Understanding Pain: A Journey Through History and Science
In part one of this five-part series, we explored the historical journey of understanding pain as both a sensory and emotional phenomenon. Our goal was to show that pain is more than just a sensory experience; it is shaped by various factors beyond mere nerve stimulation.
Pain is a complex output created by the brain based on multiple sources of information. These include your mental and emotional state, physical health, beliefs, past experiences with pain, and signals from your nervous system. Ultimately, pain has biological, psychological, and social dimensions, all influencing whether your brain generates the sensation of pain and how intense that pain feels.
At the end of the previous article, I highlighted four key takeaway points about pain (click here to revisit them). Today, we will dive deeper into the first takeaway:
“There Are No Such Things as Pain Nerves—Only Nociceptors.”
Over the last decade of practice, helping my patients understand the difference between nociception and pain has been one of the most common challenges I face. This article aims to clarify this important distinction.
What Is Nociception?
Understanding Nociception
Nociception can be defined as the detection of potentially harmful stimuli applied to the body. These stimuli can take many forms, including extremes of heat, cold, mechanical pressure, and chemical signals. Essentially, nociception is the body’s way of alerting us to potential dangers3 .
To put it simply, nociception refers to the transmission of specific signals through the nervous system, which informs the brain that there is actual or possible tissue damage.
Pain: The Final Output
While nociception provides valuable information to the brain, pain is the final output—a sensation and emotional response created by the brain. This output is generated after the brain evaluates all available evidence and makes a decision to protect the body.
The Brain’s Decision-Making Process
In a normally functioning nervous system, the signal of nociception is an important piece of evidence. However, it’s important to note that other factors also influence the brain’s decision to produce pain4. These factors include:
- Memory of Previous Experiences: Past physical or emotional experiences can shape how your brain interprets current sensations.
- Current Health Status: Your overall health can affect pain sensitivity.
- Emotional State: Feelings of stress or anxiety can amplify pain sensations.
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The Role of Other Evidence
Just like a non-noxious stimulus can block the transmission of nociceptive information from reaching the brain (as outlined in the “Gate Control Theory”5 ), other sources of evidence can also mitigate or reduce the influence of nociceptive signals. A growing body of research has shown that nociception is not synonymous with pain. It can trigger brain responses without necessarily causing the feeling of pain6,7 .
Real-Life Examples
Several real-life examples highlight the disconnect between nociception and pain.
1. Phantom Limb Pain
Phantom Limb Pain is a condition where amputees experience pain or discomfort in a limb that is no longer there8 . Research indicates that up to 64% of amputees suffer from some form of Phantom Limb Pain9 .
In this case, there are no nociceptive signals coming from the missing limb. So, why do amputees still feel pain? The answer lies in the brain’s subconscious perception of danger and lack of safety regarding the missing body part.
2. The Builder’s Accident
Another documented medical case involves a builder who jumped onto a 15cm nail, which he thought had pierced his foot10. He was in extreme pain and required strong sedatives to calm him enough for medical staff to remove his boot. Upon removal, they discovered that the nail had passed between his toes without causing any injury. Again, there were no nociceptive signals from the foot, yet he experienced intense pain.
3. A Belarusian Pilot’s
Experience In another remarkable case, a Belarusian pilot impaled his shoulder on a tree branch (with the thickness of the branch being equivalent to a lamppost!) but felt little pain11 . This example further illustrates that nociception does not always correlate with the sensation of pain (link for article: https://www.mirror.co.uk/news/world-news/pilotsshoulder-impaled-huge-tree-12642881).
4. The Beetroot Incident
A man who consumed a large quantity of beetroots for lunch mistook the resulting bright red stools for blood, believing he had sustained severe internal damage12. This case shows how the brain can misinterpret sensations based on context and expectations.
Why Does This Matter?
You may be wondering, “So what if nociception is different from pain? How does this knowledge help me?”
The Power of the Mind
Understanding the distinction between nociception and pain can empower you in your healing journey. Research shows that the mind has a significant impact on healing and pain management13,14. While simply meditating for hours may not suit everyone, the concept of the placebo effect demonstrates that our beliefs and mindsets can influence physical health.
Harnessing the Power of Placebo
In medical terms, this phenomenon is known as the placebo effect. Recent advances in pain science, particularly through the Cortical Body Matrix Theory of Pain15, show that there are numerous ways to engage the mind to alleviate pain.
