Since pain is a subjective experience, clinical definitions vary widely. Consider these attempts to define pain:
“A concept of sensation that we feel as a reaction to the stimulus of our surrounding, putting us in harm’s way and reacting as a form of defense mechanism that our body has permanently installed into its system.” (Yam, et al. 2018)
“Pain results from the activation of a subset of sensory neurons termed nociceptors and has evolved as a ‘detect and defend’ mechanism. However, lesion and disease in the sensory system can result in [pain that] serves no protective function.” (Smith, 2018)
“Nociception is the neural process of encoding noxious stimuli, whereas pain is defined as an unpleasant sensory and emotional experience.” (Smith, 2018)
“We must distinguish between the experience of pain and the meaning that the person gives to it… the person’s beliefs about the cause of the pain may be right or wrong.” (Brodal, 2017)
“The exact cause of most [LBP] pain remains unproven.” (Panjabi, 2006)
“Phantom limb pain… is associated with neither a damaged tissue area, nor an inflamed part of the body.” (Salto, et al. 2018)
“The pain signal is exposed to a wide variety of influences and is never an exact or predictable or reproducible representation/presence of genuine or patient imagined tissue damage, and can never be seen or diagnosed from a picture.” (Dean, 2016)
Pain is a story, an idea, an interpretation. Pain can’t be objectively demonstrated. When the clinician touches the area of the patient’s complaint, and the patient says, “Ouch” the origin of the pain is not located at the touch-site. The origin of pain is located in the brain; an experience interpreted by several factors related to the touch-site. Pain does not originate not nor occur at the injury. A signal is generated at the touch site, called ‘signal X’.
Signal X is delivered from the touch-site along a series of 3 nerves: (1) from the touch-site tissue to the dorsal root ganglia (DRG), then (2) signal ’ jumps the first synapse at the DRG and onto the second nerve cell (any level 2-4 above or below the root-level) where it either ascends on the same side (ipsilateral) or opposite side (contralateral) of the spinal cord, then (3) signal X jumps the second synapse in the thalamus on to the third nerve cell and is delivered to the cortex (cognitive brain) across the final synapse to be evaluated for touch depth qualities, touch area qualities, temperature, vibration, joint position information, muscle tone information, and nociception (a signal with pain-experience qualities.) At each of the three synapses 45+ chemo-electrical reactions occur to preserve the exactness of the signal… what are the chances of that? These signals X (any of the sense-signals) arrive at the brain from all over the body (billions of nerves) 24 hours a day with no interruptions, only one of which is a perception of pain (nociception.) However, the nociceptive signal does not always arrive at the cortex in its purest preserved form, and other signals arriving at the cortex can be confused for nociceptive signals. Test question: “Can the body experience pain?” the answer is no. Only the brain has the experience of pain, then assigns it back to the most logical area of the body. When the patient says, “It hurts here”, the clinician is not going to correct them. However, the clinician needs to be careful when treating pain at the site of the injury and remember that the pain is a lived experience within the brain only; an interpretation, a story.
The experience of pain is always real, and can be life-altering for the LBP patient, an undeniable truth. The patient’s greatest fear is that the pain will never go away. Clinically, however, pain should be understood differently, less as a symptom and more as a corruptible nuisance. ‘Pain is not the only problem’; sometimes it is the clinician’s understanding of it.
LBP Blog General information
These articles intend to (1) re-evaluate the prevailing clinical practices thought to manage low back ‘pain’, (2) submit and debate novel low back ‘pain’ contributors and mechanisms, (3) meet patient expectations & satisfaction and clinically meaningful results, (4) recommend a conservative non-surgical course of care to over-ride ‘pain’ instantly, and (5) restore ADLs and patient confidence on the first visit at low cost. This article has a companion podcast.
Dr. Dean Bio
Forester Dean is a chiropractic and physiotherapy sports medicine doctor practicing in Los Angeles, California. Dr. Dean is a lifetime athlete, and currently teaches tennis, track, boxing, yoga. The Core X System™ Campus flagship location was opened by Dr. Dean in 2020. www.preformancecxs.org
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