Introduction:
Understanding Pain: Types, Causes, and Effective Pain Management Strategies
Pain is an undeniable part of life. Whether it’s a sharp twinge after a fall, a dull ache from overexertion, or chronic pain that just won’t go away, everyone experiences it in one form or another. But what exactly is pain, and why does it occur? Is pain simply something to endure, or is it an essential signal that something within the body is amiss?
In this article, we will explore the several types of pain, their causes, and how understanding pain can empower you to manage it effectively. We will also discuss how early intervention, correct management, and rehabilitation strategies can help reduce pain and prevent long-term discomfort.
What is Pain and Is It Really a Bad Thing?
Pain is something we all experience, whether we like it or not. But is it all bad? Not necessarily. Pain gets a bad rap, but it is actually your body’s way of screaming, “Hey, something’s wrong here! Fix it!” It is like that one customer who is complaining—yeah, it’s annoying, but if you listen closely, they’re giving you the chance to fix the problem before it blows up. The key is not to ignore it and hope it goes away.
Dr. Brand, a well-known hand surgeon, wrote extensively about pain, he described pain as a gift that nobody wants”, and yet it is a gift.” I know—it sounds weird but think about it, pain is telling you to pay attention, so you can address the issue before it gets worse. Instead of reaching for those painkillers, popping pills, experimenting with marijuana or other quick fixes, we should listen to what pain is telling us and investigate its cause.
By doing so, we can avoid masking the symptoms and instead address the root cause of the pain. Whether it is muscle strain, nerve compression, or systemic conditions, addressing the root cause is the key to true relief. So, let us do some detective work before we mask that pain.
Are All Pains the Same?
Oh! Definitely not! Pain is not a one-size-fits-all kind of thing. It can happen for a bunch of different reasons, and each kind is unique in how it feels and how we deal with it. The body’s anatomy—the way the muscles, tendons, ligaments and bones are intended to work together —it can get thrown off when things aren’t moving or positioned the right way, which means when the normal anatomy is altered due to poor biomechanics, it results in pathology and that’s where the problem starts, resulting in pain.
For example, a fall can mess with the structural integrity of the body. You might break a bone (hello, sharp pain!) or hurt a ligament or tendon. That is the kind of pain that hits hard and fast, often unexpectedly. It is like your body was cruising along and then—bam—something snaps, twists, or strains.
But there is also the kind of pain that sneaks up on you over time. Repetitive overuse, like typing on your keyboard non-stop or incorrect lifting techniques, can lead to tendinitis, carpal tunnel, or other chronic issues. And let us be real, as we age, our joints start to show their wear and tear. It is not a fun reality, but it’s the truth. Osteoarthritis, for instance, is just the body’s way of saying, “Hey, you’ve been using me for years, and now it’s starting to show!” It is the price we pay for overusing our joints and not doing maintenance on it.
I always tell my patients, “Just because you’ve always done something a certain way doesn’t mean it was the right way to do it.” There is always a right way and wrong way to do everything, including moving your body and using your joints, and prevent those nasty aches and pains. Understanding how your body works is key to staying pain-free.
Now, pain from trauma—accidents, falls, things you just cannot predict—that’s different. It is hard to control, but most other types of pain, totally within our control. We just have to pay attention.
What types of pain can one experience?
- Pains can be sharp from tendinitis, fractures, or arthritis. Pain from arthritis can be sharp with use but otherwise dull achy.
- Radiating pain in case of nerve involvement or trigger points. Pressure on the trigger point can result in pain radiating down the arm.
- Ligament or tendon involvement may cause and popping snapping sensation which may cause sharp yet lingering pain. Trigger finger pain can be sharp when the finger locks but once unlocked it can dissipate.
