They say women naturally have a higher threshold for pain, partly due to the fact that we go through the process of childbirth which is deemed to be one of the most painful experience. But can women truly have a different threshold for pain? Have you ever wondered why our body feels pain? What is the purpose of pain and why some times, you get pain during activities that are not usually painful such as sitting and working on your laptop? The purpose of pain in a healthy person is to alert the brain and body that potential damage has occurred to the bodily tissues. Pain is considered as a protective reflex response to a physical stimulus (such as trauma). Hence, the bigger the injury, the greater the pain. Traditionally, it was assumed that all pain was a symptom of an underlying organic cause. Once the cause of pain is healed/ mended, the patient should be relieved of this pain. If the cause of pain was not found, the patient was thought to be perhaps lying or imaging this pain. But we now know that this is not always the case, because sometimes the pain that we experience is much more complex and different from the traditional pain where there is a actual tissue injury. We may experience pain suddenly with no apparent reason, does that mean the pain is “bad”? Pain in this scenario no longer serves its traditional purpose of alerting one to tissue damage. “Normal” or Nociceptive Pain is pain that is proportionate to the degree of actual tissue damage. A more severe injury results in a pain that is perceived to be greater than that pain caused by a less severe injury. Such pain serves a protective function. Examples of nociceptive pain include acute burns, bone fracture. “Abnormal” or Neuropathic Pain occurs through changes in the peripheral nervous system, especially during diseases involving damage/ changes to the nerves (nerve compression/impingement, cancer or diabetes) that leads to “impulses” being sent to brain that is then perceived as pain. Likewise, damage to the central nervous system (involving the brain and/or spinal cord) can also cause non-painful sensations from the peripheral nerves to be wrongly interpreted as pain by the brain. Finally, prolonged or increased exposure to painful stimulus may also cause changes to the central nervous system leading to the condition called central sensitisation where pain is disproportionate to the degree of tissue damage and can also persists even in the absence of continued tissue damage. Thus, neuropathic pain serves no protective function and provides no benefit to the overall health of the person. Neuropathic pain patients may experience certain emotions especially when doctors and other healthcare professionals are not able to appropriately diagnose and recognise the cause of their pain. Such emotions include, feeling depressed and thinking that the pain felt is actually “all in the mind”; disappointment when others are not able to empathise with their ordeal; or even defeated when management for pain has been unsuccessful. A person can begin to think they need to ‘resign themselves to a lifetime of pain’.
Every one’s pain has a different cause; fortunately here are some personal coping strategies you can apply when dealing with pain. Coping with one’s mood and emotions especially during pain exacerbation
- Primary goals is to view pain as a controllable experience and decreasing the use of maladaptive coping strategies.
- In the case of skill development, a new skill is introduced and patients are encouraged to develop and refine the skill during low pain periods before attempting to implement the coping skill during an actual period of pain exacerbation. The skill is shaped over time, so that the skill is gradually applied to increasingly challenging (i.e. painful) episodes as the individual becomes more proficient in that skill. A similar approach is taken to the application of many pain coping skills, including cognitive or behavioral distraction, relaxation, pacing of activities, and the appropriate use of social support.
- understanding one’s cycle of pain and anticipating potential aggravating and easing factors/ actions
- being positive and minimise negative thoughts such as “I’ll never get better!”, “Everyday it’s getting worse!” and “I should just give up and suffer the pain!”
Minimising one’s disability in terms of functional activities
- start with graded exercise, and breaking an activity into segments to reduce fatigue. Once you have gained confidence in a specific part of activity, for example sitting over the edge of the bed and standing, in this case, having sufficient strength to lift your bottom over the bed, you can try getting out of chairs of different heights or bed of different firmness.
- Every little success is still a success. Start practising with common activities that you frequently do at home, such as washing the dishes, standing and ironing clothes then gradually progress to brisk walking and other gentle sports.
Cultivating health behaviours (exercise, appropriate use of medications)
- reducing reliance on medications (don’t start popping pills at the first sign of symptoms!). Frequent consumption of painkillers may gradually cause you to develop an increased threshold to its effects which leads you to increase your dosage or have to have a stronger form of medication instead.
- always aim to reduce dosage of medications gradually. For example, having to take painkillers one pill a day. This SHOULD ONLY BE DONE AFTER THOROUGH DISCUSSION AND CONSENT FROM YOUR GP.
Coping a loved one’s pain
- be supportive of your loved one’s attempts to manage their pain
- trusting that their pain is real and it is truly upsetting even if you do not understand how they may experience such pain of such intensity
- providing a listening ear to their complains may help to settle them down and increasing their confidence in managing their pain