If you are like me, you have an intuitive understanding that, in general, tissue damage is the cause of pain. The more damage there is, the more pain you feel.
And if you do share this understanding with me, we are both very, very wrong!
Pain can come from tissue damage (and often starts there), but the perception of pain especially after acute injury is complex. No matter what, the pain you feel is real, but you often need to address both physical tissue damage and how your nervous system is reacting to that to experience relief.
Modern research into these ideas started in WWII when a doctor serving in the army noted that about 75% of the severely wounded soldiers he saw reported zero to moderate pain and did not want pain medicine. All of the patients in his study were alert and none were in acute shock.
How could this be? If tissue damage was the main driver of pain, then these soldiers should all be reporting severe pain based on their injuries. Clearly there was more to pain than tissue damage.
Subsequent studies on the mechanisms of pain have shown that the experience of pain relies on a combination of signals from your nerves as well as a whole host of factors; your genetics, stress levels, how well you sleep, what you eat, cultural norms, and even whether or not you expect to be in pain!
I highlight this last piece for a reason – several studies have shown that seeing imaging (e.g. X-ray, MRI) of a normal structural change in your body, if framed in a negative light, makes you feel more pain! This exemplifies the incredible strength of your brain and perception – simply seeing there is something “wrong” with your body can make you actually feel more pain.
This is not to say you can “think your way out of feeling pain,” but it is important to recognize and respect the role that your belief system has on the amount of pain you feel. Using negative language about an injury or the ability of your body to heal can actually worsen your pain and blunt the healing process, leading to further pain and disability.
So what can you do when you are in pain?
Let’s break up what you can do to help yourself into 2 categories: Physical and Psychological.
Physical:
Particularly with acute pain (lasting less than 3-6 months), tissue damage is often part of what is causing pain. Pain in these circumstances is a normal, biological process for getting you to slow down and not further damage the tissue while it is healing.
The most important physical steps you can take to help it heal more quickly will encourage increased blood flow to the area. Increased blood flow will help the body move through a healthy inflammatory process more quickly and bring the resources your body needs to move into the next phases of healing.
How to move blood to an injury site:
- Physically engage and move your body in ways that do not create more pain (that would be counterproductive). Minimal pain is OK, but stop or dial it back if the pain is getting up to 3 or 4 out of 10. Increase movement and load as the pain allows. Movement of the local injured area as well as general cardiovascular training are helpful in different ways and should both be included when possible.
- Use heat on the local area(s) to dilate blood vessels and allow for more blood flow. Don’t use ice!
- Injury and individual-specific acupuncture to help move blood, release trigger points and restore soft tissue function as needed.
- Body work (cupping therapy, gua sha, massage, etc.) to break up fascial adhesions, help move lymph and blood.
Psychological:
I will repeat this, because it is that important: if you feel pain, your pain is real. Tissue damage is not required for pain to be very severe so do not let yourself or others minimize your pain when there is no clear physical cause.
Taking steps to “convince” yourself that your body can and will heal from the injury or enduring pain may be the most important step in your recovery.
How to make yourself believe the pain will get better:
- Movement in ways that do not create more pain is just as important for your psychological recovery as it is for your physical recovery. Engage in activities that recruit the muscles around areas of pain to give data points to your nervous system that these areas can function without pain. Increase movement and load gradually as pain allows.
- Sleep, like movement, will also help you physically and psychologically so it is important to prioritize. Allow yourself to get even more sleep than you normally would to account for the increased need. Sometimes pain directly interferes with sleep and that is OK. Get the rest when you can.
- Check in on your pre-conceived notions about what recovery looks like. It is often not linear. You may feel better one day and worse the next for no clear reason. Try to avoid putting too much meaning on the pain levels of any one day and know that you will get better if you stick to the plan.
- Acupuncture to help manage anxiety, promote sleep and give more sensory input to your nervous system that the areas of pain can be manipulated with minimal pain and in a lowered stress state.
- Operant-behavioral therapy, cognitive-behavioral therapy, mindfulness-based stress reduction, & acceptance and commitment therapy are all approaches that can be effective as well. Here is a good summary of what they are.
Pain can be very complicated, and often requires a nuanced approach. If you or someone you love is dealing with pain, give me a call or schedule an appointment and let’s see what the best next steps are for you!