Pain from Nerve Compression: A Hidden Aggravator
Here’s something that a lot of people don’t realize: nerve pain. Nerve compression happens when nerves are pinched or irritated along their path, from the neck all the way down to your fingertips. This happens as nerves have to pass through tunnels and can get pinched due to various reasons. This is often the result of poor posture, sitting in extreme positions resulting in compression of the nerve or development of swelling around the nerve pressing it. It’s not just uncomfortable—it can feel like tingling, numbness which is like ants crawling along the path of the nerve, the annoying “pins and needles” feeling. And guess what? A lot of people have no idea what’s causing it and where it’s coming from to even begin to correct it.
And then there are the conditions you are just born with. Some people have systemic issues like Rheumatoid arthritis, Raynaud’s or Scleroderma that can cause chronic pain all over the body. These conditions often require blood work to accurately diagnose and treat. It is one of those things where the pain seems to come from nowhere, and it can be tough to pinpoint, however over time if not managed properly then it may cause disfigurement of the joints. There is therapeutic treatment available for it, but unfortunately, they are rarely referred to the hand therapist until it gets really bad, which doesn’t have to be the case. A therapist can provide various practical solutions to control the pain and prevent deformities if referred early.
Hypermobility Syndrome: When Flexibility Turns into a Problem
Here is a real kicker: lately, my clinic has been seeing a flood of patients with hypermobility syndrome (also known as Ehlers-Danlos Syndrome). A lot of them do not even know why they are in pain. They have often been misdiagnosed with fibromyalgia, when the real culprit is hypermobility. These patients experience everything from nerve involvement in the neck to migraines, tendinitis, and even muscle pain.
You would think being flexible is a good thing, right? But for people with hypermobility, it is actually the opposite. They are so flexible that their joints are overextended, which leads to instability. They do not have a good “joint sense,” meaning they do not know when they have stretched too far and when to stop. Because of this lack of end feel they complain of being stiff as they do not get the satisfaction of stretching. So, they keep stretching to feel good, but it ends up making things worse and causing early-onset arthritis as the joints become unstable over time due to over stretched ligaments.
Take the neck, for instance, too much movement in the neck can put pressure on the nerves coming out of the vertebral facets, which leads to pain, headaches, and nerve symptoms. In these cases, Botox is the last thing they need! They do not need to relax the muscles—they need those muscles to stabilize their joints.
These patients often present with aches all over their body. It’s tough because they can’t get any flexibility of the soft tissue (muscles / tendons) as the joint gives before they could feel the stretch, so they complain that they feel stiff, even though they have too much movement. Another reason they feel tight is because lack of flexibility of the muscle tendon unit prevents nerve gliding through the muscular tunnels. So, what do you do when you are in constant pain and stretching makes it worse? You have to work with it, be mindful of it, and treat it properly.
Solutions for Pain: Treatment That Works – for patients with hypermobility.
Luckily, there are solutions for these kinds of issues. For example, functional splints can help stabilize the joint and prevent further damage. Myofascial manipulation with nerve glides is excellent for pain reduction. But here is the thing—once the pain subsides, the real work begins i.e. stabilization exercises. If the ligaments (primary stabilizers of the joint) that hold the ends of your bones together are not doing their job, you have got to strengthen the muscles (secondary stabilizer) around them to take up the slack and stabilize the joint.
The Danger of Sedentary Lifestyles and Overuse
There are solutions for Pain: Treatment That Works – even for patients with Repetitive stress injury.
This requires a thorough history and a detailed assessment (detective work). A big part of treatment is understanding how your body works, how your job or lifestyle might be contributing to the problem, and how to modify it. Sometimes, you might be doing everything right, but you are still overusing the same muscles and joints and not giving them proper breaks. Some jobs are sedentary, and the body may require some pumping action of the muscles to flush the stagnant fluids out that are causing the problem by pressing on the nerve endings. The flushing of the fluid is needed to get the fluid back to the heart and into the stream to get it oxygenated.
Here is what you can do to fight back:
- Cardiovascular activity boosts the metabolism which helps the body to heal itself. Our body has a capacity to heal if we only give it a chance, thus adding brisk walking or swimming or jogging aids in healing for repetitive stress injuries.
