Pain is an unpleasant sensory and emotional experience usually produced by

something that injures, or threatens to injure, the body. Pain begins with a
stimulus, but is influenced by physiological and psychological factors before it
becomes part of our consciousness.
Although pain is something that we invariably want to escape or to stop, it serves
several very important functions. Pain protects us by triggering a reflexive
withdrawal from something damaging before we can suffer further injury, such as
when we drop a hot pan before we sustain extensive burns. It is also a warning
system that lets us know when an injury is about to occur: the burning ache in our
muscles during extreme exertion warns us to stop using them. Pain forces us to
immobilie or protect an injured part, such as a broken ankle, thus giving it a
chance to heal. Pain also lets us know when we need to seek medical help, and
teaches us what behaviors to avoid in the future.
!erves known as nociceptors are distributed throughout the human body. "hen
you cut your finger, for example, the nociceptors in that area send messages to the
spinal cord about the injury. #he spinal cord, in turn, sends neurotransmitters to
the brain, indicating the extent of the injury. #he neurotransmitters head first to the
brain$s thalamus, which forwards the messages on to areas of the brain that deal
with pain and emotion. "hen the physical pain ceases, so do the nociceptors and
neurotransmitters.
%ut our nervous system is not a simple circuit board that merely relays
information between organs. &any variables exist in how we perceive and
prepare ourselves for pain. 'or instance, over(the(counter pain relievers like
ibuprofen or acetaminophen dull the effects of pain by reducing the chemicals
that our bodies use to sense injury )source: *ids+ealth,. #hey offer a good
standby for headaches and sore muscles, but you$ll probably need something
stronger for a severe injury.
%ut if your doctor gave you a pill and told you it would make you feel better,
it might work even if the pill had no medical ingredients. #his is called the
placebo effect, and it was discovered by army medic -r. +arry .+enry/
%eecher during "orld "ar II. +e ran out of pain(killing morphine, but
continued treating wounded soldiers, telling them that they were receiving
morphine, when in fact he was giving them plain saline solution. !onetheless,
some 01 percent of the soldiers reported that the pain had eased )source: #he
Independent,. 2ater studies also have shown how a significant number of
people who believe they are taking medicine get better even if they are
actually receiving a placebo. #he opposite also can be true (( patients who
believe that their pain medication has been stopped begin to feel worse, even
though they, in fact, are still receiving it. It appears that our brains have
significant control over how we feel pain.
How We Feel Pain
How The Nervous System Detects and
Interprets Pain
From Erica Jacques, former About.com Guide
See More About
diagnosing chronic pain
living with chronic pain
depression and chronic pain
How does your brain now when you feel pain! How does it now the difference between the soft touch of a feather and a needle
pric! And, how does that information get to your body in time to respond! How does acute pain become chronic pain! "hese are not
simple answers, but with a little e#planation about how the nervous system wors, you should be able to understand the basics.
The Nervous System
$our nervous system is made up of two main parts% the brain and the spinal cord, which combine to form the central nervous system&
and the sensory and motor nerves, which form the peripheral nervous system. "he names mae it easy to picture% the brain and spinal
cord are the hub, while the sensory and motor nerves stretch out to provide access to all areas of the body.
'ut simply, sensory nerves send impulses about what is happening in our environment to the brain via the spinal cord. "he brain sends
information bac to the motor nerves, which help us perform actions. (t)s lie having a very complicated in and out bo# for everything.
Pain e!ins with Nerves
*et)s say you step on a roc. How does a sensory nerve in the peripheral nervous system now this is any different than something lie
a soft toy! +ifferent sensory nerve fibers respond to different things, and produce different chemical responses which determine how
sensations are interpreted. ,ome nerves send signals associated with light touch, while others respond to deep pressure.
,pecial pain receptors called nociceptors activate whenever there has been an in-ury, or even a potential in-ury, such as breaing the
sin or causing a large indentation. Even if the roc does not brea your sin, the tissues in your foot become compressed enough to
cause the nociceptors to fire off a response. .ow, an impulse is heading through the nerve into the spinal cord, and eventually all the
way to your brain. "his happens within fractions of a second.
"our Spinal #ord$ The Middle Man
$our spinal cord is a comple# array of bundles of nerves, transmitting all inds of signals to and from the brain at any given time. (t is a
lot lie a freeway for sensory and motor impulses. /ut your spinal cord does more than act as a message center% it can mae some
basic decisions on its own. "hese 0decisions1 are called refle#es.
