Pain is an alarm bell, it tells us that damage is being done, or has been done, and warns us to stop doing anything that might be making the damage worse. This is how we learn that standing in a fire is a bad idea. But sometimes pain lies.

The alarm response is what “acute” pain should evoke, stop doing anything that is causing the pain, then find out what damage has been done and how you can make the best of the repair job.

If for example banging your head against a brick wall causes pain, stop. Next check to see if your head is intact, treat any damage that has already occurred, then it might be a good idea to seek psychiatric help, to prevent the problem from recurring! 

In this instance “acute” refers to something of short duration; medical symptoms or complaints are often defined as acute when they last three weeks or less. During this time we expect the repair process to be getting under way, and while the pain may not be resolved in all cases, we at least expect it to be getting less severe.

Some pain lasts much longer than this though, and is then called “chronic” pain. This can be a completely different animal, and as such needs to be dealt with in a completely different way. 

Chronic pain which is due to a long term illness often needs long term management while the underlying problem is being dealt with in the best way possible; but many cases of chronic pain do not fall into this category. In these cases the damage that caused the pain initially has been resolved, yet the pain continues as if the acute damage were still present. Such is true of some chronic back or neck pains

What happens here is that the pain pathway has had so much practise that it has got the whole job of transmitting pain down to a fine art, so that even a perfectly ordinary, non-damaging stimulus, such as the normal movement of a joint, causes the pain pathways to fire.

I want to be clear here, this is not a “It’s all in your head, stop being such a wuss and pull yourself together” message. If there is one thing worth understand when getting your head around pain, it’s that ALL pain is in your head. What we call pain is the result of your brain interpreting a whole variety of sources of information. 

Recently I watched a volunteer on a Derren Brown TV programme sitting in a tank of water only slightly above freezing, he was completely comfortable despite the temperature being low enough to be slowly killing him! His comfort was the result of a hypnotic suggestion, that is, something going on in his head. The instant the suggestion was removed, he leapt out of the tank in obvious discomfort.

There are numerous other examples where processes going on in your head can reduce or remove the sensation of pain. You may have experienced some of these yourself, sometimes something as simple as having your attention distracted by a conversation or a gripping film can “take your mind off” that toothache. Equally, processes occurring unconsciously between your ears can increase or even produce the experience of pain, such is the case in some instances of chronic pain.

Because we interpret pain as a warning signal, we avoid activities that cause us pain, which in the case of chronic pain syndromes can be most activities. This increasing lack of activity in turn leads to the problem of “deconditioning.”

The loss of muscle strength, joint mobility and co-ordination produced by deconditioning causes more activities to be painful, so we do even less and become further deconditioned. It is this downward spiral that leads many victims of chronic pain to become progressively more disabled, without any reduction in the sufferers experience of pain.

In these cases, what is required is a carefully controlled and progressive reconditioning programme, with a progressive increase in activity even if we do experience some pain. Professional help is really helpful here, firstly to rule out current tissue damage as the cause of pain, and secondly to help design and supervise a controlled return to activity while avoiding increasing the pain.

A thorough assessment is necessary to rule out any remaining, treatable physical causes of pain. Helping the patient to understand that, “Hurt doesn’t always equal harm”, can free them from the disabling fear of pain. Occasional flare-ups may occur during the rehabilitation process, these are guides that help fine tune the process rather than signs of damage. A variety of tools help manage these and allow the patient to get on with progressively reclaiming their life. Over time the re-conditioning process helps to reduce the sensitisation in the nervous system that is causing the pain

Sometimes a red light is just a light that happens to be red, rather than a life limiting warning.