What is pain? Whenever I refer to this reoccurring question in my field, I remember a line from a cartoon movie I watched as a child; The Mighty Ducks, the details of the scene are blurry, but as the hero character goes to punch an object as he exclaims, “Pain is an illusion.” After he punches said object, he replies to himself, “An illusion that really hurts.” That is a wonderful way to explain physical pain we perceive from our body. It is only a signal, from our body, to our brain. A signal that, in fact, really hurts sometimes. Pain science is a large area of interest in the Physical Therapy field at the moment and I have heard many analogies, stories, and metaphors attempting to rationalize the enemy that PT’s have forged battle with since the inception of our field. I will share a few that make particular sense to me. If you are interested, there are far smarter people than myself that may help you to understand it better (Peter O’Sullivan for example). As far as I know, these are true stories; however, they are just my recount of them without direct referencing…
A construction worker is using a nail gun, he shoots the nail gun, misses the target, and the nail pierces through his work boot. He screams in terrible pain and is rushed to the ER to prepare for treatment. When the boot is removed, it appears that the nail did not pierce the man’s skin. The man assumed he impaled himself with his nail gun. The brain responded appropriately and the man experienced pain relative to that of a nail piercing through one’s foot. Pain can lie to us, and our brain can be tricked into believing that we have pain when there has been no harm done to our physical self.
(https://www.youtube.com/watch?v=MG22iFL-VgE - another interesting example of this phenomenon).
A lady was walking along the side of the road and a window shattered. The woman was hit with the debris from the crash and had a large piece of glass stuck directly into her head. When the doctor at the ER asked if the woman was okay, the woman responded that she was, in fact, not in any pain and was unaware of the piece of glass that was stuck into the side of her head. This woman was struck directly through the part of the brain that is responsible for nociception (the response to pain signals) and was therefore was in no pain and unaware of her life-threatening injury. Pain can be an important defense mechanism to provide safety and protect our well-being.
The final story comes from a man walking across a railroad track. He trips over the track, falls, and severely sprains his ankle. He is writhing in pain, thinking to himself that he may have broken his ankle. Then, he hears the horn of a train and when he turns and looks, the train is streaming down the track towards him! He quickly jumps up and off the tracks, out of harms way. After the adrenaline rush from escaping certain death subsides, he begins to realize that his ankle is still hurt and needs attention, but for the few short moments that he was scared for his life he had completely forgotten about his injured ankle. Pain signals can be turned off in the event of a more important or life threatening situation. This indicates that environment absolutely has at least some influence on the pain that we feel. We may have limited control on the pain we are feeling, but we can control the environment around us that could be contributing to our pain.
Pain is something we perceive based on information given to us. No different from our vision or our hearing we gather information around us and perceive our reality based on the information available. Pain can be useful in protecting our well-being, but it can also be overwhelming and a significant life burden to some. What we need to develop is a healthy relationship with our pain and use it as a guide to explore our movement through this physical world.