Why Do I Hurt?

Why Do I Hurt?

Pain is a normal and necessary part of life. Pain is also essential for survival. If we didn’t experience pain we would be much less likely to avoid those situations that are threatening and dangerous to our health and survival.

Living with frequent or persistent pain is not normal. Unfortunately there are millions of people who suffer from chronic pain. Our health care system has grappled with how to effectively treat pain for as long as doctors have had patients. I believe a reason why pain rates are increasing is because as health care providers our training and education is steeped in the biomedical model of treatment with diagnosis and treatment directed at our tissues such as as muscles, ligaments, and joints. Of course these tissues can become injured and be the source of pain, especially in the first few days or even few months after an injury has occurred. Medical treatments and medicine can be very effective in this stage of healing. But what about the pain that persists beyond normal tissue healing times? This chronic pain state has not been as well understood or treated by our medical/pharmaceutical system.

Thankfully, times are changing. In the last several years our knowledge of how pain works has increased considerably. New innovations and research have allowed brain scientists to better understand our nervous system; brain, spinal cord and nerves, and how they play a central role in a pain experience. Call me a geek, but I find it is fascinating stuff. And the cool part is that the research shows that if you are a chronic pain sufferer, understanding your nervous system a little better, and understanding why you hurt, has a very real therapeutic benefit in helping you overcome your pain. To this end, I would like to ‘explain pain’ to you.

Each area in our body has nerves. In fact, our bodies contain 45 miles of nerves and more than 400 individual nerves! These nerves are all connected like a network of roads. The nerves connect our body parts to the spinal cord (The super nerve network that runs through our spine), which then connects at the base of our skull to our brain.

Nerves are continually active to some extent. If you are alive, they always have little energy buzzing through them. They serve as monitors of your body and environment and inform you and your brain of anything going on in your body. Some nerves work like a living alarm system. Take for an example when you step on a nail. You want to know about it right? Of course, so that you don’t step on more nails, so that you will give it some attention, put a bandage on it and maybe get a tetanus shot. Nerves send messages using electrical impulses. When there is danger, such as a nail in the foot, the nerves increase electrical activity and “wake up”, sending a lot of danger messages to your spinal cord and then up to your brain. They let the brain know there is danger and action is required. Pain is produced by your brain essentially to get your attention and take action.

Once you take care of the nail and your foot, the nerves (alarm system) gradually settle down and returns to its normal resting level of activity.
When you hurt yourself, have an accident, undergo surgery or experience a lot of emotional stress, the same process as the nail in the foot occurs. When you develop pain in a certain body part, the nerves in these areas “wake up” alerting your brain to the danger in the area. The nerves around the area alert the spinal cord, which in turn, tells the brain there is a problem in the area and action is possibly required. This process is normal; it’s simply the nerves doing their job. After a few hours or days, the nerves return to their normal, resting state.

Now, here’s the problem. In some people, the nerves that “wake up” calm down very slowly and do not return to their normal level of sensitivity. They stay more sensitive. In this state, it does not take much activity to get the nerves to fire off danger messages to the brain. This is what has been described as an extra sensitive alarm system. With this increased nerve sensitivity, activities that used to be easy and pain free, like walking, doing the dishes or washing laundry are painful. We naturally stop doing these things and believe that something must be wrong. Often we blame the tissues (muscle, joint, tendon etc.) not realizing that the tissue is probably not the issue any longer but rather you have an extra sensitive nervous system.

One way to know if your alarm system is overly sensitive ask yourselves the following questions:
Have your activity levels before reaching pain decreased a lot?
Is pressure on your skin or around the painful area very sensitive?
When doctors or therapists test or move your body parts are they very sensitive?
Are you currently taking medicine to calm your nerves such as Cymbalta, Lyrica, Neurontin or anti-depressants such as Paxil, Zoloft and Prozac?

If you answered yes to any of these questions, or if you have persistent pain past a normal amount of healing time then there is a good chance your nervous system is extra sensitive. In future articles I will discuss some of the reasons why the nerves become so sensitive and what you can do to help calm them down.

Darren Marchant  MSPT
FIT Physical Therapy