What is pain?

Google defines pain as “highly unpleasant physical sensation caused by illness or injury”.

This seems to be missing a little. It makes no mention of emotional or mental pain. So maybe we should take the Pain Australia definition, “An unpleasant sensory and emotional experience associated with actual or potential tissue damage.”

Most of us would agree that pain is generally a bad thing. It frustrates us. We aim to avoid it, and a lot of what we do as physios aims to mitigate it. But pain, like all sensations is completely normal (if somewhat unpleasant) to experience. In the most part it is suitable warning “associated with actual or potential tissue damage.”

Things get tricky when the relationship between damage and pain gets out of whack. Consider an example.

  • A small child is pushing his truck along, slips and grazes their elbow. They dust themselves off, checks for damage but cannot see the graze due to the location. So, they get back to it and continue rearranging the garden. 

In this example there is clear and obvious tissue damage, but a very low pain response. The child is “fine”. To answer why, we must consider this key point. Pain is an experience, not a sensation. Pain is not determined by damage. 

The experience of pain is dictated by a multitude of physical and psycho-social factors. Negative influences include stress (physical, emotional, mental), illness etc.

Whereas the pain experience can be improved by positive influencers like: happy mood, good health (mental, emotional, physical), reassurance etc. 

Referring to our previous example. Picture our young truck driver with grazed elbow. Playing happily, blissfully unaware of his boo boo. Along comes dad who immediately notices the graze. Now consider the impact of what happens next. Option 1. “Oh no! What happened to your elbow?? Are you ok? That must’ve hurt?! Let’s get you inside to clean that up.”

Option 2. “Hey bud, how’re you going? Looks like you’re having fun?”

It is likely that the child will respond in two quite different ways. 

When considering pain, we cannot look at it in isolation. The experience is multifactorial and all factors should be addressed. If you are struggling with pain, consider what else is going on. When does it feel it’s worst and what factors unrelated to the tissue could be involved? Likewise, when do you feel your best and why? Furthermore, how can you spend more time in that space? 

Author – James Sincock

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