The 5 W’s of Pain

Pain is one of the central factors affecting our quality of life. Pain can also be one of the most debilitating experiences. On one hand, pain can be a good thing that is essential to protect us and to warn us of impending danger to our bodies.  Pain can protect our body while it is healing and help us avoid further damage. On the other hand, pain can be frustrating, all consuming, and affect many aspects of our life – emotionally and physically.


All of us have experienced some degree of pain in our lives. Most things in life worth learning involve some degree of falling, getting hurt, and getting back up again! Furthermore, as we age, we are at more risk of suffering from pain due to illness, disease, arthritis and musculoskeletal injuries.


Pain is a feeling triggered in the nervous system. There are many descriptions of pain – it may be sharp, dull, constant, intermittent, localized or all over. Pain can come from many different sources in our body such as skin, bone, muscle, vascular and joints.  To simplify, there are two stages of pain: acute and chronic.  Acute pain is our alarm system. This tells us that something harmful is happening to our body. Pain lasting 3 months or longer is classified as chronic. In the chronic stage of pain, both physical and emotional stress is involved.  It is not always clear what causes chronic pain. 

A thorough medical examination is required to rule out serious conditions such as infections, rheumatoid arthritis, thyroid issues, and autoimmune disorders.  Less serious, but still medically important to address are issues such as fractures, ligament sprains, muscle/tendon tears, nerve root compressions, whiplash injuries and the like.  With an appropriate treatment plan of physical therapy – such as joint mobilizations, exercises, and muscle retraining – many of these musculoskeletal conditions will typically heal in 6-8 weeks. Why do some issues go on for months or even years?


In order to understand our natural stress response, it is helpful to understand a bit about our nervous system. The nervous system is a complex network of information “highways”. This consists of our central nervous system – the brain and spinal cord, and our autonomic nervous system – branches from the spinal cord that reach our extremities, bones and organs.  The autonomic nervous system (ANS) controls our internal environment and consists of the sympathetic nervous system and the parasympathetic nervous system.  The sympathetic nervous system (SNS) facilitates our “fight or flight” responses. When we sense fear and danger our SNS kicks in to increase the heart rate, raise blood pressure, reduce digestion, increase ventilation, and cause certain muscles to tense.  This is all good news for our survival when we have an emergency to react to.   Adrenalin and cortisol are two key hormones responsible for the body’s reaction during the fight or flight response. This natural stress response is usually self-regulating. This is where the parasympathetic nervous system comes in – our “rest and digest” response.  As the adrenalin and cortisol levels drop, the body lowers the heart rate, lowers blood pressure, increases digestion and returns to a happy balance.

If stressors in life are always present, you are constantly feeling stressed, fearful, tense, or nervous, the fight or flight response system stays turned on.  The long -term activation of the stress response system, and the subsequent overexposure to cortisol and other stress hormones, can disrupt your body’s natural processes. This puts you at risk of many health related problems.

Many research studies have focused on the emotional aspects of chronic pain. Results show that fear, depression, perceived injustice (ie. not my fault!) and catastrophization of pain were significant risk factors for the development of chronic pain.  Another study showed that thoughts alone can trigger an inflammatory response in tissues due to the activation of the autonomic nervous system (natural stress response).  This overload of the fight or flight response in our body eventually lowers our pain threshold. This means that postures, movements and activities that normally do not cause pain, start to become aggravating and painful.  This is known as nervous system hypersensitivity, or hyperalgesia.

This hypersensitivity, and subsequent chronic pain, is driven by a cycle of inactivity, sleeplessness, irritability, negative emotions = release of stress hormones = more pain!  Fortunately many studies have also focused on how to decrease this nervous system hypersensitivity. There is a way out of this vicious cycle of persistent pain! Studies have shown that exercise, sleep, laughter, hopefulness, positive thoughts and emotions all play a role in the release of endorphins (“happy chemicals”) and thus help to decrease hypersensitivity and raise our pain thresholds.


When to take control and reduce your potential risks? Start now! Studies show that people who learn to actively cope with pain have better recovery. To prevent sliding into that vicious cycle there are steps you can take to reduce your pain, whether you have an acute injury or suffer from chronic pain.

We all experience some degree of natural degeneration and wear and tear in our joints – but muscles, joints, and spinal discs become unhealthy with prolonged inactivity.  Begin a progressive exercise program, maintain a healthy diet, hydrate, use relaxation techniques, BREATH, yoga, cycling, swimming, use of mobility aids,  strength and flexibility programs.  These are all ways that can facilitate blood flow, improve mobility, improve your sleep, release endorphins and help to improve your mental health.  As studies have shown not only physical efforts but positive thoughts and good mental health make a difference to our pain thresholds.  When there is so much accessible information out there it is easy to be misinformed and get into the habit of self- diagnosing. This can perpetuate the fear of pain, and the hopelessness that has been found to influence the chronic pain cycle.  Ensure you take baby steps and pace yourself. This will help your system slowly adapt and gradually reach that happy balance once again.


Where to seek help? As physiotherapists, we have extensive knowledge of how the body works and have specialized hands-on skills to assess, diagnose, and treat symptoms of illness, injury and disability. Our goal is to restore your strength, function, movement and overall well-being.  We will assess strength and weaknesses, gait, posture, balance, joint range of motion, and functional movement.  Our treatment includes education (a big part of demystifying pain and injury!), exercise, and manual therapy. This may include joint mobilizations, muscle trigger point release, Active Release Techniques (ART), acupuncture/IMS, and muscle pattern retraining.  How can these techniques help to affect pain?

Manual therapy techniques can stimulate and elongate connective tissue surrounding joints and help to activate nerve structures that are transmitting pain signals to our brain. Acupuncture has been shown to stimulate the release of endorphins and other neurotransmitters like seratonin (a mood enhancer). Exercise promotes physical and mental health and improves sleep.  So, laugh a little, smile and get moving right on into Bragg Creek Physiotherapy so we can help you!