Pain Is in the Brain—Not in the Tissues
September 25, 2024Who Has Persistent Pain?
September 25, 2024This is part two in my series of blog posts on pain. If you didn’t get a chance then read the first post here.
You have a really good alarm system
To recap—pain is produced by the brain in response to a perceived threat. This means that not ALL tissue damage causes pain and not ALL pain is caused by tissue injury. That being said, your alarm system is a really complex one and it mostly gets it right.
Acute pain
When you have an injury, you feel pain because your brain wants you to. Think about the last time you had a cut. Maybe you bled. At the time it probably hurt. If it didn’t hurt immediately, then it definitely hurt as the tissue healed. In fact, sometimes it hurts worse as the tissue is healing! As you saw the tissue healing and you felt less pain, you probably moved more without even thinking about the injury. Tissue healing follows a predictable pattern. Usually within a week or 2 you are back to normal and not even thinking about the injury. This is the definition of normal tissue healing and acute pain. Acute pain doesn’t last too long.
Tissue healing is predictable
Not all tissue heals as quick as a cut. In fact it can take up to 6 months for some tissue to heal. And depending on the type of tissue healing it can take a while for the pain to go away. If you have ever broken a bone then you know what I am talking about. It takes a lot longer for bones to heal so the pain doesn’t go away as quickly. But during the time of the healing the pain SHOULD change. It won’t always be the same. This is because the tissue is changing.
Chronic pain
So some of you might now be asking the question—if my tissue healing is predictable, and most tissue heals within 6 months then what is causing my pain? Chronic pain is NOT the same as ACUTE pain. In fact many of you had an acute injury that started off your pain. AND maybe your pain feels the same as when you first got injured. Maybe your pain feels worse. Here is the thing—this doesn’t make sense from a ‘tissue injury’ stand point. In fact, your pain should have gone away as your tissue healed. AND unless you have a compromised immune system (aka you are REALLY sick and you do not heal well in general) it is safe to say your tissues have healed. So NOW you are dealing with chronic pain!
Let’s compare acute and chronic pain shall we?
I made up a little chart to help you out with this.
| ACUTE PAIN | CHRONIC PAIN | |
| Tissue involvement? | Usually yes | No, or even if there is tissue injury seen on a scan it still doesn’t explain your pain according to your doctors |
| Length of time pain is around | Less than 6 months | 6 months or longer |
| Pain behavior | Gets better and changes over time | Stays the same, gets worse, has flare-ups sometimes that are not due to any obvious cause |
| Limits function? | Yes, but only for a short time | There are more and more activities that you are moving away from over time |
| Inflammation? | Yes for healing purposes | Sometimes but there are different cells and they aren’t there to heal tissue, because there usually isn’t tissue to heal |
| Pain medication | Anti-inflammatories as well as other meds as prescribed by your MD to address acute pain | Nerve medications, anti-depressants for chronic pain, other medications as prescribed to address chronic pain—usually anti-inflammatories don’t work |
| Treatment | Rest and let tissues heal but when appropriate start moving again to also help tissues to heal and remodel properly | Keep moving and work through fear with movement |
So now what?
As you understand the differences between chronic and acute pain, you begin to see that chronic pain needs a different type of treatment. Understanding your diagnosis is VERY important in treating it properly. Education is one of the MOST important things you can do to help treat your pain. As well as cardiovascular exercise, meditation, breathing, and movement without fear or guarding. It is easy to say these things but not always easy to do these things—especially if pain has kept you from moving for a long time. We will continue to address this in future blog posts.