The pain that you feel is dynamic - not static

I've already presented the concept that pain is an experience produced by the brain.  Let's explore that a little further using a common pain experience.

You get sunburnt for example.  You have a shower the next day, and the water feels like it is burning you.  But, of course, it's not burning you. You used the same water temperature the day before and it didn't burn you.

It just that now you're sunburnt the water feels like it's burning you.

The brain is a great conjuror.

Let's give this experience a name: hyperalgesia.  hyper for increased, and algesia for pain.  Interestingly, this meaning of this term has recently been given an official up-date by the International Association for the Study of Pain (www.iasp-pain.org), and is now an umbrella term for all conditions of increased pain sensitivity.

A special brand of hyperalgesia is allodynia, which is when pain is experienced in response to a stimulus that does not normally provoke pain.

So, hyperalgesia in general, and allodynia as a specific case, provide great insight into the dynamic state of our pain experiences.  

If you get sunburnt, this usually results in a pain experience.  However, as time goes on, that pain experience can be modified so that a stimulus that would normally hurt, such as scratching, will hurt more if it is applied to the sunburnt area, and a stimulus that would not normally hurt, such as clothing on the skin, will now hurt.

Notice the change from a 'non-sensitised' state to one of 'sensitisation'. Not only have you injured your tissues, but the brain is creating an increased pain experience to normally painful stimuli, and a new pain response to normally non-painful stimuli.  It would seem that, if necessary, our nervous system can function to make us hurt.

In summary, if you jam your finger in a drawer, you:

(1) don't actually feel pain in your finger - you feel it in your virtual finger - the one in your brain; and

(2) just moving your finger, which would not normally hurt, can be painful.  Not because you're damaging your finger by moving it, but because you're nervous system has switched into 'sensitisation' mode

I have always found that fascinating.

Understanding pain. Let's start with the brain.

The first thing that everyone has to face is that all pain is in the brain.  The pain is not in your back, thumb, neck, shoulder, elbow  - or whatever.  The pain is in your brain.

Your brain creates it.  

You don't see with your eyes.  You don't hear with your ears.  You don't taste with your tongue.  You don't smell with your nose.  And you don't feel with your body.  All of these sensory experiences are a product of the brain.

Of course, the brain creates these experiences based on information it gets from your eyes, ears, tongue, nose and body - but the experience is a brain experience.

I have chosen to use the word "brain" and not "mind" for a very specific reason.  It would not be true to say that "all pain is in the mind", for this would imply that pain is a purely psychological phenomenon.  It is true, however, to say that "all pain is in the brain", because until we become aware of pain, it is not called pain; and awareness is a cortical function - a function of the brain.

When I explain this to patients, I also have to acknowledge that from their perspective, they are indeed "feeling" the pain in their body, just as they are "seeing with their eyes".  It seems too academic to say that "the pain that you're feeling in your back, is not in your back".  For the patient, the pain is where they say it is, and for the most part they just want it gone.  

This is a fair objective - to want the pain gone.  But to begin to develop a consistent approach to solving patients' pain problems, one has to understand pain.  And to understand pain means that you have to understand that pain is in the brain.