What is pain?
Pain is something you feel physically and emotionally – it is not pleasant and is due to a perception of real or potential damage to your body.
The amount of pain a person experiences is not always equal to the amount of damage or harm to their body. Someone can experience pain without tissue damage or can have tissue damage without pain.
How does your body process pain?
While pain may start at different places in your body, all pain is perceived and processed by your brain. Pain is your body’s warning system alerting you to harm.
A pain signal travels through your nerves (usually - but not always - starting from those nerves closest to the source of harm), up your spinal cord to your brain. Your brain then interprets the pain signal based on its intensity and location, as well as a variety of other information such as your surroundings, previous injury experience, your beliefs, your emotional state, and many other factors. You feel the pain after your brain has processed all of this information.
Pain is personal
When your brain processes a pain signal, it considers many factors that are personal to you. As a result, you feel pain differently from everyone else - even from people who may have the same disease or injury as you. Just like your experience with arthritis can be very different from someone else’s, the same goes for the pain you experience. This also means that pain treatments (including medications and other interventions) that work for one person may not work for another or may work differently.
There is a strong mind-body connection in pain. Your emotions and thoughts play a large role in how you experience pain, and pain can affect all aspects of your life.
Types of pain
Acute pain is short-term pain that serves to protect you and prevent more damage by causing you to change your behaviour. Some examples are pain caused by an injury, surgery, or a toothache.
When our body is injured or damaged, our nerves communicate this message to our brain. The brain then responds by sending a message to our body to react. Acute pain helps us protect the injury to our bodies and prevent further damage. Usually, this pain goes away when the damaged part of your body heals or no longer needs protection, or the unpleasant stimulus has been removed.
Chronic pain (also called persistent pain or long-term pain) lasts longer than acute pain, typically for more than three months. People who live with chronic diseases often live with chronic pain. This type of pain does not necessarily mean that damage is occurring – even though it might feel that way. While chronic pain is not fully understood, we know that it is sometimes caused by a problem with one or more nerves and the way they send pain messages to the brain.
Some people with chronic pain also experience ‘pain sensitization,’ which is basically your body turning up the volume on your pain. This often leads to a heightened sensitivity to pain and touch. In chronic conditions such as arthritis, areas of the brain that send and receive danger signals become more sensitive over time. The more the brain processes pain, the more perceptive it becomes until it remains in a state of heightened alert and response, which can distort the experience of pain.
Our thoughts, emotions, and activity levels can increase the sensitivity of the nervous system, leading to pain being felt more often and more intensely. Although there is currently no cure for chronic pain, we can treat chronic pain by learning how to manage it.
Both acute and chronic pain are influenced by biological, psychological, social and environmental factors. Understanding the differences between acute and chronic pain, as well as the transition from acute to chronic pain is the first step in addressing ongoing pain.
When you live with chronic pain, you are rarely entirely without pain, but you will have good days when you feel less pain and bad days when you feel more. Pacing yourself and your activities and tracking how you feel from day to day will help you learn to understand your pain. These approaches will also help you maintain a schedule so you can better predict what your days with pain will be like.
Where does arthritis pain come from?
While we continue to study the mechanisms of pain in the body, we know that most arthritis pain typically arises from one or more of these sources:
Inflammation – pressure on nerves in and around joints due to swelling
Joint damage – damage to tissues in and around joints, nerves and/or surrounding tissues due to injury or prolonged inflammation
Pain sensitization – prolonged pain can lead the body to send pain signals to the brain, even in the absence of a specific ongoing pain source
Some of the factors that can contribute to your experience of arthritis pain – how it feels to you – include:
Physical activity – joint strain from either excessive or insufficient physical activity
Muscle tension – muscles may be tense because of stress, insufficient physical activity or poor posture
Fatigue – exhaustion from managing chronic pain, lack of mobility or poor sleep due to pain can impact coping skills
Anxiety and/or depression – stress and low mood can increase the perception of pain and decrease your capacity to cope
Too much focus on pain – strong body-mind connection means that focusing on your pain can increase pain sensitivity and reduce coping skills
Attitude and belief system – your outlook on life can directly impact the level of pain you experience, and your ability to cope with it
Social environment and support – people who feel the support and understanding of strong social networks feel less overwhelmed and better able to cope with their pain than people without that support
The best pain management results often involve a combination of ongoing self-management and medical treatment. This multi-modal approach to treatment includes physical, psychological, pharmacological (medication-based) and preventative strategies.
The arthritis pain cycle
Chronic pain may be affected by the following:
Physical problems caused by injury, disease or surgery
Tense muscles (which may actually be your body’s reaction to protect injured joints)
Depression or other negative emotions and feelings
Your experience of pain is influenced by the factors above – as they feed into one another, they can prolong and amplify your pain. If you are able to break the cycle by addressing even one or two of the factors, it is possible to achieve some significant relief from your pain.
Additional contributing factors
While chronic pain can increase stress levels that play a role in the pain cycle, stressful experiences such as trauma or discrimination can also impact the intensity, severity and duration of pain. Research has shown that chronic stress resulting from a history of trauma or ongoing experiences of discrimination such as racism can have a negative impact on our bodies and can contribute to pain and inflammation.
When our body is in continual fight-or-flight mode, it triggers our nervous system to be on the lookout for danger, which can lead to an increased sensitivity to pain. The chronic stress caused by experiences of trauma or discrimination can impact the neuroendocrine system and lead to dysregulation of the stress hormone cortisol.
Stress hormones can have helpful short-term effects by keeping us alert in dangerous situations, such as increasing our heart rate so blood and oxygen will move quickly throughout the body. Additionally, stress hormones can inhibit inflammation and slow down digestion so that energy is reserved for our important heart and brain functions.
In the long-term, however, high levels of stress hormones can impact pain experiences by negatively feeding into the pain cycle. Elevated levels of cortisol in the circulatory system for longer periods of time can lead the body to become cortisol resistant and send our immune systems into overdrive, leading it to attack cells and tissues that aren’t a threat.
Trauma-informed and anti-discriminatory healthcare can play a role in helping to address these issues, but just being aware of how chronic stress can contribute to your experience of pain can help you take control of your symptoms. A multi-level approach to pain management that addresses physical, psychological, and social factors is important.