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The 4 Scenarios of Pain and Tissue Damage
“Pain equals damage” is easily one of the biggest pain myths of all. No, pain does NOT equal damage. Let’s take a closer look.
Where pain and tissue damage are concerned, there’re 4 possible scenarios.
Scenario 1: No tissue damage. No pain.
Scenario 2: Tissue damage. Pain
Scenario 3: Tissue damage. NO pain.
Scenario 4: NO tissue damage. Pain.
Scenario 1 is straight forward, that’s when all is well. No damage, no pain. Happy days.
Scenario 2 is also straight forward and we’ve all experienced it to varying degree, it involves an incident you can “blame” for your pain. E.g. You cut yourself, you bleed, it hurts. Or you fall over, twist your ankle, your ankle hurts. Scenario 2 involves an event and the event can be an injury, surgery, childbirth.
That Time I Freaked My Patients Out
Scenario 3 is not uncommon at all, in fact most people have experienced tissue damage without pain. No? How about that mysterious bruise or that cut you had no idea how you got? The bruise and the cut are definitive signs of tissue damage, yet you had no pain!
I once had a mysterious bruise on my arm that was so big my patients became concerned about my safety! It was quite an impressive bruise once I realised it existed. It was about 5cm in diameter situated perfectly on the “grabbing” spot on my arm. I had no idea how I got it! I even went around my house and at work trying to match it up with something I could have bumped into and found nothing. It remains one of the biggest mysteries of my life to this day.
The Little-Known Pain Without Tissue Damage Scenario
Scenario 4 is the least well known yet it is something experienced by 1 in 5 Australian! Pain in the absence of tissue damage is what chronic pain is all about. How is this possible? It is possible because pain is not a representation of the state of your tissue. Rather, pain is a complex biopsychosocial phenomenon with a myriad of contributing factors. The state of your tissue can be one such factors, however, it can not be a factor at all.
Not convinced? Here’s another story for you: I once ordered some posters online and they arrived in a mailing tube. I excitedly went to open it and as I grabbed the lid to prise it open, I felt a super sharp pain on my fingertip and quickly withdrew my hand. Whoever packaged it decided it was a grand idea to staple the lid shut from the inside outwards! The tube got squashed in the courier’s van and the lid was slightly popped so the staples, instead of lying flat, were standing up like a spiked collar waiting for my unsuspecting fingers. The pain was so sharp I was convinced it had punctured through my skin and I fully expected to see blood. There wasn’t any. I had severe pain in that instant yet there was no tissue damage whatsoever. My brain perceived the threat, warned me about it, I withdrew my hand, threat averted, pain gone.
You would have experienced something similar too, such as touching something hot or stepping on something sharp, there was aggressive pain and the pain made you stop. If you haven’t stopped, you probably would have hurt yourself. That’s how pain is supposed to work, as a warning system.
Persistent Pain is a Nervous System Issue, NOT a Tissue Issue
Pain serves a very important function of protecting us from danger, we need it for our survival. However, sometimes pain persists when there is no threat and this is a nervous system sensitivity issue and not a tissue damage issue. In people with chronic pain, the warning system is sensitised, the threshold for danger is lowered, and the alarm goes off when there is no need to. Imagine being stuck with an overprotective body guard who is easily spooked and can only respond to threats the way that’s usually reserved for the ultimate zombie apocalypse? It will be horrible and highly disruptive to your life to say the very least.
You Are Not Stuck with Chronic Pain
Does this mean people with chronic pain are stuck with that forever? No, not at all! It is possible to retrain your body guard, aka your nervous system, to once again read threats correctly and respond appropriately. Overcoming chronic pain requires a multidisciplinary team providing you with medical support, mental health support, and movement health support at a minimum, some may also require nutrition support, sleep support plus more that are unique to their situation. One of the key components in overcoming chronic pain is to practise graded exposure to movement, this is a process where a physiotherapist assesses your individual needs, discusses with you your goals, movement preferences, addresses your movement concerns, prescribes the correct type and dosage of movement, and progresses them with you when you’re ready to help you improve your movement tolerance, recalibrate threat threshold, and to reduce sensitivity to movement.
Overcoming chronic pain is not easy and it will take time and dedication, but with a strong team of experts alongside you it is possible.
’Til next time, Be Free In Your Movement™.
This information is not medical advice. Got health concerns? Consult a real-life health professional.
Views are my own.