When Should PAIN Guide Our Actions?
| by Dr. Matt Weaver, DC |
We have all heard the saying, “no pain, no gain” which has such a nice ring to it. At times, this phrase can be incredibly motivating and in others, it may lead us astray. My goal is to increase our understanding of pain and what kind of pain is okay versus pain that we should let dictate our actions.
I believe that there are elements to voluntarily choosing uncomfortable situations that make us more resilient as humans and do actually provide “gain”. This is why I think that a more precise phrase would be “no discomfort, no gain” ...but that doesn’t roll off the tongue near as well, so that won’t gain any traction.
Understanding the Complexity of Pain
Pain is an incredibly unique and individually lived experience that is difficult to define and even more difficult to empathize with. You can have two people go through the same experience or injury and have very different pain outcomes because there are so many things that contribute to our pain experiences.
The illustration below does a great job of putting some imagery to the complexity of pain:
Pain, injury, and recovery have to be dealt with within the context of the BIOPSYCHOSOCIAL model of care. Let’s break that down really quick:
Biology – This is our physical body… think tissue damage (tear, strain, broken bone, burn, etc…) and nociception which is a fancy word for pain signals traveling to the brain from the tissue that is damaged.
Psychology – The emotional side of things… ie. Depression, anxiety, fear, etc…
Social – The impact of those around us... i.e. How is my support system? Am I engaged with community? Do I have meaningful relationships?
Now that we are operating within the biopsychosocial context of pain, we can start to talk about when to worry about pain and when it's actually okay.
For starters, pain is a normal human experience and trying to live a life to completely avoid pain at all costs is folly. I think that the more we normalize it and live in a way that is expectant, the less surprised we will be when it comes.
Trying to live a life to completely avoid pain at all costs is folly. The more we normalize it....the less surprised we will be when it comes.
Acute versus Chronic Pain
In an acute situation, pain can be a reliable guide for movements that should be avoided in the short term to protect the tissue that is injured. This is a time where is it okay to avoid painful activities and really listen to the painful feedback that you are receiving.
In a chronic situation, pain can be quite misleading at times. Our body is really good at healing but sometimes, pain responses can linger in our nervous system for a long time. Take low back pain for example, 90% of chronic low back pain is non-specific, meaning, there is no identifiable injured tissue that is producing the pain (Kahere et al, 2020). We also know that people experience pain when there is no damage to any tissues and vice versa. People with damaged tissues may experience no pain at all (Caneiro et al, 2021). A great example of this is when soldiers return from war with terrible injuries from the battlefield, yet because they are so overjoyed with the fact that they are home and away from battle, they don’t experience pain (Best et al, 2010).
That is not to say that pain is all in our head. That is something that you should never accept – remember the bio, the psycho, and the social – pain is multifactorial in nature.
In most chronic pain situations, the nervous system is interpreting pain from an area that may not have any tissue damage, but those neurons have learned to fire painful signals from that area. This is referred to as neuropathic or nociceptive pain.
This is why it is important to re-engage with activity and society as soon as you are able to after an injury in order to decrease the likelihood of a chronic pain condition developing.
With chronic pain, it can be difficult to navigate the pain because you may experience some days that are okay and some days that are really bad or a pain “flare-up”. This is where it becomes important to respect the pain, but not be ruled by the pain.
Typically when people experience pain flare-ups after an activity, it has to do more with the dosage of that activity rather than the activity itself. Pain responses can be very sensitive so it is important to gradually expose our bodies to an activity that we want to re-engage with rather than jumping all-in at once.
Let's Simplify and Summarize the PAIN CONUNDRUM --
Acute injury (less than 3 months): Respect the pain and move as much as possible in a pain-free range of motion.
Chronic pain (greater than 3 months): It is okay to perform movements or activities that are painful. Gradually expose yourself over time and keep the pain to less than a 4/10 (10 being worst pain imaginable and 0 being no pain at all.) If you do not experience pain while performing a movement or activity, but then a day or two later you experience a pain flare-up, that tells us that maybe you did a little too much too soon so you need to tweak the dosage of that activity.
Exercise is a great tool to help with pain because you can gradually expose your body to different stimuli that you may experience in the real world, but in a controlled environment. Exercise will also make you more resilient and give you more confidence in your body’s ability to perform tasks on top of the multitude of benefits that it has on your metabolism, cardiovascular system, and mental health.
>> If you are unsure on how to start the process or are in need of some guidance, find a provider that listens to you , values your input, and collaborates with you to create a plan that aligns with your goals.
Whether you’re dealing with an injury (sports, car accident, life) or looking to enhance your physical performance, Dr. Matt can help you. He sees patients at both our Cherry Creek Clinic and our South Broadway Clinic. Click here to see availability.
“I'm not here to fix. I'm here to guide.”
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Dr. Matt Weaver, DC sees patients in-person at The Facility in Cherry Creek and The Facility on South Broadway. He offers chiropractic services for a range of conditions.
Learn more about Matt's Philosophy here.
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References:
Best M, Neuhauser D and Henry K Beecher. Pain, belief and truth at the bedside. The powerful placebo, ethical research and anaesthesia safety. BMJ Quality & Safety 2010;19:466-468.
Caneiro JP, Alaiti RK, Fukusawa L, et al. There is more to pain than tissue damage: eight principles to guide care of acute non-traumatic pain in sport. British Journal of Sports Medicine 2021;55:75-77
Kahere M, Ginindza T. The burden of non-specific chronic low back pain among adults in KwaZulu-Natal, South Africa: a protocol for a mixed-methods study. BMJ Open. 2020 Sep 1;10(9):e039554. doi: 10.1136/bmjopen-2020-039554. PMID: 32873683; PMCID: PMC7467525.
