The Pain Game: Pain Perception

“Stop being a woos” , “I’ve done that, they don’t hurt that much”, “hard up princess”…all common sentences which enter the Australian vocabulary on a regular basis in order to tell someone that the pain they are feeling wouldn’t affect you in such a way. How a person perceives pain is completely individualized and personal to that person at that particular time.
What impacts our perceived pain can be as simple as reduced sleeping hours to anxiety about a memory associated with the same interaction from when were a child, and even more complicated than that.
In this article we look at what pain is to people, how culture and history effect pain and the complications associated with pain perception.

The amount of pain which is felt by an individual is not necessarily equivocal to the amount of tissue damage which has occurred at the time of trauma or thereafter.  Pain is the body’s best alarm system in the face of danger, if tissue damage has occurred to some extent and pain is not felt then there is a high chance the brain has not interpreted this change in tissue structure or chemical structure to be a threat. The brain is our interpreter of all messages; it is the deciding factor if we as individuals feel pain. Age and gender have shown to not influence how we feel pain, however; life experiences and cultural identity have an influence on how we express pain.
A female is more likely to be honest about her pain before she endures child birth, after this time it is a social influence which tells her that nothing will ever be as painful and therefore a true pain expression is suppressed.
Similarly, a male is seen to hide his pain in many cases due to being seen as a protector and provider in a social text which should not show weakness.

The unfortunate downside to the suppression of pain acknowledgement or expression is that trauma of significant nature can go untreated and result in further issues down the track such as re-injury, poor mobility, loss of use and mis or undiagnosed issues of severity.
Missing your optimal repair time can lead to the formation of scar tissues, misalignments and below optimum activation.

Pain has been identified to feel different within different tissues, once again, the descriptions which are provided by many patients are those which best makes sense to them. Bone and joint injuries are commonly described as a grinding, gnawing or aching feeling, much of the time these descriptions are made as it makes sense to use from a mechanical point of view. As mentioned in our previous pain article as pain hangs around for longer and longer time periods the type of pain which is described, regardless of body region changes.
Severe muscle injury is something which is not too common; many times the muscle fibers which have undergone trauma are superficial and heal quickly. The reason for this is due to the muscle flexibility and adaptation. When we develop or receive trauma associated with muscles our innate survival mechanisms kick in and the once long stretchy muscles shorten to prime ourselves for escape or battle. If this continued over a long period of time due to ongoing pain or for that matter fear of pain then there can be negative consequences associated with that behavior. This is important to note for practitioners who are wondering, why, if they believe everything they are doing is correct, why my patient is not getting better. The quick response which many forget over the years is to treat the person not the problem.

Central sensitization of the nervous system in the very simplest terms is brain and spinal over activity after the healing process has completed. It is at this time when addressing a chronic injury that it is important to understand the reasons behind the pain and not just the diagnosis itself. Of course the first component most practitioners are comfortable with is nociception contribution as this is focused on so intently at educational institutions. However, this is only one part of the puzzle. What attitudes and beliefs does this patient have in regards to pain? Are they blaming themselves, do they feel as if they are being punished by a higher being or trying to push on through a something they should be resting?
This can also lead to a state of suffering, a time where a non-vocalization of a feeling is eating the patient inside which may increase fear or bitterness towards others “all the quacks can’t seem to get it right!”
Pain escape behaviors may manifest within these suffering thoughts; there may be a leading toward unconventional self treatment with drugs and alcohol. Retail therapy may begin to occur as a distraction from the pain they feel, this however can also develop into gambling and adult gaming which can have further affect on the patient and their family. This then leads us to the social environment and the impact it can have upon a patient; locking themselves away from others, reading blogs on their particular issue with an obsessive demeanor.
All these issues need to be addressed when treating a person and not just the condition presented to you, this is why developing a good referral system with those of different abilities is essential for best patient care.

And this is where things can become messy for a patient, all these practitioners of different backgrounds, beliefs and theories about what is best for a patient can be confusing and lead to increased anxiety. It is highly suggested that a team be developed together, in the best interest of the patient with a General Practitioner or Specialist over-looking all treatments and educational processes which are being taught.
The patient should be fully understanding of any prescription supplied or medical practitioner which they are referred to and the role they will have in treating them.
Any and all questions asked by the patient should be answered in a manner which the patient will be understand – any information which is considered to be too in-depth or an overload of information is given then it should be given in writing for consideration at a later time.
It is important that the patient avoid health practitioner dependence and be aware of the part they play in bettering their own health. As well as how they aim to reach short and long term goals with the aid of their health practitioner team.

This summary has really just been the tip of the iceberg that is pain perception. If you have found it as interesting as I did when learning about it, I highly suggest you look up some of the references labeled below and view more of Lorimere Moseley’s videos on youtube or TedX.
As we have seen, a person’s pain perception and then how they display that perception of pain is highly variable and subject to change due to life experiences. Pain is the primary reason most allied health practitioners are sought out for consultation and without understanding pain itself or what pain is to that individual we cannot possibly provide optimum care.
Until next time

Jackson McCosker
Director /Chief Editor


Butler, D. S., & Moseley, G. L. (2014). Explain Pain. Adelaide: Noigroup Publications.

Butler, D. S., Beames, T. B., Giles, T. J., & Moseley, G. L. (2012). The Graded Motor Imagery Handbook. Adelaide: NoiGroup Publications.

Garland, E. L. (2012). Pain Processing in the Human Nervous System. Primary Care Clinic and Practical .

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