Explaining "pain" to your clients and athletes: A guide for trainers and coaches

If you have been in the fitness/coaching industry long enough, you will have dealt with a client or athlete who is in pain whether it is acute or chronic. If it hasn't happened yet, it will at some point.

Even if you have or have not had a client or athlete in pain, you have most likely experienced it yourself. Chronic. Acute. Or both.

However, do you really understand what "pain" really is and what is going on in the body.

Here is a TRAINER/COACHES GUIDE TO PAIN with special thanks to Diane Jacobs and the folks at somasimple.com for their information and support.


DESCARTES AND HIS THEORY

About 400 years ago, a smart French philosopher by the name of Rene Descartes came up with the idea that PAIN was created by peripheral sensors in the body that sent "pain" messages to that brain. Basically, if you stubbed your toe, an "alarm bell" of some type rings your brain. However, this proved to not be the case.

In the last 50 or so years, pain science research has come out that opens our eyes to the true cause of "pain." Led by pioneers like Ronald Melzack and Patrick Wall, we have newer and workable theory of pain which is now being known as Melzacks Neuromatrix Theory. However, I will go over this in more detail at a later time. Right now, I want to give you an overview of Pain as we understand it now.

NOCICEPTION DOES NOT EQUAL PAIN

This is probably where most people, including myself, get tripped up a bit. We think, we bang our knee and then BOOM, there's pain. Well, turns out its more complicated than that. Here are a few things to keep in mind:

1) First, recognize that pain and nociception are terms that are often used interchangeably unfortunately, so please bare with me while I deconstruct the above bolded statement. 

2) Pain CAN exist without any nociception. For instance, there are many documented cases and a tremendous amount of research done about PHANTOM LIMB PAIN where there is no limb but there is a perceived pain where that limb would be. Luckily thanks to the pioneering efforts of doctors like V.S. Ramanchandran  and Mirror Box Therapy, many of those afflicted with Phantom Limb Pain have been helped. 

3) If there is pain, the brain can choose to ignore it given the circumstances. There are well documented cases of soldiers who have been wounded on the battlefield and kept on fighting. Not until they ceased fighting did the body experience "pain" because the situation of staying alive throughout the battled overrode the pain perception. Same things happen in the wild to animals like zebra who have been wounded by a lion but still keeps running, if possible.

4) Nociceptive input is required for the developing infant brain so that starts to create an experience of pain. There is an disorder called congenital insensitivity to pain where a person can feel no pain. This is especially dangerous for young children as any infections, broken bones, burns, etc go unfelt by the child  and there is a greater risk of them dying young. 

According to the International Association for the Study of Pain, "PAIN" is defined as:

"Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage."

Wait! Pain is an EXPERIENCE and not some sense???? 

Yes, that's pretty much what it is. It was once thought that pain nerves in the body would send signals through the spinal cord to the a pain center in the brain much like the way the visual, auditory, gustatory, etc senses worked. However, this is not the case. 

According to Diane Jacobs, PT: Instead [of a pain center] there are circuitry routes, billions of neurons, receptor sites on them (lots and lots of receptors that can change to different ones, alter what they are sensitive to, thanks to "synaptic plasticity") and transmitters. There are convergence zones and arborizations, ascending and descending fibers, switchback and feed forward stations, and lots of somatotopic representational areas (brain maps of body parts). There is brain behaviour, and parts or areas that light up for pain as well as for other functions on fMRI. But there is no verifiable "pain center," a center devoted exclusively to receiving pain signals, same as there is no actual "little wo/man", or mayor, up there running anything or guiding our lives.

SO WHERE DOES PAIN COME FROM THEN???