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What is pain?

Pain is always a subjective experience that is influenced to varying degrees by biological, psychological, and social factors. So, what are these Bio-Psycho-Social factors?

  • Pain can depend on peripheral factors like tissue damage, injury and inflammation (the bio part)
  • It also depends on perceptions, beliefs, thoughts, emotions, and social stress (the psycho social part).
  • It is also complex, meaning these different factors interact in ways that are often individual, context-dependent, environment dependent, and unpredictable (the social part).

Pain, input or output?

  • Pain is the OUTPUT of a highly sophisticated protective system that functions like an alarm. Potential threats to the body are detected in the periphery, and then communicated to the brain. The brain interprets the meaning of the information and creates pain if it perceives the need for protection. The sensitivity of this system can change based on many different factors, including injury, inflammation, emotions, stress, memories, and general health.

Are pain and tissue damage strongly related?

  • Because pain depends on perception, tissue damage does not always cause pain, and vice versa, pain can be felt in the absence of tissue damage. For example, people pain free, frequently show significant damage on MRI, and back pain usually cannot be linked to any specific pathology (non-specific back pain).

Is bad posture connected to pain?

  • The link between pain, posture and allegedly defective movement patterns has been overemphasised. Research shows very poor correlations, and often no correlation, between these factors. Furthermore, pain treatment focused on correcting specific “dysfunctions” rarely or never outperforms general exercise.

Is it important to understand pain?

  • On the other hand, psycho social factors have been overemphasised. For example, anxiety, catastrophisizing, and fear of movement increase the risk for chronic pan, while optimism and self-efficacy predict recovery from injury. This is why educating patients plays a crucial role in the recovery.

By Emanuele Calabrese

Consultant Osteopath and Head of Rehabilitation at RRMG

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