Good pain vs bad pain. Is there a difference?

I’m not a doctor of pain, nor do I have multiple degrees in this field. But as someone with a degree in teaching (in addition to my other non-science degrees), I’m able to understand some information and break it down into simpler terms that others might be able to put to good use. So here goes!

What is pain and how does it come about? To understand this, I went to a book called “Pain and disability” by the US Institute of Medicine Committee on pain, disability and chronic illness behaviour; and to the National Library of Medicine (NCBI) to gain more knowledge in this field.

For hundreds of years scientists thought that the more physical damage inflicted upon us, the more pain we would feel. E.g. if you took person A and poked them with a small nail and they feel a 2/10 pain, and you took person B and poked them harder with a bigger nail, they should feel a5/10 pain for example. But this is not true. Just because a muscle or some tissue in our body is damaged, doesn’t always mean every individual will feel the same amount of pain.

We are capable of experiencing pain that is not in proportion to our injuries e.g. a papercut can feel incredibly painful when it’s only a very small cut vs some people that can break their bones but not feel very much. So why is this?

To answer this question, we must first go back to the question of what is pain and how we experience it.

According to the International Association for the Study of Pain, pain is an unpleasant sensory and emotional experience arising from actual or potential tissue damage. Clinically, pain is whatever the person say she or she is experiencing whenever he or she says it occurs (Fink, 2000). Pain management is not the result of lack of scientific information, considering the explosion of research on pain assessment and treatment. Yet reports documenting the inability of health care professionals to use this information continue to appear in the literature. Studies have found that two of the chief barriers for health care professionals are poor pain assessment and lack of knowledge about pain (Ferrell, 1995). This explains why there are so many people out there going to health professionals and barely getting any results for their pain only to come to me for some solutions!

Pain happens through four major processes: transduction, transmission, modulation, and perception. Pain receptors are stimulated through mechanical, heat and chemical stimuli. These pain receptors called nociceptors only start to turn on when you are dangerously close to getting hurt, or when you have accidentally gotten hurt (e.g. burnt your hand on the kettle or stove). This makes sense because I’ve always thought that the degradation of our joints or muscle imbalances can happen for years and can even continue to worsen in the background without us knowing it. Only when it crosses a certain threshold will our bodies start to tell us that the pain exists and that we must do something about it.

This nociceptive pain can be due to muscle, skin, bone (somatic pain) or internal organs(visceral pain). This nociceptive message is then transported from the peripherals of your body to your spinal cord and into your brain which then determines whether to recognise the pain or to block it out by sending “feelgood” chemicals.

Your body will choose to recognise the pain to allow you to change your surroundings e.g. for you to move your hand away from the stove, or will choose to block the pain out instead.

Pain can:

·       Be amplified long after the damage has been done (e.g. getting sunburnt),

·       Be amplified if that specific site of pain has been aggravated numerous times

·       Be felt at a different location to where the origin of the pain point actually is– this is called “referred pain”. Pain arising from deep structures (e.g. lower back) can often be felt at sites distant from where the tissue damage actually occurred (e.g. hip tightness or knee pain).

·       Lead to other pain points in the body – called a “Vicious Circle” by a scientist named Livingston in 1943. He described it as e.g. having pain in your chest from a tight muscle, but then feeling pain in your shoulder and then bicep and then wrist because other nociceptors have been activated. Pain that is left untreated for too long can produce more pain in other areas of your body and if that pain is left untreated for a long time, could have you feeling sustained pain at a high level, even if the problem area has already been solved.

Pain threshold (the level at which you start to experience the pain) and pain tolerance (how long can you tolerate the pain for) also playa part in how you feel. Pain tolerance can be affected by numerous factors including personality traits, feelings at the time, attitude to pain and previous experience with that pain, understanding why the pain is happening, understanding that the pain can end and finding the means to limit that pain in some way.

Massage can often provide relief to someone for anywhere from a few days to a week depending on the severity of the muscle knot or trigger point and the frequency of the massages previously performed. But when it comes to musculoskeletal pain, my opinion on it is that the only long-term solutions are to find movements that strengthen the muscles, and stretch them simultaneously. All other options are complements and aids to pain management.

So how do you identify good from bad pain?

Pain can be:

·       Neuropathic – burning, shooting, tingling, radiating or numbness. This is nerve pain and can feel like a fire or an electrical jolt.

·       Somatic pain – achy, throbbing, dull pain. This pain is usually felt by people that have arthritis or lower back pain (among other things)

·       Visceral pain – dull, deep, squeezing, pressure, cramping. This is pain from your internal organs.

Other questions to ask: Does the pain come and go or is the pain always there? Do certain activities or actions bring the pain on? Do certain activities or actions reduce the pain e.g. massage or sitting/sleeping a certain way? Identifying these patterns will be a good way for a specialist to help you get closer to your pain-free goal. The more research I do as a professional trainer (i.e. a non-medical professional), the more I realise that there is a lot of help out there for people in pain – whether behavioural (i.e. going to your happy place, or creating a strong mind) or science-based movement and training which is what I offer. I define bad pain as nerve pain and pain that is just always there, and good pain as pain that comes and goes (because to me that means I can get it to go away more!)

In my experience and in my opinion, most muscle pain (and even some pain that feels like nerve pain and bone pain) can be fixed if not lessened through a good training program that combines strength work and stretching. But obviously this is only when you have determined that it is only a surface level problem of which you will need a medical professional for!

If in doubt, consult a good doctor first (there’s always a good one out there somewhere who’s not prescribing just pills and injections!)who should be able to point you to a specialist in their field.

References:

Institute of Medicine (US) Committee on Pain, Disability, and Chronic Illness Behavior; Osterweis M, Kleinman A, Mechanic D, editors.(1987). Pain and Disability: Clinical, Behavioral, and Public Policy Perspectives. Washington (DC): National Academies Press (US); The Anatomy and Physiology of Pain. Available from: https://www.ncbi.nlm.nih.gov/books/NBK219252/

Fink R. (2000). Pain assessment: the cornerstone to optimal pain management. Proceedings (Baylor University. Medical Center), 13(3), 236–239. https://doi.org/10.1080/08998280.2000.11927681

Kellgren J. H. (1938). Referred Pains from Muscle. British medical journal, 1(4023), 325–327. https://doi.org/10.1136/bmj.1.4023.325

Ferrell, B. R., Dean, G. E., Grant, M., & Coluzzi, P.(1995). An institutional commitment to pain management. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 13(9), 2158–2165. https://doi.org/10.1200/JCO.1995.13.9.2158 

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