Explaining Pain

I treat athletes. Athletes suffer from pain. Athletes experience pain. Athletes feel pain.

But do they?

I bring this question up because while many of us subscribe to a biomechanical model of patient management, there seems to be an emerging trend toward a more neurophysiological model. That is, with a therapeutic philosophy that is grounded in reducing the threat associated with pain.

This reminds me of one of my former hockey players who, as your prototypical "tough guy", would seem to have never suffered from pain. In fact, a common response that he (at the age of thirteen) would so often provide me with is that "pain is just an emotion". 

Maybe he was right! According to International Association for the Study of Pain, pain is defined as:

An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

An experience? Associated with...potential tissue damage?

To understand this further, physical therapist, Diane Jacobs give us this brief example:

...the literature on pain is full of examples of soldiers shot but not realizing it in the heat of battle, football players running around not realizing their leg was broken until after the game, guys falling into ice crevasses, breaking an arm, not being able to climb out with it but not feeling much pain - until rescue and they were up on top in a stretcher in a helicopter, people trapped in overturned cars who cut off their own leg after about a week without a drink, so they can crawl for help and a drink, a guy who got his hand caught by a falling rock ans was trapped for a week in the grand canyon, cut off his trapped hand and escaped. These people probably hurt, but they did not have to deal with actual "pain" while their brains were busy dealing with a greater threat. ... The brain will NOT allow a pain experience to arise until safety is in sight, and it can relax. Then the pain arises. Moseley says, the brain always asks itself, "How dangerous is this? Really?" And it calmly and matter-of-factly deals with its organism's survival on a priority basis. When it's safe, it turns its attention to allowing healing to occur in whatever is broken/ripped/torn. This involves upregulating nociception, and permitting peripheral sensitization.

Although there is still a lot to learn and understand about the notion of pain, a good place for most to start is "Explain Pain" by Butler and Moseley.