Foot, leg and other types of pain are a very real experience for all of us at one time or another. But what does it mean when your feet hurt or you back is sore?
At one time or another, we all have experienced pain.
It is one of the common facts that connect us human beings.
To each of us, pain feels and means something different.
To a mother giving birth, pain may contain excitement as she will see her unborn child very soon.
To someone with excruciating foot arthritis, pain may mean they can no longer enjoy their regular walks with their children.
All clinicians working with people in pain need to have a thorough understanding of what pain is, how it is generated and how pain can be managed and reduced.
Pain research has been moving forward in recent years in leaps and bounds and, what we now know about pain, can help us manage it more effectively.
At a very basic level, pain is your body’s way of saying there is something happening to you that puts your physical, mental and/or emotional self in danger.
All pain experiences are normal and are an excellent, though unpleasant response to what your brain judges to be a threatening situation.
We have all heard stories of unsympathetic Doctors telling someone “It’s all in your head Mr Jones!” and yet, to a limited degree, this is correct.
When you cut your finger with a knife you experience pain in your finger, however, the reality is, there is no pain in your finger, it is in your head.
Having said this though it is very important to stress that pain is normal, personal and always real.
Pain can be influenced by the things you see, hear, smell, taste and touch, the things you think and believe, things you do, places you go, similar experiences you have had in the past, people in your life and things happening in your body.
Once your brain has completed this assessment (usually in a fraction of a second), it will determine a level of risk the injury presents to you and creates a sensation of pain equal to that risk.
So basically, how strong the pain is depends on how much risk the brain feels you are exposed to.
The amount and type of damage that has occurred is, however, rarely related to how much pain you experience.
There are many documented cases of people managing to do extraordinary things without noticing a significant injury to their bodies.
On the other hand, some people suffer from terrible pain with little to be seen on x-rays, scans and MRIs.
A word on scans and x-rays: reading reports can make your pain worse.
In the medical profession, we use language differently to “normal people”.
Words such as severe, degenerative, subchondral cyst formation, tear, and rupture can be very scary words when you read them on imaging reports.
To trained health professionals though, these words just explain the type of changes in the tissues scanned.
How your health professional explains the results of your x-rays or scans can also affect your pain.
If your doctor tells you “that’s the worst knee I have ever seen” or that your back is “terrible, I don’t know how you can still be walking” (both real examples, unfortunately), this can really amplify your pain.
You will have pain when your brain concludes that there is more credible evidence of danger than safety related to your body and thus infers then need to protect.
Another problem with imaging is that it can pick up numerous changes that may be completely unrelated to the pain you are experiencing.
I have seen far too many clients get an X-ray done of a sore hip only to be told they also have ‘terrible’ back problems as well even though their back has never once caused them a problem.
There is no single “pain center” in the brain; a number of areas of the brain have been proven to activate when we experience pain.
Research has also confirmed pain is a conscious experience.
So when we think our pain has woken us up at night, we have actually woken up then experience pain.
Pain can be broadly classified into one of two types: acute or tissue damage pain (think the pain experienced with a broken leg) and persistent pain.
1. Acute pain (or Nociceptive pain) is that pain you feel when you tread on a broken bottle or catch your little toe on the corner of the bed in the middle of the night.
This type of pain typically reduces as the injury heals and is commonly seen as a “normal” process in injury healing.
2. Persistent pain is that pain that continues when damaged tissue has healed yet pain remains.
This type of pain can be very complex and at times, difficult to understand and manage.
When threatened, your body is capable of activating many protective systems including immune, endocrine, motor, autonomic, respiratory, cognitive, emotional and pain.
Any or all of these systems can become overprotective.
When your body’s protective pain system becomes overprotective, this becomes persistent pain.
Just like a tennis player who plays game after game of tennis and consequently gets better at tennis, your body gets better and better at producing pain them more pain it produces.
This causes your protective pain system to be turned up and get sensitive and means you are more likely to experience pain even if the threat is minimal.
Dr David Butler from Adelaide’s world-renowned Neuro Orthopaedic Institute explains persistent pain as your:
“body systems getting better and better at looking after you – nerves conveying danger messages becoming more sensitive, brain cells involved in making pain becoming more sensitive too, and the coping systems such as the emotional, cognitive, endocrine and autonomic systems get edgy – being switched on and turned up for extended periods of time.”
While all protective systems can be turned up and edgy, the notion of bioplasticity (meaning that all body systems are changeable) suggests that they can change back.
An extreme example of persistent pain is phantom limb pain; pain experienced in a limb that has been amputated.
People experiencing phantom limb pain are 100% sure that their amputated limb hurts even though the limb is no longer there.
In a situation like this, the body has become so good at producing pain that despite the fact the limb is no longer there, the brain is convinced the limb is still a threat to the body so continues to produce pain.
When you understand why you hurt, you hurt less.
If you have a pain problem, you are not alone - millions of others do too.
However, there are many researchers and clinicians working to find ways to help.
Once you understand pain, you can begin to make plans, explore different ways to move, improve your fitness, eat better, sleep better, demolish danger signs, find safety signs and gradually do more.
Pain is an experience we all share though what our pain feels like and means to us is a very unique, individual and real experience.
Persistent pain sufferers need empathy and help to manage their pain and educated health professionals to understand what pain is, what pain isn’t and how we can support our clients through their pain journey.
If you suffer from foot and leg pain and need help, make time to come see our trained Podiatrists.
We WILL listen to you, believe you and work with you to help you find a way through your pain.
Complete Podiatry, Owner and Principal Podaiatrist