An area of the spinal cord called the dorsal horn acts as an information hub, simultaneously directing impulses to the brain and bac
down the spinal cord to the area of in-ury. "he brain does not have to tell your foot to move away from the roc, because the dorsal
horn has already sent that message. (f your brain is the body)s 2E3, then the spinal cord is middle management.
How "our rain Sees Pain
Even though the spinal refle# taes place at the dorsal horn, the pain signal continues to the brain. "his is because pain involves more
than a simple stimulus and response. ,imply taing your foot off the roc does not solve all of your problems. .o matter how mild the
damage, the tissues in your foot still need to be healed. (n addition, your brain needs to mae sense of what has happened. 'ain gets
catalogued in your brain)s library, and emotions become associated with stepping on that roc.
4hen the pain signal reaches the brain it goes to the thalamus, which directs it to a few different areas for interpretations. A few areas
in the corte# figure out where the pain came from and compare it to other inds of pain with which is it familiar. 4as it sharp! +id it hurt
more than stepping on a tac! Have you ever stepped on a roc before, and if so was it better or worse!
,ignals are also sent from the thalamus to the limbic system, which is the emotional center of the brain. Ever wonder why some pain
maes you cry! "he limbic system decides. Feelings are associated with every sensation you encounter, and each feeling generates a
response. $our heart rate may increase, and you may brea out into a sweat. All because of a roc underfoot.
Where it %ets #omplicated
4hile it may seem simple, the process of detecting pain is complicated by the fact that it is not a one5way system. (t isn)t even a two5
way system. 'ain is more than -ust cause and effect% it is affected by everything else that is going on in the nervous system. $our mood,
your past e#periences and your e#pectations can all change the way pain is interpreted at any given time. How is that for confusing!
(f you step on that roc after you have a fight with your wife, your response may be very different than it would if you had -ust won the
lottery. $our feelings about the e#perience may be tainted if the last time you stepped on a roc, your foot became infected. (f you
stepped on a roc once before and nothing terrible happened to you, you may recover more quicly. $ou can see how different emotions
and histories can determine your response to pain. (n fact, there is a strong lin between depression and chronic pain.
When Acute Pain ecomes #hronic
(n this scenario, after your foot healed, the pain sensations would stop. "his is because the nociceptors no longer detect any tissue
damage or potential in-ury. "his is called acute pain. Acute pain does not persist after the initial in-ury has healed.
,ometimes, however, pain receptors continue to fire. "his can be caused by a disease or condition that continuously causes damage.
4ith arthritis, for e#ample, the -oint is in a constant state of disrepair, causing pain signals to travel to the brain with little down time.
,ometimes, even in the absence of tissue damage, nociceptors continue to fire. "here may no longer be a physical cause of pain, but
the pain response is the same. "his maes chronic pain difficult to pin down and even more difficult to treat.
This section concentrates on acute pain, which occurs almost immediately upon tissue damage or injury and lasts only a limited time. When pain persists
and cannot be avoided, it can be quite destructive. In effect, it becomes a disease in itself. Pain that lasts for weeks, months, or years is called chronic
pain and is a major source of suffering, disability, and economic loss.
The Physiology of Pain
The nature of pain has intrigued philosophers for millennia. The ancient reeks conceived of pain as an emotion. In the late nineteenth and early twentieth
centuries, the view of pain as sensation became preeminent! it was seen as a direct response to a stimulus. "rom the mid#twentieth century to the present,
these two views have been combined, so medical scientists who study pain now think of it as a subjective e$perience with distinct discriminative and
emotional components.
Pain is associated with a variety of behaviors. % painful stimulus will arouse us, as in &Pinch me to see if I'm awake.( It can focus our attention on the site of
an injury! &I looked down at where it hurt and saw I was bleeding.( It can cue us to try to escape from the cause of an injury or immobili)e us so that we do
not suffer further damage. In addition, pain causes changes in heart rate and blood pressure, and an endocrine response with elevated stress hormones. "or
each response elicited by the pain*producing injury, there is a unique central nervous system pathway.
In healthy individuals, the sensory e$perience of pain is usually triggered by events in the body that activate speciali)ed nerve endings, called primary
afferent nociceptors. +ociceptors are activated by any process that either causes damage or has the capacity to cause damage if continued or intensified.
,ost primary afferent nociceptors respond to a variety of no$ious stimuli-e$treme hot or cold temperatures, intense mechanical manipulations .pinching,
pinpricks, cutting/, increased tissue acidity, and other causes of injury. +ociceptors can also be activated by a variety of chemical agents released from cells
that are damaged or responding to a foreign body such as a splinter or infectious agent .for e$ample, a bacterium/.
