Pain

What is one of the main reasons any individual decides to book in for physiotherapy?  

“Pain…”  

What are the most common questions a physiotherapist will ask upon arrival?  

“Do you have any pain…?”  

“Where is your pain…?”  

“How severe is your pain…?” 

But how do we define pain? What exactly is it and why do we feel it?  

The Oxford English Dictionary makes reference to noxious (harmful) stimuli and tissue damage with its definition. However, how I like to think of it is more applicable and individually relevant through a quote by McCaffery & Beebe in 1999.  

“Pain is what the person says it is, existing whenever the person says it does.”  

We know and have seen that two separate athletes can have full ACL ruptures in the same knee and yet one can be in instant agony and the other can keep playing for 15 minutes without even knowing something is terribly wrong. In this case we definitely have quite significant tissue damage, yet the perception of pain is vastly different between the two athletes. Why? 

Pain is a complex experience that is based intricately on the contributions of thoughts, emotions and sensations. Therefore it is crucial that we as treating physiotherapists not only understand the elements of the pain gate theory – how pain is actually produced by peripheral and central sensory pathways within the nervous system – but also have a grasp on the biopsychosocial factors of a patient’s life which can reduce, nullify or intensify experiences of pain.  

This is particularly emphasised when assessing and treating chronic pain presentations, whereby extended periods of time dealing with pain have changed the way in which it is perceived by the individual. The biological, social and psychological contributions to pain show us that pain can be a reflection of the current state of a person’s tissue but does not provide a severity measure of this presentation – as seen by the ACL example above.

Ultimately, pain is protective. This protective phenomenon may not be an accurate indication of actually doing any harm. It is a sensation produced in order to:

protect or prevent damage
bring about fear caused by previous trauma for similar experiences
change behaviour to avoid painful thoughts and/or emotions

Physiotherapists are optimally placed to offer reassurance to patients who fear their pain or are experiencing functionally limiting pain. We have the clinical expertise to educate and facilitate supervised excercise programs in accordance with relevant meaningful goals. We are here to not only assess and treat pain presentations on a superficial level, we strive to understand the individual and their biological, social and psychological factors in order to address pain across its complex spectrum.

Some of our most common used treatment techniques used to combat pain include but are not limited to:

• soft tissue massage
• stretching – tension/spasm relief
• joint mobilisation
• dry needling
• corrective exercise
• postural awareness
• hot/cold therapy
• education on the causes of your pain and providing relevant advice

If you or someone you know is experiencing pain and are ready to improve function, tick off your goals and begin enjoying an improved quality of life, then book in with one of our experienced physiotherapists and start to address your presentation in a way which is meaningful to you.

Remember… ”Pain is what the person says it is, existing whenever the person says it does.”