What is Pain? With or without tissue damage?

Pain is an unpleasant physical and emotional experience unique to each person; that is associated with actual or potential tissue damage. Increasing evidence has emerged to show pain is a warning signal produced by the brain. Contrary to popular belief, pain does not necessarily indicate that there is an injury or actual tissue damage.”

For instance, the fire alarm in a building can be triggered due to a fire drill or a technical fault in the system instead of an actual fire. Similarly, pain can occur in many situations, even in the absence of actual tissue damage.

Pain is an experience that is unique to the individual – for instance, if two individuals are pinched on their arm with the exact same amount of strength, it might be painful for one but may only feel uncomfortable for the other despite it being the exact same injury. Thus, pain or pain severity is not an accurate indicator of physical damage as it is personal subjective expression and response to the signal given.

Similarly, pain could be a positive or a negative experience depending on the individual. After a workout, someone may feel positive about the muscle soreness and enjoy the feeling while someone else might feel negatively about the muscle soreness and associate it to damage or exacerbation of an injury. Hence, with different interpretation of pain and what we think the pain means, we have very different thresholds and sensitivity to pain.

How can I tell if there is tissue damage?

An injury is usually accompanied by physical signs such as inflammation, swelling and bruises. Furthermore, there might also be tissue damage present if the pain is constant and regardless of positions. For example, with an ankle sprain with a ligament tear, we would usually see swelling, redness or bruising as well as warmth in the region of injury. Regardless of what position we put the ankle, we often times find the pain to be dull, achy and constant.

Why do we feel pain if there is no damage?

Apart from being an indication of damage, pain could also be a protective signal sent by the brain. More often than not, pain is felt in the absence of tissue damage. This could be due to an association to previous pain experiences where your brain is sending a messaging signal for your body to decide how to react to the situation.

For instance, while taking a walk – something touches your leg. Your receptors send a message up your nerve fibres to your brain to tell you that something just touched your leg. Your brain has to determine if it is dangerous and usually looks for precedence or past experiences of similar encounters for reference. In this case, your brain might determine that it has happened before and is a similar feeling to when twigs brush against your leg – and so, may dismiss the potential of danger and decide to carry on without checking on your leg. At the end of the walk, it is revealed that the pain was actually caused by a snake bite instead of a twig and your brain had mistakenly dismissed the pain signals as non-dangerous. Subsequently while taking walks, when experiencing the same feeling of something brushing against your leg, the brain would immediately associate the pain signals to the previous encounter of a snake bite and immediately deem it as danger – amplifying the pain sensations. However in this case, it was just a twig brushing across the leg.

Post injury, one can continue experiencing pain even though their tissues have already healed. In this case, the pain is no longer a helpful indicator and can prevent effective healing as the body will continue protecting the injured area and this may result in one avoiding the usage of that body part.

Pain in Singapore

More and more people are seeking help for pain due to the increased awareness of pain and treatment options in recent years. In the past, painkillers were viewed as the only solution when it came to dealing with pain. However now, people are more interested in fixing the root cause of the pain instead of just treating the pain symptoms – preferring treatment options such as physiotherapy instead.

Recent evidence shows that increased education and understanding pain brings about an actual reduction of pain symptoms. In addition, it has increased the variety of treatment options – healthcare professionals have also benefited from the increased awareness. Physiotherapist now are better at treating pain now due to the availability of new research articles regarding pain treatment – from being more adept at identifying pain experiences and being able to treat them more effectively.

Contributed by Samuel Ong