Pain: Why do we feel it?
What is pain?
That is a loaded question with a complex answer! To give a simple explanation, “it is an unpleasant sensory or emotional experience that is unique to the individual.” The key word being “unique” as perceptions of pain and how to it relates to our physiology can be quite complex. We deal in evaluating the cause, alleviating, and managing musculoskeletal pain in our patients. You can have the best physical therapist in the city of Miami with a huge knowledge base, but it is equally important for YOU as the patient to have a fair understanding of what causes your pain. That is the purpose of this blog: to help you understand the different constructs that contribute to pain.
Physical Construct
Plain and simple! This is the actual structural deficit contributing to pain, examples include: herniated lumbar disc, muscle strain, ligamentous sprain, and/or tendonitis. Damage to these structures are detected by the peripheral nervous system via “nociceptors”, that information is relayed to your central nervous system (spinal cord and brain) which allows you to interpret where pain may be occurring.
A common example is when you “roll your ankle” (an inversion ankle sprain). As a result, when ligaments are stretched beyond their ability to resist it causes a sprain. The central nervous system receives this information. Then you are aware of the damage that has occurred in a specific area of your body via pain signals.
Rational Construct
This construct relates to the individual’s understanding of their pain. This construct is often where providers such as medical doctors and/or physical therapists are sought out for consultation, particularly for pain that does not resolve on its own. We rely on diagnoses based off the provider’s evaluation to help us understand what is causing our pain and what we can do about it.
Emotional Construct
This construct can be more complex to understand. It is mainly associated with fears that develop due to loss of functional abilities since pain has begun. This is often influenced by:
- Cultural Beliefs
- Upbringing
- Coping methods
These constructs influence one another and are interdependent. We are going to jump right into the problem of the emotional construct becomes one of the dominant contributing factors.
How do we implement this model in physical therapy?
When we see patients, at times they have been experiencing chronic musculoskeletal pain ( lasts >3 months). This can begin to influence how a patient feels at an emotional level, where conditions such as fear of movement tend to form. The patient can then begin to develop irrational fears regarding their pain. For example, absolutely avoiding picking objects up from the ground due to lower-back pain.
As physical therapists, we assess and determine the cause of musculoskeletal discomfort and identify the mechanical & physical cause of the pain the patient is experiencing through detailed testing. At this point of the evaluation, we discuss examination findings with the patient and help them rationalize it through detailed explanations and helping them understand that this is treatable. What is often seen is the emotional construct growing smaller and is now balanced with these other constructs. The patient should then have a good understanding of how to collaborate with their physical therapist.
We hope that this has helped you gain a further understanding as to what it is, why we feel it, and how physical therapists can help you understand it. It is a complex case, but in our explanations, we can help empower you to know that it can be treated and reduced. Are you feeling pain or discomfort in your body?
What’s Next?
We can help! Contact us today and our team is ready to assist and help your body become pain-free. You can also check out our Youtube channel and see what patients have to say about their positive experience with us! You can also watch our video series on yoga for back pain here. Want to read more on specific types of pain? Read our blog on the how tight hamstrings can cause low back pain.
Written By: Dr. Stan Sowinski, PT, DPT, MTC
Citation:
Paris, S. V. (2015). FCO Foundations of Clinical Orthopaedics. The three elements of pain.