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Why Do I Hurt?

Pain is unavoidable, it’s something that we’ve all felt before. It’s actually really important that we do feel pain, it protects us. But sometimes when we have an injury, the pain doesn’t just go away! A recent study found that 50.2 million people reported pain on most days or every day. That means 1 in 5 people are dealing with chronic pain right now! That’s a lot, right?! Let’s take a look at why this is…and most importantly, how to get rid of it!

What pain is supposed to do:

Pain is good! Believe it or not. Pain is our alarm system alerting us to the potential for damage if we don’t take action. For example, if you touch a hot stove…it hurts. That tells you to get your hand away or there will be more damage to your skin. Or if your stomach hurts really bad. That’s your alarm telling you to go to the doctor before more damage happens, like your appendix bursting. So pain is good, it keeps us alive! It’s meant to protect us, and for the most part it does a good job. But sometimes our pain system goes a little haywire. The alarm keeps going off even after the tissue damage has healed, and even starts going off on its own! Let’s take a look at why this happens, and why 20% of the US population struggles with chronic pain!

What pain is NOT supposed to do:

When we strain a muscle or joint, for example, the pain signals from the nerves in that area go into our spinal cord and up to our brain to produce the sensation of pain. When that happens over and over again, chemicals build up around the pain nerves along the whole pathway. This causes them to become more and more sensitive. Which means it takes less and less of a stimulus from that muscle or joint to set off the nerve and feel pain! The fancy name for this is called ‘central sensitization’. No good.

This would be like your smoke detectors in your home going off every time you cook. A little bit of steam and smoke is normal. It doesn’t mean the house is burning down, but the smoke alarm system is going off anyway. This is why people with chronic pain report pain with things like massage or even light touch like a bed sheet! The pain pathway is too sensitive and the alarm is going off after very little stimulus. Even when we know light touch doesn’t actually damage anything, it still hurts for some people! This can be a frustrating process for anyone experiencing chronic pain. But just know, it’s not all in your head! And this is the physiological reason why it happens!

We also need to remember that our nerves are smart! During this process, your nerves ‘remember’ the things that were painful. Just like we store muscle memories, we also store pain memories! Here’s what that means. Let’s say you have back pain and bending forward hurts. The next time you see a sock on the floor, your nerves will remember that bending hurts, and your nerve pain pathways start to become active before you even go to do the movement! Essentially priming you to feel pain for bending. Pretty crazy, huh?

This learned response to pain happens throughout our lives as well. As kids and young adults, we see how other people respond to pain, and begin to form patterns for how we will respond to pain ourselves, when the time inevitably comes. So our past experiences will factor into how we develop and store these pain memories. Yes, if you have chronic pain, you can blame your parents…at least a little bit…maybe!

So we’ve discussed two main processes that contribute to chronic pain - the pain nerves becoming more sensitive and sending more signals, and the brain storing pain memories. When these happen for any length of time, it puts our whole nervous system on edge, in a state of hypervigilance. Like that crazy neighbor that pays way too much attention to what everyone else is doing. As a result, we become more sensitive to other inputs to our nervous system…things like emotional states (stress and anxiety), lack of sleep, illness, or poor diet can all create more pain. Over time, our whole body becomes more sensitive, and pain can start to spread to other areas!

Sounds pretty scary, I know. We can see that a lot of things can contribute to the alarm system going haywire. The take-home message is that it’s complicated. Just understand that there are explanations for why you feel so much pain…and you’re not going crazy or just ‘getting old’!

BUT(and that’s a big but)...there’s good news too! All of the things we just talked about are reversible! And so is chronic pain. We see too many people who have not had success with Physical Therapy at other clinics. And it’s because most PTs don’t understand chronic pain well enough. But we do!! And we can help you too! Ask us how below!

-Robert Drenning, PT

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