Bring the Pain: Understanding Pain and What to do About it

I love idioms about pain: Pain sucks. No pain, no gain. That is a royal pain.

And then there is the philosophizing character, Dalton, in the movie “Roadhouse”: “Pain don’t hurt”

Everyone’s pain is individual. Patient after patient has proven that to me. Actually, the definition of pain is physical suffering or discomfort caused by illness or injury. However, clinically, pain is a combination of noxious stimuli (nociception) and an individual’s emotional level. Tendonitis is an injury but it develops over time. Perhaps as the condition developed, a person had small amounts of pain (egotistically called “soreness”) and only small emotional responses. A person can describe tightness as excruciating or annoying, or someone can have a broken toe and give a range of descriptions from debilitating to a little discomfort (I’ve seen both happen). In addition, everyone is effected by stress individually. In a moment of intense stress, a person’s pain level can decrease significantly. Then again, in times of prolonged stress, pain can become nagging and chronic.

Something interesting I’ve seen is how much pain a person thinks they need to endure before seeing a professional health care worker. Obviously, this is a pretty complicated and subjective topic. So let me simplify it into a few important points so as to empower you to make good future decisions:

1. Pain is a signal: It means there is a process occurring in the body.

2. Often it is an inflammatory process. This is NOT a bad thing. Overall in my opinion, Inflammation = healing.

3. Sometimes, pain is indeed due to a muscle spasm. This is called splinting. Your body wants you to stop moving that area for a while… y’know… like a splint.

4. Pain has many considerations, like quality (burning vs aching), frequency, radiating, shooting, sharp and dull. They all give information of what process and what tissue is affected.

5. The stages of healing (aka inflammation) are basically…

6. Acute: 24-72 after damage. This is often the most painful period.

7. Repair: day 2 through day 45. Cross-links occur, and white blood cells and fibroblasts and platelets patch the area and debride the area. Increased REST is important. (I recommend increasing vitamin C during this.)

8. Remodeling: 6 weeks to 1 year. Cross links and collagen proteins align themselves along lines of force.

9. Note: sometimes we experience too much inflammation. For example, in some cases it can crush a nerve and that is BAD. In these cases, pain is often accompanied by numbness and or tingling or pins and needles. Intervention is paramount if you are getting numbness.

10. What you can do for yourself:

11. The most common personal intervention is in the acronym, PRICE:

12. Protect – wrap that sucker up if possible, or if it’s a back problem, use a back brace

13. Relative Rest – “hey doc, it hurts when I do this,” “well don’t do that!” this is a TEMPORARY solution because every day that you don’t “do that”, the muscles and connective tissue that allow you to “do that” become weaker

14. Btw: “rest” also means you need to sleep more

15. Ice – this is controversial these days. It's still accepted to apply ice for 15 min at most to reduce swelling. I will be discussion icing in a future article.

16. Compression – it restricts motion, helps clotting.

17. Elevation – if it’s a limb that’s hurt, during those first few days to a week, it can help to raise the limb above the heart to decrease swelling.

18. I often advise my patients that, if they have a pain, to wait a few days. If it doesn’t subside, see a physician immediately. Do not wait any longer. Every day you wait, you make compensations in the way you move that you may never be able to correct. In some cases, you can end up having unnecessary pain for years after.

19. One thing I hear all the time: “its just muscle.” I will estimate that 80% of the time, a lay person’s diagnosis is incorrect and it is not actually “muscle”. It’s not rocket science, but it IS anatomy and physiology combined with an organized patient history and examination. i.e. Do NOT diagnose yourself. I understand the urge to diagnose and treat yourself, but every day you wait to get a real diagnosis, prevents true effective treatment which can lead to chronic pain conditions.

20. Finally, it’s ok to try something to help yourself, e.g. foam rolling, ice or heat application, massage, but the timing of treatment is important. Certain treatments are great in the long run, but not great for pain symptoms. Other treatments reduce pain quickly, but stop the healing process and produce lingering subcutaneous scars. To simplify, if you don’t get at LEAST a 50% improvement of pain or if it keeps coming back, then you are likely misdiagnosing or mistreating.

Overall, be smart. Internet research is so common these days. I am very much a supporter of learning more about your diagnosis. Just be smart about it. It may save you a ‘world of pain’.