There are two types of nociceptors, and the differences between them can easily be understood. 0et's say that you tripped and fell, landing hard on one knee.
1ou would e$perience an acute, well*locali)ed, painful sensation in your knee, followed by a dull and aching sensation. This reflects the two types of fiber
systems that conduct pain from the periphery into the central nervous system. The first pain signals are carried by %*delta fibers, which are insulated with
myelin and therefore conduct rapidly. The longer*lasting pain signals are carried by 2*fibers, which are unmyelinated and conduct slowly.
+ociceptors from the body carry their message to the spinal cord, where they end in very specific areas. Those areas contain connections to the neuron
pathways that conduct the message to the brain stem. Pain messages from the head arrive at similar groups of neurons in the hindbrain. The central nervous
system neurons that receive the pain messages from all over the body target a variety of structures in the brain.
If significant tissue damage has occurred, or if there has been a prolonged or particularly intense activation of a primary afferent nociceptor, it will become
sensiti)ed. 3ensiti)ed nociceptors can be activated by moderate stimuli that normally do not produce pain. 4ne common e$ample of sensiti)ed nociceptors is
the agony produced by bath or shower water on sunburned skin. If you have arthritis, have &thrown out( your back, or have e$perienced a sports injury, you
are also familiar with how you can be reasonably comfortable at rest but feel significant pain during normally innocuous movements. That is due to
sensiti)ed nociceptors in joints, tendons, and muscles.
2hemical agents that do not activate nociceptors can also produce sensiti)ation. The best known of these agents are prostaglandins, which appear when
tissues are inflamed by infection, arthritis, or other factors. Their synthesis depends on the en)yme cycloo$ygenase. This en)yme is inhibited by many of the
medicines that are used to treat pain! aspirin, acetaminophen, ibuprofen, and the new cycloo$ygenase 5 selective drugs, celeco$ib .2elebre$/ and rofeco$ib
.6io$$/. These drugs are particularly effective for pain associated with sensiti)ation and are better for tenderness than for continuous severe pain.
The central nervous system's pain transmission neurons can also become sensiti)ed in a way similar to the primary afferent nociceptors. This process is
called central sensiti)ation, and it is set in motion by neurotransmitter chemicals released at the central terminals of nociceptors. Thus, when a person is
injured, the subsequent activity of nociceptors produces a bigger and bigger response in pain transmission pathways7 pain begets further pain, even if the
stimulus that triggered the response remains the same.
The Psychology of Pain
%nother part of the brain is at work when we e$perience pain, integrating the physical sensation with psychological factors. Perhaps the most familiar
e$ample of the power of psychological factors on pain involves headaches. It is almost a clich8 that emotional stress can bring on a headache. 9ven our
vocabulary of stress incorporates this concept! &This job is a real headache.(
,emories, emotions, thoughts, and especially e$pectations are now known to have an enormous influence on how people perceive pain. % rough outline of
the central nervous system pathways that mediate these psychological effects is beginning to emerge. In fact, the regions of the forebrain that are involved in
emotion .the frontal and temporal lobes and the amygdala/ are known to feed into a neural circuit in the brain stem that directly controls the pain pathways.
"urthermore, the control e$erted by this pathway is bidirectional, meaning that it can either reduce or enhance pain.
This pain*modulating pathway was discovered in the mid#twentieth century during an e$ploration of the brain stem using electrical stimulation. %n area
was found, called the midbrain periaqueductal gray, which, when electrically stimulated, produced a profound reduction of pain in both rodents and people
with chronic pain. We now know that this area is part of a circuit that receives connections from the frontal lobe, the amygdala, and the hypothalamus and,
in turn, connects directly to the spinal cord neurons that relay pain messages from primary afferent nociceptors. This pathway mediates the painrelieving
effect of powerful painkillers like morphine. In fact, the circuit has neurons that secrete morphine*like compounds, called endorphins and enkephalins.
These chemicals interfere with pain*impulse transmission and can significantly lessen the perception of pain.
In animals, the pain*modulating pathway is most easily activated under conditions of threat, such as in the presence of a predator. The animal's system
anticipates tissue damage, which would normally be painful, but being incapacitated by pain would lead to even greater injury7 therefore, the animal has
evolved the ability to dampen its perception of pain temporarily. It is not clear what situations activate this pathway in humans, but possible e$amples
include athletes injured in the midst of competition, or soldiers wounded in combat7 such people may not reali)e they have been hurt until after the stressful
situation has ended.
