Pain Without Pain

So back to the Pain List - Ten Steps to Understanding Manual and Movement Therapies for Pain.

"2. Nociception (warning signals from body tissues) is neither necessary nor sufficient to produce pain. In other words, pain can occur in the absence of tissue damage."

Perhaps even more surprising is that tissue damage, even when severe, may not result in pain. A few weeks ago I had the privilege of attending a seminar with Lorimer Moseley, one of the leading researchers in pain science and physiotherapy. His book Painful Yarns contains many great stories about the pain experience. In one, he recants the experience of a man who had the great misfortune of having a hammer go through his neck. Arriving in the Emergency Room, the man showed no sign of being in pain and even joked about the situation. Joked, that is, until he banged his knee on a table and doubled over in pain.

Moseley concludes that in order to experience pain, one's brain must
(a) conclude that tissue is in danger, and
(b) conclude that one should do something about it.

Mr. Hammerhead Shark, as he is named in the story, had concluded that he was safe and he took action to resolve the problem. Pain, therefore, was not necessary in spite of significant warning signals from the tissues.

On the other side of the coin, pain can, and frequently does, occur in the absence of tissue damage. Mr. Hammerhead experienced more pain with a bang to his knee that resulted in no damage. In many instances, pain occurs without any signalling from the tissues at all. We'll examine how in upcoming posts.