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How Do We Perceive Pain?

Most peple attribute the perception of pain to the actual stimulus that caused the pain...(bee sting, stubb your toe, etc).  The bodies perceptive ability is very detailed and there is still alot we don't understand about the complex processes of the CNS (Central Nervous System) which is made up of the brain, brainstem and spinal chord and the PNS (Peripheral Nervous System) which is made up by all the nerves that exit the spinal chord/column and traverse the rest of the body/organ systems.

Pain is actually perceived in the Cerebral Cortex.  This is basically the top part of the brain.  Why does this matter?  Well on any given day you could provide the same stimulus (bee sting) to ten different people and their perception of that stimulus will be significantly different.  Things that affect this perception are mood, state of mind, childhood upbringing, social-economic status, depression, fear, anxiety, excitement and on and on..  Many things affect how we perceive pain and this is important to take into consideration as there may be some other reason for feeling pain than purely an external stimulus.  This is why clinicians must treat their patients as people not merely a diagnosis, thus taking into account emotional, mental and psychological state and their effects on human pain and suffering.

Another observation about Pain, pain is usually the last thing to show up and the first thing to go with treatment.  It is important to recognize that pain is the "alarm" system for the body when something is not right.  One's pain almost always diminishes early in treatment, however function may not be back to optimal levels.  This is important to understand when going through the rehabilitation process.  Just like you wouldn't expect to strengthen a muscle with one or two workouts, you likewise can't expect to change joint/ligament/muscle dysfunction in one or two treatments.  The focus on treatment is restoring function (Range of Motion, Flexibility & Strength).  When these areas are working well, function is high and pain is low.

Treating pain alone and using pain as the sole measure of a persons health can be misleading.  A person can have mild to moderate levels of dysfunction with little to no pain.  A couple great examples of this are those of Acute Myocardial Infarction (heart attack) and  Spinal Disc Herniation.(blown/slipped disc)  With a heart attack often pain is the first and last signal of a problem.  While a person may set the stages for a heart attack over 20 years, pain was never present until it became severe enough to cause a life threatening event.  Commonly with a Disc injury in the back I hear things like, "All I did was bend over to tie my shoe" or "I didn't even do anything and then I couldn't move because the pain was so severe."  Here again years of micro-trauma from poor posture, lifting, work duties and life in general cause injury to the disc but it's not until it gets severe enough that you have pain that disables you.  Pain is always an expression of function or the lack thereof.  The key is realizing that you can have dysfunction without pain.  Pain usually brings you in the clinic.  Once your injury has been resolved or reached maximum medical improvement (MMI) it is then a very good idea to maintain preventative treatment aimed at keeping function good so you stay in the safe zone and out of the area that leads to acute pain.

Hope this helps you understand a little better the process of that nagging thing we call PAIN.

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