- Take frequent breaks: Stand up, stretch, and move every 30-60 minutes. It does not take much to keep tissues flexible.
- Make sure you are using your equipment correctly: Adjust your chair, desk, and monitor to the right height and angle. You would be amazed at how much that helps. So correct setup along with correct use is important to avoid injuries.
- Icing after identifying the cause of pain: If you are dealing with muscle or joint pain, ice can reduce inflammation and give you some relief from pain and discomfort.
So, providing a detailed history helps the provider get to the right diagnosis. When getting treatment, patients may experience some discomfort which is normal, however when you are trying to gain range of motion, if you stretch too far you may get a sharp pain which may be detrimental to your recovery as it may cause swelling which will cause more pain as it will press on the nerve endings, and that in turn, will continue the cycle of pain. Thus, stretchy pain like when you workout and you stretch to relieve pain is a ‘good pain,’ it relieves the discomfort yet gives you improved range of motion.
Similarly, when a therapist is working on you for some nerve involvement, then it’s important to know which sensation is okay, and when you need to stop the therapist. For example, if the patient goes from numbness to tingling sensation, that is a better sensation. Patient think tingling is worse as it bothers them, and find numbness better as they don’t feel much, but in essence, tingling is the nerve waking up and on the path of healing while numbness is where the nerve is compressed more; so when a practitioner is working on your they need to know the direction the sensation is going even if it feels annoying, it may be a better sensation than numbness and they are on the right path to provide the healing that you are looking for.
With all you know thus far, we can now discuss individual diagnosis and its management.
Tips:
Pain should never be ignored, period!
Unless traumatic as suggested earlier, most pains are created by us so stop the activity, look for the cause, take a break and stretch, ice and add cardio to the routine.
If this does not solve the problem, seek a professional’s help.
Nerve compressions, if resolved early may result in full recovery thus early treatment is essential.
Arthritis pain requires management as once arthritis sets in it cannot be reversed.
Tendinitis requires in corrective activity to prevent the problem from returning.
Hypermobility if not managed early results in erosive arthritis with patients requiring multiple joint surgeries.
Rheumatoid arthritis requires on going management when flareups happen resulting in stiffness in the joints and restrictive ROM afterwards along with development of deformity.
Thus, early splinting and learning joint protection techniques go a long way in keeping patients’ pain-free.
Why do we need to seek early treatment to painful symptoms?
Pain following trauma persists in many: one in four have moderate to severe pain 12 months following trauma, and up to one in three have significant pain and disability 3 years later.
Poorly controlled pain in the 1st week following injury increases the risk of severe pain one year later by 2-3 times.
Pain: More Than Just a Sensation
Pain is not just a simple signal telling you something is wrong with your body. It is way more complex than that. Sure, pain starts with tissue damage, but from there, it involves your brain, emotions, and past experiences. The longer you live with pain, the more your body adapts to it. And that’s where things get tricky.
Pain can trigger activity in multiple areas of the brain, which leads to a phenomenon known as central sensitization. Sounds fancy, but it is just a way of describing how your nervous system gets “used to” pain over time. People who have been in pain for a long time may not even recognize how bad it really is anymore. It is like they have built a tolerance to the discomfort.
For example, when a healthcare provider asks, “On a scale from 0 to 10, how bad is your pain?” Someone who has been dealing with it for years might say it is a 3 or 4—even if to some other person it may be worse. Why? Because to them, it is not bad enough to land them in the ER, it is just a “normal” part of their daily life. But for someone who is not used to chronic pain, that same sensation might be an 8 or 9. It is all relative.
This is the essence of central sensitization—your body starts to tolerate pain so much that it becomes a habitual part of your life. The brain rewires itself to accept pain as normal, even when it should not be. And that’s dangerous because living with pain in this way can turn into a vicious cycle.
