Pain Theories - Why do we hurt?
Again, pain is complex, and many patients want an explanation and relief. There are several theories around pain and pain suppression that have served as a foundation for the use of some physical agents (e.g., electrical stimulation) and others that are developing with ongoing study and research.
Nociception is the ability to detect and perceive pain from an external stimulus. Persistent pain is increasingly considered a pain experience - one that can present without a preceding external stimulus.
Caution: Pain is a perception. Pain has shifted toward a biopsycholsocial (body, behavior, and environment) model for the pain experience, and involves cognitive and physiological processes. Be very careful when trying to explain or account for pain using theories as a basis for your explanation. Speak to what you can support with resources and evidence, and simply be aware that theories around pain and pain modulation continue to be studied and evolve.
BIopsychosocial considerations for pain modulation
Endogenous opiates are neurotransmitters released in the body which provide analgesic effects (block effects of pain signals). Some are short-acting (enkephalins) and others are longer acting (endorphins). Endorphins concentrations in the tissues have been shown to increase with:
- intense pain
- intense exercise
- acupuncture
- laughter
- meditation
- relaxation
- electrical stimulation
Persistent pain management includes patient education in building confidence in movement, developing skills in pacing and prioritizing, using self-care tools for modulating autonomic nervous system (ANS) arousal (the "fight or flight" response). Tools for ANS regulation include topicals, aromatherapy, journaling, breathing and imagery. Fear avoidance behaviors around movement and activity can increase nervous system irritability and trigger the primary pain cycle from prolonged tension or holding patterns.
As discussed in the "Explain Pain" video from Unit 1, patients who experience persistent pain should coached in methods to distinguish "hurt from harm" and to "go to the pain, not through the pain". For some, pain is constant. Pain management are skills a patient learns to maximally function while applying techniques that use the brain to change pain.