In addition to its pain*suppressing actions, the same pathway can also enhance pain transmission. This raises the possibility that psychological factors that
produce or e$acerbate pain do so through this circuit. In fact, it has been shown that the anticipation of pain activates areas in the forebrain and midbrain
that are part of this pain*modulating circuit, and that anticipation of pain can produce and enhance pain.
3tudies have also shown that people can be trained to separate out the sensory intensity of pain from its unpleasantness, and to quantify each selectively.
Imaging shows that two different parts of the brain are involved. ,easuring the level of sensory intensity is associated with activity in the primary
somatosensory corte$, whereas the unpleasantness is associated with activity in areas of the frontal lobe corte$ usually associated with emotion .the anterior
cingulate and insular cortices/. In fact, certain surgical procedures, such as modified frontal lobotomies, can markedly reduce the suffering of severe pain
without affecting its sensory intensity. This implies that the emotional aspects of an injury may be more significant than the e$tent of its physical damage in
determining how intense we perceive the resulting pain to be.
Pain Treatment
In addition to the body's own mechanism, there are a variety of approaches to treating pain. The best approach, of course, is to identify the cause and remove
it. This should always be the primary goal. 4nce you or your doctors have identified the cause of a pain and, if possible, treated it in the best way, that pain
no longer serves its purpose and should be eliminated as quickly and completely as possible.
Pain relievers .analgesics/ are the most common over*the*counter medications, and they are quite effective against most everyday pains. 3ome people are
reluctant to use these drugs, feeling they should &tough it out( or use natural methods of pain relief, such as muscle rela$ation. It is true that pain depends on
psychological factors, and the e$perience can thus be affected by our attitudes and mental states. +evertheless, pain is, by definition, not enjoyable. There is
no reason to prolong it if it is interfering with your comfort, performance, or sleep.
Physicians can also prescribe more powerful drugs to counter pain due to a bad injury, surgery, cancer, or other causes. The most common mistake health
workers make in treating someone in pain is to give an inadequate dose of these medicines out of fear that the person will become dependent on them. The
treatment goal should be relief of pain. There is no reason to delay treatment for acute pain, and there are strong arguments for immediate treatment. "irst
of all,because of the tendency of pain to increase with time and the fact that lower*intensity pain responds better to drug treatment, earlier treatment may
require less medication and therefore cause fewer side effects. This is particularly important for intermittent pain that has the potential to become severe,
such as in the case of a migraine headache. "or acute pain, there is no e$cuse for withholding powerful painkilling drugs such as morphine. If these drugs are
used correctly, the risk of addiction is infinitesimal.
chronic pain is a serious problem but is often made worse by misinformation, negative
attitudes and beliefs, outdated ideas, negative emotions. It is recognised that chronic
pain is often mismanaged, not because we lack ade3uate treatments, but because of
fear and ignorance. #hese steps are designed to help you mentally cope with chronic
pain in the best way possible.
4. &ake sure you understand what kind of a problem pain really is.
5hronic pain is different to other medical problems, which can often be treated
relatively easily and successfully. 5hronic pain is a complex illness, caused and
maintained by a combination of physical, psychological and neurological factors.
#hese multiple causes make it difficult to pinpoint any one cause for pain, or any one
treatment. Pain is also often dismissed or poorly treated because of the 6baggage7 of
old ideas about pain 8 for example, pain where the physical cause is unknown is often
undertreated. #his is despite the fact that the role of neurological factors means pain
can occur in the absence of external causes and that such pain should not be dismissed
or considered abnormal.
#he medical establishment has struggled to meet the challenge of pain, and now
recognises that this problem cannot be overcome without combining input from other
disciplines such as psychology and physical therapies. Pain is also a subjective
experience which is impossible to accurately measure. Pain involves a range of
emotional reactions including anxiety, fear and depression.
9. Acceptance
5hronic pain is so awful that sometimes it7s easier to escape into wishing it had never
happened, or hoping for a miracle cure. If persistent, these common reactions to pain
can actually become a bit of a trap. :ou need to face the reality of what7s happened,
and find constructive ways of dealing with it.
Acceptance means more than just intellectually knowing that you have pain, it means
actually allowing yourself to feel the anxiety, fear, anger and grief that go with pain.
Acceptance is a process, which re3uires progressively acknowledging all your
feelings, and getting your physical and emotional needs.