As healthcare providers, our job is not just to treat the pain we see—it is to stop it from becoming something the patient has to live with long-term. We never want someone to get used to being in pain, to the point where it is just their new “normal.”
Luckily, there’s hope. There are a number of treatment strategies that can help break that cycle, starting with things like physical, occupational, hand therapy, relaxation techniques/ mindfulness training, and targeted exercises. The goal is to teach the brain that it is okay to live without pain, that the body can heal, and that the “new normal” does not have to include chronic discomfort.
Pain is essential, but knowing the types of pain and understanding the difference and importance of it in a situation will determine progress in rehab. One may be detrimental to progress while other if not achieved may not provide the much-needed stress to show improvement, thus the knowledge of the types of pain is important to achieve a pain free life.
Types of pain:
- Stretchy pain:Hamstring stretch, it is important to experience the stretch and when treating other body parts, the stretchy pain is what we are always aiming for.
- Fatigue – after workout: When building strength, it is important to feel the muscle work. If too easy it means it has not stressed the tissue enough to build any strength, when too painful it means it was too hard and needs to back off from that excessive workout. Fatigue that lasts just long enough for the patient to continue with their exercises is the right amount of work the tissues need at that time.
- Sharp pain/injury pain:Whether stretching or strengthening if pushed too far may result in sharp/ stingy pain. This is detrimental to progress. With this pain the patient cannot continue to rehabilitate or work out and not maintaining the continuum as the pain may linger on due to increase in swelling and result in more stiffness thus preventing the patient from continuing to perform exercises.
Two points to remember when rehabilitating a body part is:
1. If the patient walks in with a pain of 3 and during therapy the pain increases to 6, after 2 hrs the pain needs to go back to 3-4/10, if the high pain persists then the rehab was too aggressive
2. Also, if after the rehabilitation, the swelling increases in the joint, that is a sign of excessive aggressive rehab and needs to be tempered.
The other type of pain is Neuropathic pain. With this type of pain, regular analgesics does not work, but Amitriptyline, Gabapentin is helpful, Topical agents may or may not help. Note, this pain occurs due to nerve entrapment, and these medications help mitigate than just pain killers. Gabapentin is thought to work by affecting neurotransmitters in the brain, helping regulate anxiety and stress responses in the brain, by increasing levels that cause a calming effect, thus relaxing the nerves.
Stress management and the psychology of pain.
The behavior that an individual demonstrates in response to painful stimulus is an adaptive behavior that involves learning and memory.
These memories of pain may result in stress, which can add to the complex living situation, causing a cycle of pain leading to stress which influences and enhances the perception of pain.
Thus, biofeedback and management of stress, mindfulness training all go a long way in the management of pain and rehabilitating it.
How Therapy Helps Manage Pain: Understanding Postural and Muscle Imbalances
When you are dealing with pain, it is not just about the area that hurts—it is about how your whole body is reacting. In therapy, we go beyond just addressing the pain itself. We assess how the body’s neural tissues are responding, and that often means looking at things like postural changes, muscle imbalances, and dysfunctions.
For example, pain can cause your posture to shift in a way that puts more strain on other parts of your body, leading to further discomfort. These changes can be subtle, like a slight tilt in your shoulders or an arch in your back that you did not even notice. But over time, they can become a bigger problem. We also look at active and passive dysfunctions, which are essentially ways your muscles and joints aren’t working like they should. Trigger points—those tight, painful spots in muscles—are also a key focus, as they can cause a lot of discomfort.
Myofascial pain, which involves pain in the muscles and connective tissues, is another common culprit. But here is the thing—just treating the pain will not get you far if we do not address the underlying causes. That is why treatment is customized based on the assessment. Whether it is through stretching, strengthening, or manual therapy, the goal is to fix what’s causing the pain so that you can get back to living your best life, pain-free.
Remember
Severe pain if not managed in the early phase of the injury process may result in persistent pain and disability in the long run which will cause psychosocial problems. Thus, deal with pain head on to avoid long term problems.
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