 years of research, the association was now acknowledging that all pain in the musculoskeletal system is real but doesn't need to be coming directly from a tissue source.
Pain science education is an important subject for health professionals to teach their patients, especially those suffering with chronic pain. Understanding the source of pain can be a big step towards self-empowerment and effective management of symptoms. When people have a better understanding of how pain works in their bodies, their motivation is improved, and their fear of the unknown is lessened.
Some simple ways to manage chronic pain (and other types of lingering pain) are to exercise daily, sleep for the recommended number of hours for your age group, and set small, attainable goals to build your endurance.7 Physical therapy can help you learn which exercises and goals would be the best for you.
If you would like to learn more about pain science and how it can help you live pain free, schedule an appointment too meet with one of our physical therapists!
