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What is pain?

In July 2020, The International Association for the Study of Pain (IASP) revised the definition of Pain as follows:

"An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage,” and is expanded upon by the addition of six key Notes and the etymology of the word pain for further valuable context.

  • Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors.
  • Pain and nociception are different phenomena. Pain cannot be inferred solely from activity in sensory neurons.
  • Through their life experiences, individuals learn the concept of pain.
  • A person’s report of an experience as pain should be respected.
  • Although pain usually serves an adaptive role, it may have adverse effects on function and social and psychological well-being.
  • Verbal description is only one of several behaviors to express pain; inability to communicate does not negate the possibility that a human or a nonhuman animal experiences pain.

Often the cause of pain is obvious, a broken leg, or a bruise. But there are times when the source of pain is unseen, for example a slipped disc. Occasionally it is very difficult to find the exact cause of a person’s pain.

Health professionals use different terms for different types of pain.

Short-term pain is called Acute Pain. An example is a sprained ankle.

Long-term is called Persistent or Chronic Pain. Back trouble or arthritis are examples.

Pain that comes and goes is called Recurrent or Intermittent Pain. A tooth ache could be one.

Many acute pains are like an alarm telling us something is wrong. Most minor ones are easy to treat; others may be a sign of something more serious. For example the pain of a broken leg will make us rest the leg until it heals. Here the pain is helping.

Persistent pain often serves no useful purpose. The messages from the warning system linked to long-term conditions like arthritis or back pain are not needed - just annoying. Over time, it may affect what we can do, our ability to work, our sleep patterns. It can have a strong negative effect on our family and friends too.

Pain signals use the spinal cord and specialised nerve fibres to travel to our brain. This involves our whole body. It is more than just a network of wires. These fibres also work to process the pain signals. All together they work like a very powerful computer.

Sometimes this computer system can go wrong. The messages get confused and the brain cannot understand the signals properly. It can lead to chronic or persistent pain, which can be very hard to repair. Unfortunately, we cannot just re-boot the system.

Part of this process is linked directly with the emotional centres in the brain. This means how we are feeling has an effect on our pain. If we feel angry, depressed or anxious, our pain will be worse.

The opposite is also true. If we are feeling positive and happy, our pain can seem to be less. We are able to cope much better.

It shows that pain is never "just in the mind" or “just in the body” - it is a complex mix involving our whole being and how our brain interpretation the signals. This mix can change from one day to the next.

Sometimes, pain can begin very small. But the signals quickly jump along the network. It is like a football crowd. It takes only one person to start a chant or a song, but very quickly the whole stand has joined in.

This is called ‘wind- up’ and is one of the reasons why chronic pain does not go away easily. The ‘chant’ can last for hours, days or even years. This can lead to a long term, distressing problem which requires skill, time and patience to improve.

The way a pain signal jumps along the system is by the release of a chemical. These are called Neurotransmitters, and over one hundred types have been discovered. The amount of chemical released is extremely small.

There are good neurotransmitters and there are bad neurotransmitters. The bad ones make the pain worse; the good ones can help block the pain.

Again, the way we feel, our emotions are involved. But doing something we enjoy, having a good laugh or exercising, we can strengthen our ‘good’ neurotransmitters and so limit our pain.

However, if we are depressed or moody, lack motivation and are not active we strengthen our bad neurotransmitters and our pain gets worse.

Pain killers and other drugs can also strengthen these ‘good’ neurotransmitters.

Many of the modern techniques used by medical people have helped us to understand and treat pain better. But there is still a lot that needs to be learned.

Now-a-days, pain doctors realise that our personal circumstances make a great difference to how we feel pain. Only the person in pain can really say how painful something is. As a result, they are far more likely to listen to the patient and want to work together to improve the situation.

This can still be quite a challenge. Patients must be able to explain their situation to the healthcare professional. They in their turn must try to understand and help us in the best way for us.