“Why Do I Hurt?”

“Is it my flat feet?”

“Is it my posture?”

“Is it my mattress, pillow or work chair?”

“Is it that my pelvis, spine or hips are out of place?”

“Is it my tight (fill in the blank) muscle?”

And my absolute favourite:

“I think I caught it off someone on the bus.”

(Don’t laugh, I have been told this very matter-of-factly by a patient)

It is a common question, with a complex answer. Anyone that says your pain is only from one thing is often misleading you, or may not have looked deep enough into the reasons your pain began. Pain is complex and at the very least has biological, psychological and social factors that contribute to it.

I can nearly hear you say it. “Really, psychological and social factors. Not when I get pain.” Let me explain.

Pain science has evolved over the years from a simplistic one-way street theory. You touch the stovetop, a pain signal is sent to your brain and you quickly remove your hand. This is probably the most common understanding of pain within the public. Science has a term for this ‘pain’ signal - nociception. Nociception refers to a mechanical, chemical or thermal stimulus that elicits a signal to the brain that warns us that we might be in danger. When you withdrew your hand from the stovetop, you most likely did it quick enough to not be burnt. The skin might be a bit pink and sore from the heat, but there’s no burn. Because you got a warning signal (as well as some pain in response), your body was able to act to avoid damage.

The interesting thing though, is this - you can have nociception without pain, and you can have pain without nociception. Your brain receives more than just this warning signal to determine whether something is painful. The same pathways that your brain uses to receive nociception are also used by signals for stress and memories. So if you are stressed or have just gone through a bad experience, the nociceptive signals and stress signals pool together and send a much bigger input to the brain.

I’m not saying pain is all in your head. It’s not. But it is affected by more than just physical factors.

Did you know, you don’t even need a body to feel a body - WHAT!?

People with amputations must be constantly reminded that their missing limb is not there, and they often get pain into the area that used to be their missing appendage. This is called Phantom Limb Pain, and is due to the fact that the person with the amputation can still recall what it felt like to have a full limb. This is because the nerve connections that have been severed by the amputation can continue to fire off nociceptive signals to the brain, which reinforces the mental representation of that limb in their brain. This pain can range from a subtle awareness to a sharp stabbing pain. They can literally feel their missing limb, regardless of what their eyes and other senses tell them.

“But I hurt, so I must be causing damage, right?

Absolutely not!

The degree of damage does not determine the degree of pain. We know this intuitively. We all know the horrible pain of a papercut, but we also know that it will heal so we often chuck on a Band-Aid and get back to it. It might be sore if you bend your finger too much, so you make a mental note to bend it less until it heals up. Pain is a protective output produced by the brain. No one person and no one situation is excluded from this fact.

So whether you have rolled your ankle or have persistent pain that cannot be properly explained from a biological (or nociceptive) perspective, it’s always important to look at the bigger picture. Can you now see how social and psychological factors can impact your pain experience? Your beliefs, thoughts, mood and past experiences all play into the output of pain.

Please don’t let the complexity of pain scare you, let it empower you. If there is more than one thing driving your pain, then there can be many more ways to get you pain-free! The methods of treating pain are often very simple. Move a little more, move a little less, manage your stress levels, sleep a little better or get a little stronger. Just to name a few.

Want to understand more about exactly why you hurt? Please come in and see our experienced physiotherapists at My Vitality Physio. Together, we can help you understand and find the best way to help manage and reduce your pain.