In order to accept and go through the negative emotions associated with chronic pain,
you must have ade3uate safety and support. ;afety means having ade3uate control
over your pain through the right combination of medical, physical and psychological
treatment inputs. ;upport means having ade3uate emotional support from family and
friends giving you a feeling of containment and security.
#he end product of acceptance is reduced pain, inner peace, less anxiety and better
coping.
<. #ake 5ontrol.
After many months or even years of pain and failed treatments, its easy to slip into
feeling hopeless and that nothing can be done. Pain sufferers are often the butt of
negative treatment and it7s easy to end up feeling angry and victimied. #hey often
have some justification for feeling this way.
&aybe you didn7t cause the pain, and maybe you aren7t happy with some aspects of
your treatment, but guess what= 8 life isn7t fair. %laming others for your problems,
however well(justified, turns you into a victim and is like giving away control of your
life. :ou are allowing yourself to be led by your emotions, but you do have a choice.
#ake the easy path .which isn7t really so easy/ and simply blame others, or take
control and get information, communicate assertively with your doctor, practicing
pain(management strategies such as regular exercise, pacing and relaxation and stress(
management.
:ou need to decide whether you want to be a victim or a survivor, a passenger or a
driver. :our pain is no(one else7s problem but your own. :ou do have rights and even
responsibilities as a health consumer and a patient. %ecause chronic pain is difficult to
detect or measure, you need to be an informed, active participant in your treatment.
-on7t be afraid to ask 3uestions, don7t be afraid to tell the doctor what you think and
what you want, don7t be afraid to ask for stronger pain relief.
0. +ave a good working relationship with your doctor.
An open and trusting relationship with your doctor is essential. #his means being able
to tell your doctor how you feel, ask 3uestions and feel listened to and understood.
#he doctor(patient relationship must be a two(way street. Although you rely on your
doctor7s >expert? opinion for treatment advice, he depends on you for accurate
information on which to base his decisions. It is your responsibility to describe your
symptoms as accurately as possible and to report back regarding treatment outcomes,
even if unfavourable.
@nder(reporting of pain has been identified as one of the biggest causes of
mismanagement of pain. #he doctor(patient relationship can be undermined by bad
communication, ignorance, arrogance and fear. 'or example, many people are actually
afraid to tell their doctor how they are feeling for fear of being labelled as weak or a
complainer. Ather patients report down(playing the severity of their pain because they
don7t want their doctor to feel like a failureB
:ou should feel that you can talk to your doctor, that he listens and respects you, and
be satisfied that he is working competently and thoroughly on your behalf. :ou also
have a right to change doctors if you are dissatisfied.
C. !ever ignore pain.
In the treatment of chronic pain it has become fashionable to recommend ignoring
pain .after medical investigations are complete/ in the belief that it is only pain and
there is nothing physically wrong.
#his approach represents a pendulum(swing away from the old fashioned notion of
prescribing bed(rest in favour of maintaining activity. #he idea is that inactivity only
leads to depression and does not help the problem anyway.
+owever, with certain types of pain, this can lead to a cycle of aggravation, sleep
deprivation, exhaustion and increased pain and suffering, particularly if you are
someone who typically ignores pain .ignoring pain is of course, what causes most
repetitive strain injuries/.
#he other problem with ignoring pain is that every time pain occurs, it leaves an
imprint in your nervous system, a kind of 6pain memory7. #hese repetitive pain
experiences lead to overstimulation of the nervous system and the generation of
spontaneous pain signals, leading to a cycle of stress and pain. #here are thus sound
reasons for wanting to avoid pain, but again, total inactivity is not the answer. #he
best approach is a balanced one with paced activity levels and avoiding undue
aggravation of the pain.
D. +ave a balanced approach to physical activity.
It can be tempting to adopt a >do nothing? approach, in the hope that you may avoid
further pain. As we have indicated, since chronic pain is partly caused by neurological
changes, avoiding activity will not stop the pain. Avoiding activity also leads to
muscle wasting and a build(up of waste(products in the tissues, which can actually
exacerbate pain.
At other times, you may feel frustrated and force yourself to complete relatively major
tasks .eg mowing the lawns/ knowing that it will hurt later. #his may cause you to
have to take two days of bed rest to recover. #his >all or nothing? approach is
inappropriate and ineffective in the long run.
:ou need to pace activity levels. :ou can do this on your own, via >trial and error? or
with a bit of 6coaching7 in the form of professional help. #he support and guidance of
a sympathetic health professional is highly desirable to maintain motivation and deal
with fears and obstacles along the way.
