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• Overview
• Chronic Pain
• Pain Types
• Gate Control Theory

The anatomy of pain

Understanding how your body feels pain will help you appreciate how unique your pain experiences are. It will also help you better understand why chronic pain is often difficult to treat.

Pain basically results from a series of electrical and chemical exchanges involving three major components: your peripheral nerves, spinal cord and brain.

Your peripheral nerves

Your peripheral nerves encompass a network of nerve fibers that branch throughout your body. Attached to some of these fibers are nerve endings, nociceptors, which can “sense” unpleasant stimulus, such as a cut, burn or painful pressure.

Nociceptors are concentrated in areas more prone to injury, such as your fingers and toes. That’s why a splinter in your finger hurts more than one in your stomach or shoulder. Some nociceptors sense sharp blows, others heat. One type senses pressure, temperature and chemical changes. Nociceptors also can detect inflammation caused by injury, disease or infection.

When nociceptors detect a harmful stimulus, they relay their pain messages in the form of electrical impulses along a peripheral nerve to your spinal cord and brain. However, the speed by which the messages travel can vary. Dull, aching pain such as an upset stomach or an earache is relayed on fibers that travel at a slow speed. Sensations of severe pain are transmitted almost instantaneously.

Your spinal cord

When pain messages reach your spinal cord, they meet up with specialized nerve cells that act as “gatekeepers,” allowing or refusing the messages to pass through to your brain. For severed pain that’s linked to a danger, such as when you touch a hot stove, the “gate” is wide open and the messages take an express route to your brain. Nerve cells in your spinal cord also respond to these urgent warnings by triggering other nervous systems into action, such as your motor nerves. Your motor nerves signal your muscles to pull your hand away from the burner. Weak pain message, however, such as from a scratch, may be refused entry through the “gate.”

Within your spinal cord, the messages also can change. Other sensations may overpower and diminish the pain messages. This happens when you massage or apply pressure to the injured area. The result is that the warnings send by your peripheral nerves are downgraded to a lower priority.

Nerve cells in your spinal cord also may release chemicals that amplify or subdue the messages, affecting the speed at which they travel to your brain.

Your brain

Once pain messages arrive at your brain, they travel to the thalamus, a switching station located deep inside your brain. The thalamus quickly interprets the messages as pain and forwards them simultaneously to the thinking part of your brain, called the cerebral cortex, and to your brain’s limbic center. The limbic center produces emotions such as anxiety, fear or frustration that often accompany pain. It’s at this point that you actually begin to feel the pain.

Your cerebral cortex reacts to the pain messages by locating the source of the injury, assessing the damage and determining a course of action, such as ordering you to take pressure off your foot if you’ve sprained your ankle.

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Acute vs. chronic pain

Acute pain is triggered by tissue damage. It’s the type of pain that generally accompanies illness, an injury or surgery.

Acute pain may be mild and last just a moment, such as from a sting. Or it can be severe and last for weeks or months, such as from a burn, pulled muscle or broken bone. When you have acute pain, you know exactly where it hurts. A toothache from a cavity, a burning elbow from a scrape and abdominal pain from surgery are examples of acute pain. In a fairly predictable period, the pain generally fades away-when the cavity is filled, the skin grows back or the incision heals.

Chronic pain hangs on after the injury is healed, generally for 6 months or longer. As with acute pain, chronic pain spans the full range of sensations and intensity. It can feel tingling, jolting, burning, dull or sharp. The pain may remain constant or it can come and go, like a migraine that develops without warning.

Unlike acute pain, however, with chronic pain you may not know the reason for the pain. The original injury shows every indication of being healed, yet the pain remains-and may be even more intense.

Chronic pain also can occur without any indication of injury. Years ago, people who complained of pain that had no apparent cause were thought to be imaging the misery or trying to get attention. Doctors now know that’s not true. Chronic pain is real.

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