The IASP (International Association for the Study of Pain) describes pain as an unpleasant experience with sensory and emotional dimensions, associated with actual or potential injury, or resembling the experience caused by it. It is one of those definitions that packs so much into a few words that it can be difficult to understand, even for healthcare professionals.
One of my main tasks is to help make sense of it. Understanding pain and discussing questions, beliefs and expectations are part of building realistic, empathetic treatment that reflects what matters to you.
Let us take a brief walk through those concepts and the principles that guide treatment.
Pain as an experience
Every person experiences pain differently. It involves signals from the body, processing in the brain and spinal cord, past experiences, mood, beliefs and fears. Sleep, relationships and the adjustments people make to keep living also shape that experience.
Sometimes there is no injury that explains all the pain. In other situations, an injury exists but is no longer the only factor sustaining it. Reducing this experience to a local fault that needs fixing, or simply to taking a medicine, can leave a great deal out.
Pain can be much more intense than tests suggest or than previous appointments acknowledged. Leaving an appointment feeling dismissed or unheard adds to suffering. The absence of a complete explanation does not make pain less real.
Types of pain: the sensory components
Three mechanisms help explain pain. They can coexist:
- Nociceptive pain: occurs when sensors that signal a threat or damage to tissues are activated, as with injury or inflammation. It is the alarm that helps protect the body.
- Neuropathic pain: results from injury or disease affecting the nervous system responsible for sensation. It may involve electric shocks, burning, stabbing or tingling. It is not limited to a compressed nerve, and these symptoms alone do not confirm the mechanism.
- Nociplastic pain: involves changes in pain processing that are not sufficiently explained by an injury to tissues or to the sensory nervous system. It is as though the alarm were poorly calibrated, sounding beyond its protective purpose. That comparison helps make the mechanism understandable, although it does not explain everything involved.
Two other terms are useful: allodynia is pain caused by something that would not normally hurt, such as a light touch or a hug; hyperalgesia is an increased response to a painful stimulus. These findings can appear in different conditions. They are clues for assessment, not diagnoses in themselves.
Assessment and treatment
Assessing the whole person has become something of a catchphrase, almost common sense. But with chronic pain, exploring life beyond the pain is essential. What is the daily routine like? How is the workspace set up? What other hurts are there beyond the physical pain? What have you stopped doing for fear of making it worse?
Understanding emotional distress, expectations, avoided movements and loss of function helps shape care that reaches these different aspects. Your history, physical examination and a review of previous treatments help determine what needs investigating and what can already begin to change.
Family and Community Medicine offers a good foundation for this work: following a person over time, caring for physical and mental health, and understanding habits and context. Recognizing when another professional can contribute is also essential.
Physiotherapists have an important role in rehabilitation and ongoing physical work. Exercise professionals and psychologists can broaden care. Depending on the condition, it may be shared with specialists in pain medicine, rheumatology, orthopedics, rehabilitation medicine or psychiatry. Working as a team brings resources together while keeping a regular point of contact for care.
Foundations of care
Treatment is built with you. It may include medicines, movement, attention to sleep, physiotherapy and psychological support, considering what has helped before, the risks and what fits your routine. Honesty, empathy and transparency support that plan.
Learning about pain is part of appointments, along with assessing function, results and the difficulties of putting an agreed plan into practice. At later appointments, the plan may change: a proposal needs to work in life, not just on paper.
At times, myofascial techniques, such as dry needling and manual trigger-point release, may be part of care. Simple movements and manual self-care can be taught for use at home, including with help from caregivers. Procedures involving needles are limited to professional care.
The medical use of cannabis may also be discussed as an additional treatment in selected situations, including where evidence is limited. This requires a clinical rationale, transparency about uncertainty, an assessment of risks and close follow-up.
Walking again, sleeping better or returning to an important activity can guide treatment. Reducing pain and improving quality of life are goals that need to reflect your values. For some people, being completely pain-free may not be a realistic expectation. That deserves a careful conversation, without miracle promises and without giving up on improvement.
Appointments and follow-up
I see patients at Corcovado Medicina de Família in Jardim Botânico, online and at home. I prefer the first pain assessment to be in person so I can examine you. Some follow-up appointments can work well online. You do not need to arrive knowing the name of your condition: we can begin with what is happening.
If pain comes with new weakness, changes in bladder or bowel control or fever, or if it follows significant trauma, seek urgent assessment.