Lesson 1 learning intention: students will learn about pain and explore how pain fits into the picture of health more broadly
Lesson 1 success criteria: students will be able to
- Understand what the definition of pain includes
- Understand the role of the nervous system
- Describe different types of pain
- Describe how pain fits into the whole picture of health
Definition of pain
Pain is an unpleasant sensory and emotional experience which may or may not be related to an injury (damage to body tissues). Note the two important parts of the experience of pain here: sensory (we feel something in our body) and emotional (we have a psychological reaction e.g., scared, upset, angry, anxious, depressed).
Everyone experiences pain at various times in their life, pain is essential for human survival. A very small number of people have a genetic condition where they can’t feel pain. This is extremely dangerous, and most people with this condition don’t live past the age of 25.
The purpose of pain is to protect our body from danger (injury, illness, stress).
The nervous system
Our body is made up of millions of nerve cells called ‘neurons’. Messages travel along nerves between the body and the brain. Nerves travel from everywhere in the body to the spinal cord, and from the spinal cord to the brain and back again in the opposite direction. The brain is our body’s command centre, it receives messages from the body and sends messages back out to create experiences (like pain and emotions) and actions (like movements of our arms and legs).
Some nerve endings are designed to detect ‘danger’. They are activated by mechanical force (e.g. pressure, stretch), by chemicals in our blood, or by extreme hot and cold. When activated, they send a message along the nerves to your brain that there might be danger. Your brain will then sum up this message along with other information (e.g. what you see, how you are feeling emotionally, your memories of similar situations) and decide what to do. The ‘what to do’ might include experiencing pain or moving your body away from the potential danger.
An example is touching a hot surface with your finger. Your danger receptors in the finger will send a message along the nerves and spinal cord saying they have detected too much heat on the skin of your finger. Your spinal cord will automatically send a message to your muscles to remove your hand from the hot surface. This information will then be sent up to the brain. Your brain will consider this information and information from other body systems (such as your eyes seeing the hot surface, your memories of previously burning your finger, other senses to detect whether there is immediate danger you need to respond to). Depending on how your brain processes this information, you may experience pain to protect your finger from further damage and motivate you to act (stop what you are doing, run under cold water, stay away from hot surfaces).
Types of pain
- Acute pain is short-term pain, like from when you cut your finger, step on something sharp with bare feet, or break a bone. It is usually a result of an injury or illness. In this situation, pain serves as an alarm system to:
- Stop you doing whatever it is that caused the injury, and
- Protect the area to allow it to heal
The body heals itself very well. Acute pain usually goes away once the tissues are healed (usually a few days or weeks) and often doesn’t require much, if any, treatment.
- Chronic pain is pain that stays for more than 3 months or comes back time and again (recurrent). It can be due to
- An ongoing condition or disease (e.g., arthritis, endometriosis, migraines)
- Nerve damage (e.g., spinal cord injury)
- Pain that stays after an injury has healed, associated with changes in the nervous system.
- As we know, acute pain serves like an alarm system to stop us injuring ourselves or allow injuries to heal. But sometimes people feel pain even after an injury has healed, this is because the nervous system (alarm) has become too sensitive.
One way to understand this is by using an analogy:
Imagine your house has a light sensor that activates when someone approaches. It’s a useful system because it lets you know someone is outside your house. One day you notice that the light is on all night, keeping you awake, anxious, and afraid that there are people approaching your house at night. You decide to stay up one night watching the gate and notice the light is being activated by the wind. You realise that the problem is the light sensor is too sensitive and turning on even when no one is there, not only when someone is outside your house.
Similarly, in someone with chronic pain, their alarm system may be too sensitive. It may be saying they are in danger, even though they are safe. Important note: there is no question that the pain people feel is ‘real’, pain that may be influenced by a sensitive nervous system is not different to the pain due to direct injury.
We do not know exactly why some people develop chronic pain and others don’t. Pain is influenced by many processes and systems within the human body, and factors outside the body. We will discuss what influences pain in the next lesson. We do know that chronic pain is very common and has a big impact on people’s lives.
How many people suffer from chronic pain?
- 1 in 5 Australians (adults, teenagers, and children) lives with chronic pain, which increases to 1 in 3 for adults over 65 years old.
- Back pain is the 3rd biggest health issue in general population in Australia behind heart disease and dementia.
- Up to 1 in 4 adolescents experience chronic pain
- Pain is more common in girls and older teenagers.
- Common types of pain in young people are:
- Headache and migraine
- Abdominal pain and pelvic pain
- Musculoskeletal pain (e.g. lower limb pain, upper limb pain, back pain)
How much does chronic pain cost in Australia?
Chronic pain costs the Australian government over $70 billion each year:
- $50 billion on productivity costs, meaning the cost that chronic pain has on someone’s ability to attend work, perform well at work, and continue to work in the future. There is also often cost to people caring for a loved one with chronic pain, and impacts on their ability to work.
- Over $12 billion is spent on providing health care to people suffering from chronic pain, including:
- Doctors and healthcare workers (physiotherapists, psychologists) appointments
- Medical tests and scans
- Surgeries and medications
- Care in hospitals and nursing homes
- The remaining $12 billion is costs associated with informal care (e.g. care from family and friends), modifications and equipment to help people perform their daily activities and stay in their homes, welfare payments, and tax losses.
How does chronic pain affect health and wellness?
Health is dynamic and complex, influenced by many factors including genetics, lifestyle choices, access to healthcare, environmental conditions, and social elements. Chronic pain is as important a part of a person’s health as any other health condition.
In Australia, chronic pain is as big an issue as obesity, physical inactivity, and mental health. Chronic pain will likely affect you or a loved one at some point in your life. Like obesity, physical inactivity and mental health, chronic pain is related to many other health issues:
- Rates of depression are 20% higher among people with chronic pain compared to the rest of the population.
- Up to 1 in 5 suicides in Australia are related to physical health problems
- Chronic pain is linked with other physical health conditions such as obesity, arthritis, diabetes and cardiovascular (heart) diseases
- People who smoke are more likely to have chronic pain conditions
- Low physical activity levels are associated with chronic pain
Pain is part of the whole picture of health. To improve the health and wellbeing of the community, pain should be part of the conversation about being healthy and leading healthy lives.
How does chronic pain affect teenagers?
Chronic pain has a significant impact on the lives of Australian teenagers. After mental health, musculoskeletal pain (arm/ leg/ back pain) is the biggest health concern for teenagers. Like mental health issues, pain can affect all aspects of life. Teenagers with chronic pain are more likely to:
- Not do as much physical activity or play sports
- Suffer from obesity
- Have poorer mental health
- Use substances (smoking, drugs and alcohol)
- Miss school
- Not perform as well at school
- Be bullied at school
The impact of pain may last well into adulthood. Young people who suffer from chronic or recurrent pain in childhood and adolescence are more likely to have chronic pain in adulthood (up to 4 times as likely for teenagers with back pain). Pain can affect someone’s ability to live a healthy lifestyle, find and stay working, have a family and enjoy a good quality of life.
To understand this more, next lesson will focus on how physical, social, and psychological factors influence and are influenced by pain.