Understanding Pain’s Role in Injury
Pain is the body’s protector. It plays a role to help keep the body safe based on past experiences and the information it receives. Pain is produced in the brain. We get sensory information from our body and that is carried up to the brain, the brain decides if the sensation was a threat or not. If the brain decides that the sensation was a threat then a signal is sent back down to our body to feel pain.
Phases of healing
When we have an injury, our body triggers the healing response to any tissue damage. The phases of the healing response include:
Hemostasis
Inflammation
Proliferation
Remodeling/maturation.
The role of the hemostasis phase is to stop the bleeding immediately following the injury by clotting blood to prevent loss of blood. Next, the inflammatory response occurs within 24 hours of injury and typically lasts about 2 weeks. The inflammatory response is responsible for bringing cells to the site of injury to clean up dead and damaged tissue. During the proliferation phase cells are working to restore structure and function of the injured tissue.
During the injury, pain is experienced, and the pain system is doing its job to stop further tissue damage in the body. Pain is also helpful during the inflammatory and proliferation responses. It provides information on how much activity the body can handle as tissues heal. The final healing phase is remodeling and full healing can take up to a year.
Pain as a protector
I like to compare pain in the body to a house alarm. The alarm goes off if the window is broken by a burglar and everyone gets out safely. The alarm did its job. Just like pain does if we touch a hot stove. We get pain and immediately remove our hand. Pain did its job to prevent further damage.
But pain can also be unproductive if the system is compromised. This can happen if the body’s experiences, perceptions, and fear affect injury recovery by becoming hypervigilant.
If I compare the broken window getting fixed to the body healing above, it is like after the window is replaced and a leaf blows hitting the window, the alarm goes off. That is not productive because the leaf is not a threat. The same thing happens with pain. If there is a dysfunction in the system, then pain can be produced and very real, even if the activity being performed isn’t a threat and the body has healed.
Mind and body
The brain controls the mind and the body. With all of the intricacies of pathways in the brain, it is impossible to separate mind and body. Emotional stress can be stored in the body physically, just like physical pain can take a toll on emotional wellbeing.
The body can also remember trauma whether it’s conscious or not. So sometimes after injury, even if the body has healed from it, we can continue to feel pain. Our body thinks it is being helpful, but producing pain with the most basic tasks and small movements that actually are safe, are hindering recovery in the long run.
Pain is very individual and needs to be treated that way. Addressing the overactive pain system is just as imperative as addressing the physical impairments. Mindset and positivity can actually make physiologic changes in the body. You can also retrain your pain system to decrease its response if you are getting unproductive signals. This is why I take a mind and body approach to treatment.
References:
Institute of Medicine (US) Committee on Pain, Disability, and Chronic Illness Behavior; Osterweis M, Kleinman A, Mechanic D, editors. Pain and Disability: Clinical, Behavioral, and Public Policy Perspectives. Washington (DC): National Academies Press (US); 1987. 7, The Anatomy and Physiology of Pain. Available from: https://www.ncbi.nlm.nih.gov/books/NBK219252
Schultz GS, Chin GA, Moldawer L, et al. Principles of Wound Healing. In: Fitridge R, Thompson M, editors. Mechanisms of Vascular Disease: A Reference Book for Vascular Specialists [Internet]. Adelaide (AU): University of Adelaide Press; 2011. 23.Available from: https://www.ncbi.nlm.nih.gov/books/NBK534261/#
Mehra, L., & Gupta, P. (2023). Biomaterial-based fibers for enhanced wound healing and effective tissue regeneration. In N. Sharma & B. S. Butola (Eds.), Fiber and Textile Engineering in Drug Delivery Systems (pp. 73-96). Woodhead Publishing. https://doi.org/10.1016/B978-0-323-96117-2.00005-4