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What is Pain?
Pain has multiple basic components:

  • Detection of potential or actual tissue damage
  • Pain signal transmission to the spinal cord
  • Pain signal transmission up the spinal cord
  • Pain interpretation / response in the brain
  • When considering treatment of spinal pain, we are concerned with changing the potential or actual tissue damage. Two mechanisms are generally implicated in causing pain in the body:

    Mechanical Pain

    When tissues are stretched or compressed beyond a threshold, pain is felt.

    Example: Bending a finger backwards will eventually cause pain. The further it goes the more intense the pain. If left in a position of moderate pain, with time, the pain will become more diffuse and difficult to localize. If the finger is returned to a normal position within a reasonable time, the pain will disappear and no tissue damage will be present.

    Some key mechanical pain concepts to note are:

  • Pain alters with increasing and prolonged mechanical stress.
  • Pain can be severe without actual tissue damage.
  • When the mechanical stress is eliminated, the pain subsides.
  • Typical characteristics of mechanical pain:

  • the pain is intermittent
  • positioning or repeated movements change the intensity or location of the pain
  • movement in one direction generally worsens the pain and the opposite direction improves the pain.
  • joint movement improves with improvements in pain.
  • The bad news—There are no drugs that can inhibit the signals from mechanical pain.

    The good news—mechanical pain is alleviated when the mechanical stress is identified and corrected.

    Chemical Pain

    When injury occurs to body tissues, chemicals are released from cells as part of the natural inflammatory response. When these chemicals come into contact with free nerve endings, pain is produced. This type of pain is generally associated with trauma.

    Typical characteristics of chemical pain:

  • The pain is constant
  • The pain is present shortly after an injury
  • Swelling, redness, heat, and tenderness are generally present
  • Movement in all directions is painful
  •  No movement reduces or changes the location of the pain.
  •