Your brain and pain: what is chronic pain, and can personal trainers help you to overcome it?

What is pain?

 “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.”- The International Association for the Study of Pain 

 Pain overall is hard to describe. Yes, it is an “unpleasant sensory and emotional experience,” but it is much easier to explain biologically. We are able to feel pain through our nervous system, of which there are two parts; the central nervous system- the brain and the spinal chord, and the peripheral nervous system -the sensory and motor neurones. These two systems work perfectly hand in hand. The peripheral nervous system senses the environment around us and sends this information to the central nervous system, where the brain and spinal chord use this information in order to coordinate the appropriate response.

How does the nervous system sense pain?

This is exactly what happens when we perceive pain. Special pain receptors in our skin called nociceptors, sense the compression of the skin when we experience tissue damage.  With the example of a runner, if you twist your ankle whilst running, the nociceptors will detect the tissue damage in your ankle and fire off. When the pain receptors fire, they send electrical signals through the sensory neurones, which direct the signals to your spinal chord. Interestingly the initial response is an unconscious one. The spinal chord, understands that you have tissue damage in your ankle and decides the appropriate response, most likely to stop running, eliminating further pressure on the ankle. The response is sent via the motor neurones to the effector muscle (the muscle that brings about the response) to cause you to fall over and stop running. This all happens within a fraction of a second.

 In short, the pain is perceived via the nociceptor, understood by the central nervous system and the pain temporarily mitigated by the effector muscle.

But How does the tissue damage heal?

 Just because we have stopped running doesn’t mean the pain has gone away. Instead, the   pain signals from the nociceptors also travel to the brain, where the healing process begins. The brain asks a series of questions; what was the cause of the pain, was this pain worse than previous pain you have experienced, have you ever experienced pain in your ankle from running before? In this way, the pain is catalogued and associated with an experience/ situation. As a result of the brain,  the healing process is a conscious one meaning we sometimes mistake biological pain for psychological or sociological pain. 

What is psychological pain?

Our head PT Simon Green gives two extreme examples of psychological pain:

  1. Phantom limb syndrome. This occurs after a limb tissue has been so badly damaged that it has to be amputated. After amputation, theoretically, the patient should not feel pain from the damaged tissue, as it has been removed. However, many experience further pain, as their brain has experienced so much pain from this area that it continues to do so.
  2. Situational pain. An example: a client may have experienced tissue damage in a car crash. Now everytime they see/are in a car, they experience pain more than when not seeing a car. 

In both situations, the pain is psychologically linked to an event. Therefore,  in the absence of physical damage  or even when previous biological damage has completely healed, the nociceptors continue to fire. 

How do I know if I have psychological pain?

Psychological pain is not easy to understand as all pain is multifaceted. Simon relays that “clients with chronic pain (persistent pain that lasts more than 12 weeks) feel like they can’t move their painful area, preventing them from moving in a certain way and limiting their lifestyle.”

 For long term or chronic pain, psychology and sociology play a bigger part in the continued cause of the pain than physical damage, which means we should change the ways in which we can manage or treat it. Simon reassures us that this is where the help of a personal trainer really benefits. He continues, “If the pain is simply psychological,  instead of clients seeing pain as a sign of damage and to rest, PTs can change their perception of pain using useful exercises and tasks in a fitness session. In this way, they can get their movement back on track.”

At this point, it is important to remind ourselves that if we are feeling pain we should first and foremost seek a medical professional for advice and a diagnosis. Simon asserts that “PTs should never diagnose the pain. If a client comes to us asking about the source of their pain, we first of all advise them to see a doctor. After their diagnosis or confirmation that exercise is an appropriate next step, we carefully consider the injury. This includes assessing which area is injured, the advice of the doctor and the science of their injury, to tailor the training session around eventually easing this pain.” 

Medical diagnosis, assessment by the PT, followed by personalised training is the perfect recipe for getting your fitness success back on track.

So what is the training plan?

Initially, the main training strategy is a game of distraction: can we get a client to move the painful body part in a way that doesn’t hurt or without noticing that they are?

Simon explains how training distally to the affected area achieves this goal at the start. “We try to move body parts furthest away from the painful area first. For example if you have a knee injury, we will try to do exercises that focus on, for example, your shoulders. These exercises will still incorporate movements of the knee, but just in a smaller range of motion. We can then see whether the client has noticed their pain. Over a few sessions, we can do more and more training which incorporates the knees and see if the pain is still 

present.” Simon asserts that “science is still the priority. If the knee is still hurting a lot, we consider changing the exercise plan or advising the client to go back to the doctor for a further assessment.”

 Overall, the training is  fun and task-focused, with the training schedule made to fit around the client’s personal goals. Personal drive is key for recovery, and recovery time mostly depends on the motivation of the client. 

What can we conclude:

  • Pain is a sensory and emotional response, not only to biological damage, but psychological and sociological damage as well. 
  • Our body reacts both consciously (with the brain) and unconsciously (without the brain), in order to react to the pain we feel. 
  • Psychological damage occurs because the pain is associated with an experience/ situation, therefore we can feel pain in the absence of physical damage.
  • Although pain is multi-faceted, PTs can help rethink this pain using personalised exercises and tasks, to help movement of the painful areas and slowly help release the pain. 
  • It is important to remember that PTs can ONLY help after a diagnosis is given by a medical professional. 
  • Science is key- training sessions are tailored around the medical advice of the injury
  • Chronic pain does not have to be life-limiting. Personal motivation, the right people to assist you and a new perspective on your pain will help lead to recovery.

References: The International Association for the Study of Pain-