How to Tell Apart the Different Kinds of Pain - Part 1
The description of pain is one of those impossible, meta-terms that is comparable to trying to verbalize how fear or sorrow or happiness feels “inside your being.” As I alluded to earlier in our discussion on seeking help for a painful problem, there is a huge component of pain that is rooted in our mind and our emotions, as well as in our physical bodies. We know that animals will also exhibit a behavioral response to injury. Even a microscopic paramecium with a single celled brain can avoid noxious stimuli, so there is obviously a strong, biologic basis of pain that is independent of higher level intelligence and a well defined system of feelings. But the brain is a strange and mysterious thing. What can start as pain outside of our heads, can sometimes wind up dwelling in there long after our bodies have healed.
For the purposes of sanity and simplicity, we’re not going to dive too deeply into the world of “learned” chronic pain, and definitely not into such things as psychologic or spiritual pain. In fact, I’m going to keep things as traditional as possible and leave these types of emotional self-healing works to psychoanalysts and various trained professionals.
So, what do we really mean when if we classify a pain as being “traditional?” Well, the opposite is certainly not “progressive,” or “avant-garde,” type of pain.
What we mean here, is that the pain is biologically substantiated — that is, it makes sense. It is physically generated and predictable over a course of time. It usually can be described as having a particular quality and behaving in a certain way, depending upon the circumstances it finds itself in.
For example, if you are experiencing sharp pain in your neck from a recently herniated disc, you may also notice a series of other stereotypical disc characteristics — such as radiating pain and “crooked stiffness.” When an intervertebral disc is pushed out of position it will also block movement in that region, causing the person to bend or deviate their body part away from the irritated nerve. Many times a disc problem feels better when you lie down, and can start to actually go pack into place if you perform specific, repeated stretches. In the world of rehab medicine, this is called reducing a painful “derangement.”
If you’re thinking for moment that this deranged description sounds a bit cartoonish — like some screwball character with a crooked grin and crazy hair — then you’re not alone. I realized after the first five years of clinical practice that my patients’ symptoms behaved more like types-of-people I knew versus the textbook diagnoses I studied in school.
This revelation was what initially drove me to study Traditional Chinese Medicine and eventually become an acupuncturist. You see, the Chinese classify illnesses and pain according to various patterns that are observable in nature and intuitive to understand. They use terms like “fire rising,” or “dampness clouding,” or “coldness stagnating.” Someone with the same Western diagnosis of hypertension could have multiple different causes for his or her problem, requiring different treatment strategies.
It took me five years just to suspect these pain patterns even existed, while the ancient acupuncturists have known and been developing their system for well over 3,000!
I’m going to try and synthesize both Eastern and Western concepts of various types of traditional pains, so that they are easier to understand, without coming across as sounding too abstract or bizarre. Then I’ll give an example from my clinical experience so that it really cements the whole concept into a practical scenario.
Remember, it’s easier to think of these pains as behaviors of people — or better yet as some sorts of villains. So let’s personify, shall we…
Think of muscles as big, hulking bruisers that just lift things up and puts things down. They look big and menacing, but there’s no real intelligent activity. Muscles are very basic and simply follow orders from a higher power, known as your brain. They are not complex or crafty. They don’t get inside your emotions. They don’t hurt on damp days like an arthritic knee, or cause tight gripping pain down the back of your leg like sciatica. If a muscle is injured then it will hurt when you use it, and won’t hurt when you rest it.
Muscles heal fast — very fast — compared to other areas like ligaments or tendons or bones. That is because muscles are filled with an over abundance of blood and have amazing circulation. Think of when your muscles are swollen after an intense workout. They are essentially blood pumps. A pure muscle pain that lasts for months and months is very rare, and highly unlikely, unless it is permanently torn and stressed beyond it’s limit. That tight, rope-like muscle spasming often found with chronic pain is not due to the muscles themselves, but actually the nerves controlling the muscles. The muscle aches only because it is exhausted and constantly tense from the painful nerve activity.
I had a patient who came to physical therapy with me after pulling her hamstring while doing a heavy squat at the gym. Initially there was a lot of swelling, bruising, and pain, but that trailed off in a couple of weeks. The MRI actually revealed a partial tear and separation of the hamstring muscle, where it attaches into the pelvis and buttock region.
As the weeks went by, she quickly regained normal function, however even after 6 months she could not lift the same heavy weight in the gym without some minor buttock pain. As long as she didn’t do that high level stress activity, she was fine. Whenever she attempted it again, it hurt. That muscle tear from the MRI could not reattach because it was too far torn away. Therefore, the power of the muscle could never be equal to the uninjured side. There are simply not enough “horses pulling the carriage” as there once were.
That is a true muscle pain. “I pick things up and put things down.” It is not very common in chronic pain conditions, unless there’s a permanent tear, severe weakness, or actual disease process present like fibromyalgia or muscular dystrophy.
Continued in Part 2
We will continue to dive deeper into our discussion on the various types of pains, such as those from tendon and ligament injuries and chronic repetitive stresses. In addition, we will examine the specific type of derangement pains often seen with herniated discs and meniscal injuries. Hopefully, as you better understand the distinctive "behaviors" of some of the body's many characteristic responses to injury, the whole process will seem less threatening and more intriguing.
If you would like to schedule a visit to talk with us at Alté View regarding your specific type of pain, then please reach out to us here.