Pain 101: Establishing the Basics
What is pain? What is chronic pain? What is acute pain? What do I do when I have pain?
‘We risk becoming a victim to that which we do not understand.’
-MHP
“Currently, in the United States, estimates are that 100 million individuals suffer from the negative effects of protracted courses of pain and inflammation.”(2)
This I week decided the best way to get some basic pain education under your belt is to create a dictionary style post (non-alphabetized). One that you can return to as needed, or direct others to, for simple straight forward answers. With a little help and credit to Adriaan Louw who created my Therapeutic Pain Certification program and Merriam-Webster, plus some dabbling of my own experience, consider this the pain 101 course to establish the basics. There are some take homes at the bottom, so be sure to read all the way through. Here goes!
Pain: …’An unpleasant bodily sensation or complex of sensations that causes mild to severe physical discomfort and emotional distress’… Pain is OUTPUT of the BRAIN when it PERCEIVES a THREAT to the body or a part of the body.
There are some key elements to this definition. I will highlight them.
1. Pain is both a physical and emotional experience. The lesson here is that we cannot look at any pain experience as a purely physical or biomechanical experience. That is outdated information that stems from old pain theories. This has big implications for questions we should ask ourselves and discussions we should be having with our healthcare providers.
2. Pain is created by the brain (but don’t forget, your brain is not JUST your conscious mind) - pain is a subconscious creation of the brain when the sum of inputs indicates that something threatening is happening. Please see pain neuromatrix for more information.
3. Pain is created when the brain perceives a threat to the biological system that is your body and mind. It is a reaction like an alarm, alerting you to an issue. It is telling you something you need to know.
Acute Pain: Pain of recent/sudden onset and lasting no more than 12 weeks/3 months. This is generally linked to expected normal tissue healing times. Typically we see a clear cause such as a rolled ankle at a basketball game. Generally, easier to treat than chronic pain.
Pain of Insidious Onset: This is pain that appears to have ‘come out of the blue’ or has no clear cause and may have just gradually evolved.
Chronic Pain: Pain that lasts longer than 3 months. This is pain that extends beyond normal tissue healing times. It may evolve after an episode of acute or insidious pain. Due to the changes seen in the central and peripheral nervous system chronic pain is no longer seen as a symptom, but its own disease process. Thankfully, with an influx of recent research we now have tools to address these changes…more on this in future posts.
Pain Neuromatrix: This is a newer pain theory (and the one widely accepted today) first proposed by Ronald Melzack when he noted that prior theories couldn’t explain phantom limb pain (pain in a limb that had been amputated and healed well - AKA pain in a body part that is no longer on a body and did not explain the chronic pain experience). This theory suggests that pain is generated by the brain, not the tissues and peripheral nervous system, and is a more complex result of a variety of inputs (visual, reactions from those around us, memory, physical bodily harm, thoughts, etc). The memory piece is a big one and notes that when a memory is triggered the pain can also be triggered. This theory also highlights that pain can be created not only by physical factors, but also by emotional and cognitive factors. While the theory has been around for a while, we still struggle to properly adapt in the healthcare world.
It is important to note that with the use of functional MRI’s and study of pain we know that the pain experience involves several areas of the brain. These areas of the brain have been triggered in every pain experience ever studied. Most importantly, there is NO SUCH THING as pain you made up. All pains are REAL and not created by our conscious thinking.
Biopsychosocial Pain Treatment model (how I treat chronic pain): is a holistic model of treatment that respects the complexities proposed by the pain neuromatrix theory and promotes strategies to assess and address biological factors (injury, inflammation), psychological factors (thoughts and emotions), and social factors (support systems) that are impacting the pain experience. Sadly, many attempts at treating through this model involve seeing multiple practitioners and can become very disjointed, costly and time consuming…this doesn’t have to be the case.
In order for our modes of treatment to keep up with the science here are a few pointers on how to address pain as well as some questions we should be asking ourselves when we are met with pain.
When you have an acute pain with a known injury seek professional help and address it right away. This impacts how the tissues will heal and helps prevent chronic pain development. Be aware of how this injury impacts other areas of your life such as work, socializing, etc. Are there additional factors that make this injury particularly bad for you at this time? Are you fearful about anything related to the injury? These factors may increase the pain levels and worsen outcomes if not addressed.
When you note an acute pain of insidious onset mark the date on your calendar and then ask yourself these questions:
- Have I recently changed my physical activities (including housework, exercise routines, sleep habits, eating, etc)?
- Have I recently been experiencing a moderate or major stressor? Note that I said experiencing. We will discuss further, but you can cope with stress very well consciously, but it is still impacting you physically…pain may be that sign.
- Did I have a past injury in the painful area? Or is this an area of concern for me because of someone else’s awful experience? (remember, fear drives pain because fear is a threatened state of mind).
Typically these questions will help you find the greatest contributors to triggering pain. Then you need to address them as best you can and expect gradual improvement. If pain is impacting your ability to function, or is accompanied by other worrisome signs (fever, rash, weight loss, bowel and bladder changes, weakness, dizziness, visual changes or speech issues), or if pain is worsening, or not improving over several days, or improvement plateaus and does not resolve (this is why you mark your calendar) it’s time for help.
Future posts will have more tips on how to address these various contributors to pain plus some amazing stories of recovery, but first start thinking of your pain experiences as a pie graph. Each pain may be impacted by physical, emotional and cognitive inputs to various degrees. Get used to assessing how much each area plays a role. Then you will be better informed as to which treatments will have the greatest impact.
A note to those of us living in modern society if you are ‘too busy’ to address your own body’s needs please remember, this body and mind are all you have. Make them a priority and respect that they work very closely together…for you to continue doing all that you do. They are your foundation.
Please, forward this to a few others. If you have questions or comments, please email me.
meredith@unfurlwellness.com
With compassion,
If you enjoy reading scholarly articles here is some more in-depth information from today’s post.
(1)Moseley GL. A pain neuromatrix approach to patients with chronic pain. Man Ther. 2003 Aug;8(3):130-40. doi: 10.1016/s1356-689x(03)00051-1. PMID: 12909433.
(2)Trachsel LA, Munakomi S, Cascella M. Pain Theory. [Updated 2023 Apr 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545194/
