Therapy thoughts (11/6/25) - Finally, the truth about pain!

FINALLY, THE TRUTH ABOUT PAIN

Well, that title sucked you in : )

How many opinions, ideas & concepts are there around pain? Imprecisely, I would say there was a bunch! Just remember that opinions are like arseholes, everyone has one, and they all stink a bit. 

Here are some of these ideas from over the last 30 years! 

Pain is an opinion of the brain- Ramachandran 

Pain is an alarm – lots of folk : ) 

Pain is protective (danger)  – Lorimer Moseley 

Pain is restorative – Pat wall 

Pain as a homeostatic emotion – Bud Craig 

Maybe sometimes pain just is, especially chronic. It is a malfunctioning of the system potentially? 

I think I lean towards the idea of homeostasis mostly. But I also reserve the right to change my mind 🤣

Pat Wall criticised the idea of pain being protective back in 1979! He said that is occurred too late, often after damage, to be protective. Instead, it drives us to seek recovery. It could be protective in the sense that we learn to avoid things next time, but this would be a function of behaviour rather than physiology. 

Pain as a homeostatic emotion, looks at the sensation and the subsequent emotions that drive behaviours. This would fit with hunger, thirst, fatigue as other sensations that drive behaviours. 

What I like about the homeostasis concept is that it involves many systems that make up humans. These reside in both the brain and the body rather than dualistically focusing on tissue or the brain as is often the case. We have lots of systems to help regulate our internal state such as the inflammatory, immune, nociceptive, stress & cardiovascular. All of these are affected by and affect our behaviours. 

For me, at the most basic level, pain is simply a response to a stimulus, at a peripheral level this is mechanical, thermal, and chemical. A sensation is a product of the sensory system! 

Sometimes our system is more responsive than others, this could be lifestyle related, health related, adaptive from previous injury/pain (nociplastic), so a smaller stimulus provokes a greater reaction. Maybe, some folks have more reactive, sensitive systems genetically, we see this with auto immune issues. 

So a small stimulus might provoke a large response! This disproportionate reaction might last for longer than maybe considered appropriate. But this did not occur in isolation, it was the straw that broke the camels back, a small spark that set the dry environment ablaze. Its not just the stimulus that matters, but also the environment that it occurs within/to. 

What is less clear for me is the perceptual/psychological side of pain. The research is very mixed about the influence of perception & psychology on the sensation side of pain. Both from a causation and treatment standpoint. I certainly don’t subscribe to a neuroplastic perspective of pain that sees it as being generated solely from the brain. Just because there is not damage, does not mean nociception isn’t occurring mechanically or chemically! 

Is the psychological aspect of pain, more related to how we cope and respond to having pain? Our psychological state influences the behaviours that we make in response to the sensation. 

Our psychological state also likely affects the behaviours that influence the responsiveness of the system, such as health and lifestyle behaviours and overall stress/allostatic load, so in this sense there is a very real physiological impact. 

But timeframe might be the issue here, some believe negative thoughts turn themselves into pain instantaneously. More likely over time, our thoughts influence our behaviours which in turn influence physiology & epigenetic changes, rather than moment to moment perceptual influences. That perspective has probably been driven by the basic science work in the 2000’s & 2010’s using nociceptive stimulus and perceptual influences such as colours and heat! 

How much does psychology/perception directly influence nociception & pain? Who the fuck knows : )