Pain Myths #4 – “Nerve pain, muscle pain, bone pain”

May 15, 2018

We hear it mostly in advertising in the media

“Nerve pain is different” “If you think you have nerve pain, ask your doctor”

AKA get your doctor to give you drugs. Specifically the drugs made by that particular pharmaceutical company.

I hear it often here in the clinic as people try to convey their experience.

“It’s not muscle pain, it’s something else”

When we break something it hurts. It therefore makes sense that pain occurs with tissue damage.

Totally logical, but incorrect.

Pain is an output of your nervous system based on the information available of relative danger or safety.

When you break your leg, your nervous system senses danger and makes it hurt. A lot.

It is, however, much more common to have pain without tissue damage. This is because your nervous system has identified increasing danger, real or perceived, and acted to PROTECT you from it.

PROTECTION. A very unpleasant, but nonetheless, necessary and fantastically successful OUTPUT of your automatic response network – involving nervous, immune, movement systems, to get you out of trouble.

What type of pain, where it is, what it feels like and how bad it is comes from the top down, not bottom up. It is based on threat, context, past history and many other individual factors often completely external to the tissue in which it occurs.

What you are doing when you say “nerve pain” or “muscle pain” is creating a metaphor to explain these feelings, to yourself or someone else.

Think about the last thing that hurt. How would you describe it?

I would bet money that the first thing you say is “It feels like……”

Now, my high school English teacher would jump in with “Actually David, that’s a simile” but hey, what did speaking heaps good English ever do for anyone?

We need to rationalise the difference between, essentially, electrical signals, and the feelings they illicit. Hence pain stories. It feels like there is a knife in my back. It feels like nerve pain.

Technically all pain is “nerve pain” because pain is a function of your nervous system. There are different types of nerve signal which can result in different outputs, and different parts of your nervous system can influence this output in different ways.

But explaining to someone it feels like nerve pain is also a pain story. That doesn’t mean it isn’t there, or it doesn’t feel like it does. It absolutely feels exactly as the person in pain describes it. But it’s the next bit that isn’t quite what we think. When we say it feels like nerve pain we are implying that there is something wrong, structurally or functionally, with a peripheral nerve.

When we say it’s just muscle pain we are doing the opposite, that there is nothing wrong and that it is just aching. But honestly we have no idea how complex the process of experiencing pain is.

Certainly depend on a few things

Pain and structure are poorly linked.

Pain is based on danger, not damage

The experience of pain is individual.

All pain is real, but experiencing pain and rationalising what it means at the same time is really hard.

The biology of pain is even more complex than you would think, but that doesn’t mean the solution is complicated. It is hard to treat persistent pain but the basic components are –

Understand it. Identify safety in movement. Progress as you can. Build resilience.

Remember, we are not trying to cure pain. Pain is normal, essential.

We just want to decrease the frequency and severity of the pain you are in.