What’s going on? - Why you are in pain

“Why am I in pain?”

• Dr. XYZ answers one of the most frequently asked questions about pain

Most of the times I find that patients find it difficult to describe their pain. And I can’t blame them. Pain is very complex and often difficult to explain or express. It may change from moment to moment, hour to hour or even day to day. Every patient experiences pain in a different way.      
Let’s address this point first – why do we experience pain? Well, pain has an important protective function and serves as our body’s alarm signal that something is wrong. The sensation of pain is a normal response to injury or disease and helps protect our body from further damage while repairing the existing damage.

So what is the pain pathway? Our nerves are like a complex system of roadways and highways. We experience pain because of a signal that our nerves send to our brain. The pain signals can come from any part of the body and they then travel via the spinal cord where they are further processed. These areas are connected with centers associated with mood, sleep, emotions, appetite and memory. Sometimes the pain continues as the signals keep firing, and that is when the pain becomes chronic.    

I’m sure you’ve heard of these two terms – “acute pain” and “chronic pain” – and wondered what they refer to. Well, both “acute” and “chronic” refer to the time since the pain started. Acute pain refers to pain that has started recently while chronic or persistent pain is long-term pain that has lasted for three months or more. Acute pain is usually due to local involvement, whereas chronic pain could involve even the central nervous system and the immune system. 
Pain is broadly classified into three types:

• In the first group, we can include sprained ankles, non-specific low back pain or neck pain, or pulled muscles. This type of pain is associated with tissue injury or damage or even potential damage. We call this “nociceptive pain”
• The second group includes pain due to inflammation. Often when there is tissue damage, the body responds by triggering inflammation. We call this “nociceptive inflammatory pain”. In fact, this is the pain often associated with rheumatoid arthritis.
• In the third group is the pain that is due to disease or injury to nerve tissue. This is called “neuropathic pain”. Patients with this kind of pain will often experience burning, shooting, electric shock-like pain where even a light touch may be painful. This is the type of pain experienced with shingles (a viral infection leading to a painful rash), sciatica (a painful condition involving the nerve extending from the lower back to the leg), trigeminal neuralgia (a painful condition affecting the nerve carrying sensations from the face to the brain), cervical or lumbar radiculopathy (caused by compression or irritation of nerves), or diabetic neuropathy (nerve damage in diabetes patients).