Pain & brain

How is it that some athletes seem able to overcome a painful injury with ease, while others really suffer? And how can the same injury produce different pain experiences in different athletes? In the past, the scientific and medical world has seen the mind and body as two separate entities and the sensation of pain as the result of purely physical and chemical processes as a result of damage to tissues. 

Modern medicine however is beginning to show the limitations of this approach. Most magnetic resonance imaging (MRI) studies have shown that there's little link between the degree of tissue damage revealed in a scan and the amount of pain experienced, while nearly 40% of people with abnormal and damaged spines have no pain whatsoever! 

Tissue damage alone it seems is insufficient to explain the degree of pain experienced. 

       The "gate control theory" proposes that the central nervous system (CNS - brain and spinal chord) plays a central role in modulating the what kind of pain you experience i.e. the type and degree of tissue damage only partly explains what you subsequently experience; it's the CNS processing of those initial tissue damage signals that determine how debilitating and sever that pain is and how rapidly it diminishes. 

While the gate control theory has been continually modified and expanded, it has stood the test of time and is backed up by over forty years of scientific research.
Because the brain is involved in interpreting and processing pain signals, the thoughts, emotions, beliefs and attitudes of the athlete can and do play a role in the pain that is experienced after injury.

 In other words, pain effectively emerges from the combined action of the pain system, which comprises of three components:

 .           Peripheral modulation - where pain receptors are stimulated by an initial injury or trauma and then by the release of pain stimulating chemicals.

•           Spinal modulation - where the signal travelling from tissue to brain can be either amplified or decreased by nervous interactions as it enters the spinal chord.

•           Supraspinal modulation - processing in the brain involving attention, beliefs, attitudes and previous pain experiences.

         The interaction between these components is complex but helps to answer some of the questions raised earlier. For example, scans of brain activity show that different people respond differently to the same pain stimulus, while studies involving twins have shown that learned behaviours are also important.

Even in the same athlete, the pain experienced can vary significantly depending on the circumstances becoming significantly less during competition when supraspinal and spinal modulation act to inhibit the transmission and limiting awareness of the pain signal.
        Sometimes, chronic pain produces changes in the functioning of the pain system so that it becomes over-sensitised. When this happens, even everyday movements and pressures that would normally cause no irritation or pain in tissues continue to cause pain, long after the originally injured tissue has healed.
      This can be compounded by an athlete's fear and anxiety about their ongoing pain and by focusing too much attention on the pain. When this "maladaptive pain" becomes entrenched, a gradual and graded approach to activity designed to desensitise the pain system is require.

 Should you ignore pain and try to shrug off an injury?

The initial phase of sensitisation is designed to encourage you to stop using injured tissues to avoid making things worse. You therefore need to ask yourself three questions:

•           Can I cope with the pain?

•           Can I continue to contribute a meaningful performance?

•           What are the consequences of continuing?

 The answers to these may well depend on the situation you find yourself in, and require a judgement call. If that's the case, you need to qualify the questions above by asking:

•           Am I prepared to cope?

•           How important is contributing a worthwhile performance to me?

•           Am I prepared to suffer the consequences?

     Using a potentially risky pain killing injection the day before an Olympic final, would seem quite reasonable thing to do if it was the only way an athlete could compete, but the same course of action would not seem reasonable for a novice runner before a fun run!

You may be able to overcome acute pain and continue to compete, but it doesn't necessarily make it a wise decision, which is why professional advice at the earliest possible opportunity is invaluable!
     Inevitably, the most successful athletes are those who best understand the relationship between pain and performance; they're prepared to overcome pain, but make wise and informed decisions about when it is worthwhile trying to do.