E. ;leepB
2oss of sleep caused by inade3uately managed pain can lead to a cycle of fatigue,
depression and irritability. Inability to sleep, or waking up feeling tired, are signs that
your pain is not being managed properly. -eveloping a restful sleep pattern is
essential to coping with chronic pain. Improving your sleep will give you more energy
and help you feel more able to cope.
#here are many things you can do to get better sleep including relaxing, perhaps by
taking a hot bath, listening to music or playing a favourite relaxation tape before
going to sleepF self(hypnosisF a good mattressF postureF medicationF and good overall
stress(management.
G. &ake sure you have ade3uate support.
&any chronic pain sufferers become isolated, alienated from loved ones, their work(
mates and society. Inade3uate social or emotional support can lead to isolation,
depression, and increased risk of suicide. People who normally pride themselves on
being independent and not needing others are particularly 6at risk7.
@nfortunately, the negative reactions of others can discourage chronic pain sufferers
from talking about their problems or seeking help. #he unhelpful reactions of people
you thought you could rely on can be very disappointing, it7s another thing that falls
into the 6life isn7t fair7 basket.
#he reality is it7s simply ridiculous to expect yourself to be able to cope on your own
with a chronic illness that robs you of your ability to work love and play. +aving
ade3uate emotional support greatly increases your ability to cope.
#alking to close family and friends is vital. A family talk with your doctor of
psychologist can also help by enabling them to learn more about your condition and
talk about things in a neutral environment.
H. -on7t expect people who don7t have pain to understand what it7s like.
It7s frustrating, and easy to get angry when others don7t seem to understand. +owever,
because chronic pain sufferers often have no visible injury, it is easy for family and
friends, and especially children, to forget there is anything wrong. #hey may also
6forget7 because it is hard for them to have to live with the knowledge that a loved one
is in pain.
;o don7t expect people who don7t have pain to understand what it7s like and be
prepared to have to remind others about your limitations. 5hildren especially cannot
be expected to understand the implications of a condition like chronic pain. It7s a
lesson that has to be repeated many times.
41. 'orgive yourself.
#he lost ability to work, love and play caused by chronic pain can create feelings of
guilt and failure. %ecome aware of your own expectations, and any feelings of shame
or guilt and examine them critically. 5hances are you didn7t ask to be in pain.
Iepressed feelings of shame lead to resentment and later emerge as anger. 'eeling
guilty can also be a subtle form of self(indulgence 8 when you engage in self(blame
you are really wallowing in self(pity.
'orgiveness and letting go of guilt will be easier if you choose a proactive approach
by adopting these 41 ;teps.
#his information is provided by &ark Jrant to assist you to participate actively in
your treatment and cope with chronic pain in the best way possible.
K :our spinal cord is a complex array of bundles of nerves, transmitting all
kinds of signals to and from the brain at any given time. It is a lot like a
freeway for sensory and motor impulses. %ut your spinal cord does more than
act as a message center: it can make some basic decisions on its own. #hese
>decisions? are called reflexes.
K An area of the spinal cord called the dorsal horn acts as an information hub,
simultaneously directing impulses to the brain and back down the spinal cord
to the area of injury. #he brain does not have to tell your foot to move away
from the rock, because the dorsal horn has already sent that message. If your
brain is the body7s 5LA, then the spinal cord is middle management.
Pain is not just a message from injured
tissues that must be accepted at face value,
but a complex experience that is thoroughly
tuned by your brain. There is no pain without
brain. Many discoveries about the physiology
of pain1 2 have been painfully slow to reach
the public, or even health professionals. This
nowledge is useful and needs to be shared.
Professionals need it so that they can retreat
from some unfortunate old attitudes about
pain problems, such as, !if " don#t understand
it, it must be all in your head$ at one
extreme, or !if it hurts, there has to be a
tissue issue$ at the other. Patients with
chronic pain need reassuring perspective and
the bene%ts of greater con%dence and
mental health.
&veryone needs to stop thining in terms of
single causes or cures' !"t#s all coming from
the ((((, " now it)$ *early all chronic pain is
a witch#s brew of di+erent factors, complex
by nature ,not just coincidence or bad luc-.
.t the very least, pain always has a layer of
brain/generated complexity. The complexity
of pain maes it harder to beat overall, but it
also means that some factors are more
treatable or manageable than others 0 if you
have a modern understanding of how pain
wors. " can hardly imagine a better
argument that we need a more biologically
literate society)