Making sense of pain

Learn how to make sense of pain to identify what types of pain you experience and how to best manage your co-management plan

Pain is complex. Pain is difficult to explain. Pain is confusing as “hurt” (or pain), does not necessarily mean harm. Pain isn’t visible: it can’t be seen on X-rays, scans or blood tests. This can make it hard for you to communicate with others about your experience of pain. It can also make it hard for others to understand what you are going through.

Pain can be changeable from moment to moment, hour to hour or day to day. Many factors interact to influence your pain including: emotions, fears (fear of damage and avoidance/overdoing of activity), low levels of physical activity, unhelpful beliefs about pain, distress, anxiety, depression, hopelessness and a sense of loss of control, are all factors that can impact your pain experience.

Pain is a puzzle: people can have a small amount of damage (e.g. paper cut) and a lot of pain, or lots of damage with a low level pain (e.g. soldiers in battle often state low pain levels after major injury). These pain variations are normal allowing us to adapt to pain depending on context. Pain can change even without an increase in tissue damage. For example, if you sit for too long in one position, your low back pain can increase, even though there is no extra tissue damage. Such pain variations relate to a feature of our systems known as neuroplasticity.

This mismatch between pain levels and tissue damage is well known. It can be reassuring for you to know this information and understand that these fluctuations may reflect the interaction of many factors at any point in time, but typically do not indicate more tissue damage.

Pain duration

The words acute pain and chronic pain refer to the time since the pain started – not the pain level. Acute pain is defined as less than three months. Chronic pain, or persistent pain, is usually defined as pain which lasts longer than the accepted tissue healing time: usually three months or longer.

Acute pain is usually thought of as related to local issue inflammation, infection or injury, whilst chronic pain often reflects a broader (systemic or whole person) issue. In acute pain, the ‘receptors’ (called nociceptors) tend to be local to the injury site. For example, if you sprain your ankle, the pain is felt at the ankle and the local tissues are sensitised.

In chronic or persistent pain, we see growing involvement from a number of body systems including the central nervous system and the immune systems.

It makes sense then that pain treatments for chronic or persistent pain must address broader immune, nervous, hormonal, behavioral and emotional contributors to pain. This means that to ‘make sense of pain’ all these factors should be considered part of a bigger picture: you may need help to treat your pain from a number of different health professionals. Some ‘acute pain’ conditions can be complex, and therefore, may also need this broader approach to pain management.

The words acute pain and chronic pain refer to the time since the pain started – not the pain level. Acute pain is defined as less than three months. Chronic pain, or persistent pain, is usually defined as pain which lasts longer than the accepted tissue healing time: usually three months or longer.

Acute pain is usually thought of as related to local issue inflammation, infection or injury, whilst chronic pain often reflects a broader (systemic or whole person) issue. In acute pain, the ‘receptors’ (called nociceptors) tend to be local to the injury site. For example, if you sprain your ankle, the pain is felt at the ankle and the local tissues are sensitised.

In chronic or persistent pain, we see growing involvement from a number of body systems including the central nervous system and the immune systems.

The jigsaw of pain management

Dealing with ongoing pain is a bit like a jigsaw puzzle. For most people, there are at least six main pieces (or more) of the jigsaw puzzle. Importantly, medications are only one piece. Other pieces of the jigsaw include pacing and goal setting, meditation and relaxation, movement and exercise including simple stretches and a daily walk. Our pain management modules take you through each of these areas and help you to put together the pieces of the jigsaw that are best for you. You may also find this brochure helpful.

Another piece of the jigsaw is called ‘Pain Approach‘: accepting pain whilst reducing the associated fear and anxiety or low mood, reduces the struggle and energy spent on pain. Accepting pain does not mean losing hope! You can see an example of a pain jigsaw below.

Helpful insights

  • if you have persistent pain, you “do better” in terms of your quality of life, when you use appropriate pieces of the pain management jigsaw. This means using a range of active pain management strategies
  • pain is one signal that humans recognise as an “alarm” signal, which in acute pain is often an indication of injury or illness. For example, an acute muscle ‘strain’, ankle sprain or appendicitis
  • while chronic or persistent pain may indicate harm (or damage) initially, as pain continues it is often not possible to pin-point why the pain is continuing or a single location or tissue responsible for the pain
  • a key contributor to persistent pain is due to the adaptability of the nervous system: this is known as ‘neuroplasticity‘. Here, the change results in less and less movement, touch, temperature change or activities required to trigger pain. Neuroplasticity means our system can change: so this sensitivity can be reversed – this means pain can improve
  • remember: the actions of nerves and immune cells can’t be seen on Xrays or CT, MRI or bone scans, or even blood tests

Further Information

For more information about making sense of pain, see our page about neuroplasticity. Alternatively, if you need to speak to your GP or health care professional, please seek further assistance.

Using a pain team

Neuroplasticity

painaustralia - Rewire your pain and other good reads

Understanding pain: Brainman chooses

Getting a grip on pain and the brain

Chronic pain communication tool

Pain: Considering complementary approaches eBook

This module has been developed by Associate Professor Helen Slater, PhD, FACP, School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia and Adjunct Associate Professor Stephanie Davies, MBBS, FANZCA, FFPMANZCA, Pain Medicine Specialist, WA Specialist Pain Services, Perth, Australia. The information in this module is based on current best evidence research and clinical practice.


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