What Your Doctor Won’t Tell You About Pain

Ethan Evert, DPT, CSMT

Your doctor is very busy. There are frequently several important topics to cover in a short amount of time during your visit. But what if you are having pain, or you are having surgery? In the past, the topic of pain was brushed over and covered with “don’t worry about pain we have new medicines called opioids for that. You won’t feel a thing”. Well fast forward 30 years and the devastating effects of this approach are apparent. Opioids are addictive. They don’t always control pain and their side effects are numerous and undesirable. While opioids are a good choice for acute pain, they become less effective and more dangerous the longer they are used.

Pain is an innate part of being human.

The expectation that one should not have to deal with pain is unrealistic. Pain is an innate part of being human. If we did not experience these sensations we would not live very long. Think about setting your hand on a hot stove. The nociceptors (fancy word for the nerves that transmit the initial stimulus) send a message to the spinal cord (this is where, without thinking, we pull our hand off the hot stove) while a second nerve takes the signal to the brain. The brain evaluates the stimulus and provides an unpleasant sensation that we call pain. The pain compels us to do something about it. In the case of the hot stove, we seek treatment for our burn. The burn hurts for a while, but in most cases, the discomfort diminishes and we move on with our life. In this example the expectation is that a burn hurts, the tissues heal, and we move on.

But what happens in a less clear example, say back pain? We can’t see the muscles or joints in our backs. Additionally, there might not be a specific incident that caused the pain, it just gradually started hurting. The pathway is the same as the hot stove scenario. Our brain wants us to do something about it, so it signals pain. The problem is we don’t know what to do. Maybe we stretch, go to a chiropractor, a physical therapist, a physician that gives us medication, we get a MRI and still the pain persists. Now we are fearful that the back will not get better. This is where our living alarm system gets confused and so do we.

Unfortunately, our fear and anxiety will make the pain worse, not better.

There is a quote from the Greek philosopher Epictetus that “People are not disturbed by things, but by the views they take of them.” It has become our expectation that we should not have pain, because we have been told that we shouldn’t. When we have an injury, the common belief is that someone or something should be able to fix us. When this expectation is not met, it is a very natural response to have a stream of negative emotions. We start believing irrational thoughts without realizing it. We all know the world is not fair, but we get worked up when it is not fair to us. It is natural to start to catastrophize the situation. Unfortunately, our fear and anxiety will make the pain worse, not better.

We must re-frame our societal perceptions, and ultimately our own beliefs about pain.

It is well accepted that our past experiences influence our present behavior. We are able to learn from the past to better equip us for the future. When it comes to pain, we often remember traumatic or painful experiences. It is unlikely we can forget or delete these experiences, but we can change how we think about them. This is why it helps to have an understanding of how pain works. Once we have that, we can re-frame how we think about pain. Realizing that the idea that we should never experience it, or that it must be avoided entirely is unrealistic. We must re-frame our societal perceptions, and ultimately our own beliefs about pain. It is okay to have pain.

For a more detailed look out how pain works, check out our previous post Why Do I Hurt? Understanding Pain.

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