Pain is a very individualized experience. You can not see it. You can not objectively measure it. But it is very real. Two people may have a similar condition- one of them may be able to manage with minimal to no pain medication and the other may require significantly higher and/or stronger doses. Why? What makes them different?
There is much more to understand about pain than what is able to be written in these few simple paragraphs. There have been volumes of books and extensive research performed and we still do not know all of the answers. However, there have been some significant advances in the past few years. In an effort to help clinicians and researchers better understand and treat pain, attempts have been made to classify pain and results thus far have been promising. Depending on the source, there are several major classifications of pain. However, these classifications may not be completely independent of each other and may overlap. The following list is also not all inclusive. It includes pain classifications that are more likely to be chronic in nature.
The first classification is central sensitization. In this instance, the body’s nervous system is over excited and the person may experience significant pain, even after their injury or condition is healed. The person’s sensitivity threshold for pain may also be lowered, so that they may experience pain with much less of a causative factor. Something like a sheet touching their foot or even a small, insignificant bump into something may send their reports of pain sky-rocketing. It is like the fire department being called to put out a single match. There are several conditions which have been linked to an increased incidence of central sensitivity. They include depression, fear-avoidance, anxiety, poor sleep, and other stressors. These conditions often over-excite the nervous system, which is believed to be how they are linked.
Inflammatory pain is just as it sounds- pain from an acute or chronic inflammatory condition, an infection, or an auto-immune response. This could be something like an acute sprain or strain of your ankle that turns red and starts to swell or an insect bite. Under these conditions, an inflammatory response turns on to help pain and other signs/symptoms resolve within a few days, possibly with or without additional treatment. However, some conditions may be more long lasting. In some of these conditions, the inflammatory response may fail to “turn off.” In this case, the body’s defense systems may start to attack its own healthy tissues, mistaking them for being damaged. Common examples are rheumatoid arthritis, lupus, celiac disease, diabetes type I, and Multiple Sclerosis. As with central sensitization, increased activity of the nervous system (sympathetic nervous system) may contribute to increased symptoms. Two of the most common ways to manage inflammatory pain are managing your stress and gentle exercise. Qigong anyone?
The affective pain classification pertains to conditions where a person’s emotional status may influence their reports of pain or discomfort. Common examples of people in this type of classification often report increased symptoms when at a job they do not like, when in a toxic relationship, or when in some other stressful situation. These may include severe headaches, low back pain, upper neck, shoulder, and back pain and tension, etc. Once they are removed from the stressful environment, their symptoms may drastically decrease or even cease, until they return to their stressor. Oftentimes, journaling about their experience may help to identify stressors and help to alleviate symptoms. As with central sensitivity, depression, fear- avoidance, anxiety, poor sleep, and other stressors may exacerbate this condition.
Motor autonomic pain may be one of the least understood classifications of pain. Conditions which fall into this category include Complex Regional Pain Syndrome (CRPS) and Phantom Pain or Phantom Sensations, which may typically be experienced by a person with an amputation. In this situation, a person may experience a wide variety of symptoms including pain, hypersensitivity, spasm, vascular changes, and skin changes. The cause of CRPS is not completely understood. Some people develop this condition after sustaining a fairly benign sprain/strain where most others do not. In some instances, the condition may inexplicably spread to the opposite limb. In patients with Phantom Pain or Phantom Sensations, they report pain or other symptoms such as itching in a body part that has been amputated. For example, someone may have their right leg amputated below their knee but still report pain or itching in their toes or ankle. Much of the research into this classification of pain pertains to how the brain perceives the affected area. There are certain areas of your brain responsible for sensation and motor responses of each body part. It is believed that these areas become disrupted and somehow no longer recognize the affected area of your body. Through gradual retraining which involves distinguishing the right and left sides of your body, your brain is “reprogrammed” to recognize the body part, and symptoms may improve. Qigong may help to alleviate symptoms and “retrain your brain” because many of the movements are performed on both sides of the body. In addition, you often cross the imaginary midline of your body, bringing one hand or leg to the opposite side. This has been shown to increase blood flow in the brain and strengthen neural connections. All of this is combined with diaphragmatic breathing which tones down the sympathetic nervous system and increases activity in the parasympathetic nervous system, which is required for health and healing.
The last classification to be discussed is neurogenic pain. This is pain caused by dysfunction of a nerve. Common examples include neuropathy such as that experienced by people with diabetes or as a side effect of chemo or radiation treatments, nerve entrapments such as carpal tunnel syndrome, or nerve compression from a herniated disc. In the case of nerve compression, treatment is aimed at relieving the source of the pressure and restoring normal, pain-free motion. For neuropathy caused by diabetes or as a side effect of treatment, symptoms are typically treated by medications and balance and proprioception exercises, as these conditions often target the feet and legs more than the arms and hands. Qigong has been shown to be very powerful at improving neuropathic pain, and also improving balance, proprioception, and sensation.
Not all reports or experiences of pain are equal. As such, each experience should be treated accordingly. Fortunately, the practice of qigong has helped many people not only manage their conditions, but in many cases, completely eliminate their symptoms.