- Changing How You View Your Body: Reframing and developing a positive body image can reduce pain perception. This can be done through effective pain science education and the latest scientific knowledge about your pain condition (check out the latest research and understanding about osteoarthritis – it may surprise you!*) *Good book to read about this: The Knee Osteoarthritis Handbook)
- Shifting Your Thoughts: Being mindful to positively reframe negative thought patterns and harvesting more positive thoughts about your condition can lessen pain sensitivity. 16
- Believing in Your Body’s Ability to Heal: Trusting your body can significantly impact healing. Educating more about your body’s amazing ability to heal itself and learning the skills in which to harness this powerful ability can do amazing things for your pain AND your body!
- Improving Overall Health: Taking care of your physical health can lessen pain. Over the last few years, there is a growing body of evidence showing that levels of inflammation in your body increase nociceptive sensitivity and the persistence of pain17,18,19 . Four of the key areas responsible for inflammation (which you have direct control over) in the body is gut/nutritional health, exercise, sleep quality/quantity and mental health.
- Positive Self-Talk: Encouraging words to yourself can foster a sense of control over your pain. It can also help you to reframe the diverse ways in which you view your body, what you say about your body, what you believe about your body and what is happening to your body. Positively thinking and talking about your body has proven to help to reduce your pain and improve your health20,21
- Influence of Others: Surrounding yourself with supportive people can enhance your pain management process. Not only can those around you champion your journey to recovery, but they can also help to support you with keeping positive self talk and with your motivation to keep going along your journey towards becoming pain-free
Taking Control of Your Pain
Learning about and implementing these different strategies takes effort, but you are not helpless in treating your pain! There is a vast array of tools and practical strategies that can help you manage pain effectively.
The Four Key Lifestyle Strategies
We use the keywords EAT, SLEEP, MOVE, and RELAX to represent different lifestyle strategies:
Nutrition plays a vital role in how we feel. Eating a balanced diet can positively impact your overall health and pain levels. Also, the nutrition that you eat is one of the most significant factors which can lower the levels of inflammation in your body and reducing inflammation can also reduce pain levels.
Quality sleep is essential for recovery. Prioritising restful sleep can improve your pain management.
Engaging in regular physical activity helps keep the body functioning properly. Movement can ease pain and improve overall well-being. Alongside good nutrition, it can also play a useful role towards reducing inflammation in your body.
Engaging in regular physical activity helps keep the body functioning properly. Movement can ease pain and improve overall well-being. Alongside good nutrition, it can also play a useful role towards reducing inflammation in your body.
Learn More About Pain Management
Alongside learning more about pain and practicing specialised exercises, these lifestyle skills are crucial contributors to an effective plan for healing. If you’re ready to take the next step towards becoming pain-free and reclaiming your life, get in touch with us! Together, we can create a personalised journey toward long-term, sustainable pain relief.
Conclusion
Understanding the difference between nociception and pain is vital for anyone experiencing pain. By recognising that pain is a complex output influenced by many factors, you can take proactive steps to manage it effectively.
The journey to pain relief involves not only addressing physical symptoms but also considering emotional and psychological aspects. With the right knowledge, tools, and support, you can reclaim your life from pain and enhance your overall wellbeing. Stay tuned for the next article in this series, where we will continue to explore the intricacies of pain and provide insights to help you on your healing journey.
Building a Support System
Having a support system is also vital in managing pain. Surround yourself with friends, family, or support groups that understand your experience. Sharing your struggles with others can provide emotional relief and practical advice.
References
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2. Sherrington, C.S., 2023. The integrative action of the nervous system. In Scientific and Medical Knowledge Production, 1796-1918 (pp. 217-253). Routledge.
3. Legrain V, Iannetti GD, Plaghki L, Mouraux A. The pain matrix reloaded: a salience detection system for the body. Prog Neurobiol. 2011 Jan;93(1):111- 24. doi: 10.1016/j.pneurobio.2010.10.005. Epub 2010 Oct 30. PMID: 21040755.
4. Baliki MN, Apkarian AV. Nociception, Pain, Negative Moods, and Behavior Selection. Neuron. 2015 Aug 5;87(3):474-91. doi: 10.1016/j.neuron.2015.06.005. PMID: 26247858; PMCID: PMC4529956.
