For most people, pain is pretty simple: something hurts. If I were to ask you to think of something that has commonly caused you pain (go ahead and think of something) you may think of stubbing your toe, touching a hot pan, or nicking a finger with a knife. While these are all actions that may certainly cause pain in healthy individuals, pain is much more complex than just “hurt”.
By definition, pain is an unpleasant sensory and emotional experience which follows actual or potential tissue damage or is described in terms of such damage. Key points to take away from this definition are that 1) Emotions contribute to pain, 2) Pain can be described in terms of damage even if no harm or potential injury has occurred, and 3) Pain is an experience.
There are generally three types of pain: nociceptive, peripheral neuropathic, and nociplastic. When describing how pain works, we will be talking about nociceptive pain as it is the most common and easiest to understand. In general, nociceptive pain is when a mechanical stimulus (stubbing your toe) or chemical (acid burning a hand) stimulates neurons (called “nociceptors”) to send signals to the brain. However, as just noted, pain is more than just hurt. The signals sent to the brain are not, in and of themselves, painful.
Pain is a multifactorial experience. The amount and type of pain you feel depends not only on the number and type of nerves triggered and how they send signals to the brain, but also on your culture, spirituality, behavioral habits, current emotional and mental state, and how you grew up. Each part plays a role in your pain experience. One person who stubs a toe may perceive the pain differently than another person with a different background. In fact, the same person who stubs a toe during a fun race around the kitchen may perceive less pain than if they were to stub it when getting home after a stressful day at work.
When the brain is imaged during painful experiences, no single brain center lights up. Though much occurs in the sensory cortex, multiple areas all across the brain are active. Each area is a part of the pain experience and responsible for processing and interpreting the signals sent by the nociceptors. How the brain interprets these signals can differ from person to person and from situation to situation.
A simple example of this is when a child falls and scrapes a knee. If they are with their friends or alone, often times they act fine, curiously look at their cut, and get up to continue playing. However, when they see their parents, they start crying uncontrollably. The scrape on their knee didn’t magically worsen but the perception of the pain had still changed.
Of course, this example uses children who often act irrationally anyways, but the same factors hold true as adults. If you are stressed or are expecting something to be painful, your pain level will probably be increased. Now, all of this is not to say that you shouldn’t comfort a crying and hurt child so they grow up “tough and strong” with a low perception of pain. You most often should care for your kid, but it does point out how even with the same mechanical stimulus, people may perceive pain differently.
However, as we finish up this topic, it is important to know that just because someone perceives more pain with the same stimulus than you or I would, that perception is still real. The pain they feel is real. You cannot simply tell them to feel less pain because others don’t feel as much. Even though with mental, environmental, and behavioral changes it may be possible to perceive less pain over time, in that current situation we must understand that no matter how different their pain experiences may be from ours, it is still real to them.
Jordan Eldridge, DPT student