Pain is always unwelcome but it does have a purpose as a short-term hazard warning.
If we were unable to feel pain we’d be in trouble. Pain is a useful call to action which is important for learning and survival – like the pain of treading on a pin or touching something hot.
“Acute” pain is what we call this short-term pain. It doesn’t describe the intensity, just the quick onset and short duration.
“Chronic” pain often describes ongoing pain that has failed to stop at the right time when its usefulness as a signal is over.
Obviously there are conditions and illnesses that themselves are ongoing and long-term pain is then part of a continuing unwellness. But chronic pain after musculoskeletal injury may often persist because the sensitivity and volume remain turned up beyond “normal tissue healing time”.
In chronic pain, it is believed that two different types of pain fibre which carry signals to the brain either stay permanently switched on or have their volume turned up in error and stick that way. These signals trick the brain into believing there is still ongoing damage and vulnerability in the body when this is not true.
For example in whiplash following car accidents there is a huge body of research that shows hurt is not the same as harm. This research found that the sooner people get going with normal activities after a whiplash injury, the sooner they recover from it.
Pain is not a simple on-off switch that is felt identically by different individuals. Being anxious or sad about your pain really can make it worse. Emotions are like amplifiers in your brain which can turn the volume of pain up or down. So a first-aider reassuring a casualty or a soldier fighting for survival can turn this volume down. In the same way as someone who fears a trip to the dentist can unwittingly turn the volume up.
Chronic pain is one of the biggest health problems worldwide and some 20% of adults experience it. It can lead people to live defensively in fear of pain and to stop trusting their bodies even though it may just be a feedback fault.
Understanding the original cause and effect and any maintaining factors in chronic musculoskeletal pain can be a great first step towards getting out of this unhelpful state.