5. Campbell TS, Johnson JA, Zernicke KA. Gate Control Theory of Pain. In: Encyclopedia of Behavioral Medicine. Cham: Springer International Publishing; 2020. p. 914–916.
6. Hofbauer RK, Rainville P, Duncan GH, Bushnell MC. Cortical representation of the sensory dimension of pain. J Neurophysiol. 2001 Jul;86(1):402-11. doi: 10.1152/jn.2001.86.1.402. PMID: 11431520.
7. Mouraux A, Iannetti GD. Nociceptive laser-evoked brain potentials do not reflect nociceptive-specific neural activity. J Neurophysiol. 2009 Jun;101(6):3258-69. doi: 10.1152/jn.91181.2008. Epub 2009 Apr 1. Erratum in: J Neurophysiol. 2010 Feb;103(2):1145. PMID: 19339457.
8. Hanyu-Deutmeyer AA, Cascella M, Varacallo M. Phantom Limb Pain. [Updated 2023 Aug 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448188/
9. Limakatso K, Ndhlovu F, Usenbo A, Rayamajhi S, Kloppers C, Parker R. The prevalence and risk factors for phantom limb pain: a cross-sectional survey. BMC Neurol. 2024 Feb 6;24(1):57. doi: 10.1186/s12883-024-03547-w. PMID: 38321380; PMCID: PMC10845739.
10.Johnson MI, Trauma and Pain: A Fragile Link. J Trauma Treat 2017, 6:2 DOI: 10.4172/2167-1222.1000378
11.Wyatt, T. (no date) ‘Pilot’s shoulder impaled by HUGE tree branch after microlight crash lands in forest’, The Mirror.
12.Jackson, M. (2010) Pain;the science and culture of why we hurt. TORONTO: VINTAGE CANADA.
13.Zuniga-Hertz JP, Chitteti R, Dispenza J, Cuomo R, Bonds JA, Kopp EL, Simpson S, Okerblom J, Maurya S, Rana BK, Miyonahara A, Niesman IR, Maree J, Belza G, Hamilton HD, Stanton C, Gonzalez DJ, Poirier MA, Moeller-Bertram T, Patel HH. Meditation-induced bloodborne factors as an adjuvant treatment to COVID-19 disease. Brain Behav Immun Health. 2023 Aug 7;32:100675. doi: 10.1016/j.bbih.2023.100675. PMID: 37600600; PMCID: PMC10432704.
14.Ray IB, Menezes AR, Malur P, Hiltbold AE, Reilly JP, Lavie CJ. Meditation and coronary heart disease: a review of the current clinical evidence. Ochsner J. 2014 Winter;14(4):696-703. PMID: 25598736; PMCID: PMC4295748.
15.Butler, D.S. and Moseley, G.L. (2019) Explain pain supercharged: The Clinician’s Manual. Adelaide, South Australia: Noigroup Publications
16.Clarke CL, Ryan CG, Martin DJ. Pain neurophysiology education for the management of individuals with chronic low back pain: systematic review and meta-analysis. Man Ther. 2011 Dec;16(6):544-9. doi: 10.1016/j.math.2011.05.003. Epub 2011 Jun 25. PMID: 21705261.
17.Dainese P, Mahieu H, De Mits S, et al. Associations between markers of inflammation and altered pain perception mechanisms in people with knee osteoarthritis: a systematic review. RMD
18.Zhou WBS, Meng J, Zhang J. Does Low Grade Systemic Inflammation Have a Role in Chronic Pain? Front Mol Neurosci. 2021 Nov 10;14:785214. doi: 10.3389/fnmol.2021.785214. PMID: 34858140; PMCID: PMC8631544.
19.Iordanova Schistad E, Kong XY, Furberg AS, Bäckryd E, Grimnes G, Emaus N, Rosseland LA, Gordh T, Stubhaug A, Engdahl B, Halvorsen B, Nielsen CS. A population-based study of inflammatory mechanisms and pain sensitivity. Pain. 2020 Feb;161(2):338-350. doi: 10.1097/j.pain.0000000000001731. PMID: 31651577.
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21.Wallwork SB, Bellan V, Catley MJ, Moseley GL. Neural representations and the cortical body matrix: implications for sports medicine and future directions. Br J Sports Med. 2016 Aug;50(16):990-6. doi: 10.1136/bjsports-2015-095356. Epub 2015 Dec 18. PMID: 26682866.
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