Understanding Your Pain: What’s Driving It?

Pain is likely a familiar part of the experience of an athlete or active person. Sometimes pain can feel overwhelming, especially when it lasts for a long time. Understanding pain and the mechanisms behind it, can help you during this process. Chronic pain is a challenge for athletes/active individuals as it is not fully explained by injury, overuse, or biomechanics. Pain is affected by various factors such as personal situations, lifestyle, behaviours, past history, and social environment. It is important to know that it is a sensory, cognitive and emotional experience.

Understanding pain for what it is

Pain generally falls into two main categories, namely nociceptive and neuropathic.

• Nociceptive pain can be described as pain that you feel because of ‘actual’ or ‘potential’ harm. Think of it as an alarm system that goes off when you touch something too hot or twist your ankle. Nociceptive pain usually stops once the tissues have healed and the ‘danger’ has subsided.
• Neuropathic pain, on the other hand, occurs when there’s damage to your nervous system itself, which results in disordered transmission of sensory signals. This is often persistent and can feel like burning, tingling, or electrical shooting. It doesn’t necessarily need a physical injury to trigger it and can persist long after the initial damage has healed. Active individuals are particularly prone to experiencing neuropathic pain because of the high demand they place on their bodies. This includes conditions such as a pinched nerve (between bones, joints and soft tissue), disc herniation, or nerve irritation due to repetitive movements.
  • Neuropathic pain can be classified as peripheral neuropathic or central neuropathic pain.
    1. Peripheral neuropathic pain occurs when there is damage or dysfunction in the peripheral nervous system (all nerves apart from the brain and spinal cord). Peripheral sensitization occurs when the nerves in the affected area become hyper-sensitive and continue to send ‘pain-signals’ even after the tissue has healed. Take a hamstring muscle strain as an example, the nerves in that area might remain sensitive long after the tissue has healed, causing you to feel pain from activities like exercising, walking or stretching.
    2. When there is damage to the central nervous system (brain and spinal cord) it is known as central neuropathic pain. Your spinal cord and brain can amplify pain signals, making you feel more pain than the injury warrants. Central sensitisation is often an underlying mechanism involved in chronic neuropathic pain. This is when your CNS becomes more sensitive to pain signals and can make even mild stimuli feel painful.

What do I do with this information?

We now know that a person’s pain experience is highly individual and can be influenced by various factors and drivers of pain. It is important to recognise when pain is due to actual damage, and caution must be taken, or if central- and peripheral sensitisation are at play.

Practising mindfulness, relaxation exercises and rehabilitation/re-integration into activity and sport are important components of managing neuropathic pain. Addressing the psychological, emotional, social as well as physical aspects of pain need to be addressed.

If you are in pain, whether occasional or persistent, contact a professional to provide you with some insight and relief. Lamberti Physiotherapy can assist you with a diagnostic assessment and therapy – contact us here for an appointment.

References

1. Alaiti RK, Reis FJJ. Pain in Athletes: Current Knowledge and Challenges. Int J Sports Phys Ther. 2022 Oct 1;17(6):981-983. doi: 10.26603/001c.37675. PMID: 36237643; PMCID: PMC9528677.
2. Costigan M, Scholz J, Woolf CJ. Neuropathic pain: a maladaptive response of the nervous system to damage. Annu Rev Neurosci. 2009;32:1-32. doi: 10.1146/annurev.neuro.051508.135531. PMID: 19400724; PMCID: PMC2768555.